We report the case of a 14-year-old woman weighing 48 kg who was diagnosed with sickle cell disease of African origin and alpha thalassemia heterozygota with acute lower limb pain.
The patient had a history of stroke 6 years ago, last sickle cell crisis in 2012, being treated with hydroxycarbamide.
The patient was admitted to the Hematology Department due to pain in the right renal fossa radiating to the lower limbs of 1 week of evolution that did not require analgesic treatment with the combination of metamizole, ibuprofen, tramadol and diazepam.
Pain intensity on the visual analog scale is 8-9 with episodes of breakthrough pain 3-4 on the uncontrolled day.
The referred pain is the right hemicorporeal one, more pronounced in the knee, tibia and shoulder, with musculoskeletal characteristics with episodes neuropsychotic.
Blood tests showed anemia and elevated CRP.
Treatment was initiated with rest, physiotherapy and intravenous pain control with continuous infusion of chloride 10 mg/12 h and metamizole 6 g/24 h in infusion and dexketoprofen 25 mg/8 h.
For the treatment of breakthrough pain, transmucosal oral fentanyl 200 mcg maximum 4 daily was used.
Baseline pain improved by 70% in the first 24 h and breakthrough pain episodes were controlled with 3-4 transmucosal oral fentanyl tablets, with a gradual decrease in pain intensity by 7 days d.
