Different Treatment Modalities in the Management of the Painful Crisis in Pediatric Sickle- Cell Anemia
Different Treatment Modalities in the Management of the Painful Crisis in Pediatric Sickle- Cell Anemia
The aim of the present study is comparing the effectiveness of different treatment regimens
 for investigating the therapeutic potential for each one in management of Vaso-occlusive pain
 in pediatric sickle cell disease. In addition, investigators apply the Cost-effectiveness
 analysis (CEA) as a form of economic analysis that compares the relative costs and outcomes
 (effects) for different treatment regimens on vaso-occlusive painful crisis.
"Sickle cell disease is an inherited blood disorder characterized by defective hemoglobin (a
 protein in red blood cells that carries oxygen to the tissues of the body).

 Sickle cell disease involves the red blood cells, or hemoglobin, and their ability to carry
 oxygen. Normal hemoglobin cells are smooth, round, and flexible, like the letter "O," so they
 can move through the vessels in our bodies easily. Sickle cell hemoglobin cells are stiff and
 sticky and form into the shape of a sickle, or the letter "C," when they lose their oxygen.
 These sickle cells tend to cluster together and cannot easily move through the blood vessels.
 The cluster causes a blockage in small arteries or capillaries and stops the movement of
 healthy, normal oxygen-carrying blood. This blockage is what causes the painful and damaging
 complications of sickle cell disease".

 "Acute vaso-occlusive crisis (VOC) is a hallmark of sickle cell disease (SCD). Multiple
 complex pathophysiological processes can result in pain during a VOC. Despite significant
 improvements in the understanding and management of SCD, little progress has been made in the
 management of pain in SCD, although new treatments are being explored".

 The Painful Episodes:

 "The day-to-day management of sickle cell disease often equates with the management of acute
 and chronic pain. Patients manage many painful events at home so that hospital visits
 underestimate the frequency of pain

 Acute painful episodes are the most commonly encountered vaso-occlusive events in patients of
 all ages. Presumed to be caused by sickle vaso-occlusion, pain often starts in young children
 as the hand-foot syndrome or dactylitis, a painful swelling of hands and feet due to
 inflammation of the metacarpal and metatarsal periosteum. Painful episodes, which last from
 hours to many days, usually occur with little warning and a clear precipitating event is not
 often found.
Inclusion Criteria:

 Any case with the full manifestation of sickle cell disease accompanied by acute painful
 crisis aged from 5-15 years old.

 Exclusion Criteria:

 1. The presence of any other chronic illness.

 2. Patient age>18 years old or < 3 years old.

 3. Patients with hepatic diseases including cholestasis hepatic encephalopathy and
 jaundice.

 4. Patients with renal impairment

 5. Diabetic patients