Parent ​​and Caregiver Handbook for Sickle Cell

​​Appendix: Doctor ​letter to schools about travel (template)

For your convenience, download this template (Word)​. You can edit it with your own information.​​​

Re: [Patient Name]

MR#: [MR#]       

DOB: [Patient Date of Birth]                   

Date: [Today's Date] 

To Whom It May Concern:

The above-named patient is a(n) [age of child]-year-old followed at [name of clinic or hospital] ​​for sickle cell disease.

In order to decrease the morbidity from their disease, our patients and their families are educated to recognize the symptoms and seek immediate treatment of the following emergencies seen commonly in sickle cell disease. We would appreciate your cooperation in the event that any of these patients come to you for treatment.

1. Fever greater than 101° F (38.3° C): Aggressive evaluation for the source of such a fever in the young child with sickle cell disease is very important. This evaluation should include CBC, reticulocyte count, blood culture, chest x-ray and urine culture. If the patient is younger than five years, they should be started on parenteral antibiotics (e.g., ceftriaxone) pending blood culture results. If the patient is over five years of age and nontoxic, oral antibiotics can be used after an initial dose of ceftriaxone.
2. Acute chest pain or difficulty breathing: The patient should have a chest x-ray, CBC, reticulocyte count, and consider arterial or venous blood gas studies if there is any evidence of acute respiratory distress or low oxygen saturation on a pulse ox machine. If the patient is febrile, antibiotics should be started. In a patient with severe chest pain or new pulmonary infiltrate, hospitalization is mandatory.
3. Acute pain not relieved by acetaminophen, fluids, bedrest: An aggressive evaluation for the source of the pain is mandatory. CBC, reticulocyte count, and other appropriate laboratory tests are also recommended.
4. Marked lethargy or tiredness: Physical examination documenting the size of the spleen, CBC, reticulocyte count and observation are required.
5. Vomiting, dehydration: Generally, these patients should be hydrated with saline containing solution. CBC and reticulocyte count should be done, and electrolytes are selectively indicated.
6. Neurologic symptoms (seizures, weakness in the arms or legs, severe headaches, marked dizziness or visual changes): The patient should undergo an extensive neurological examination. All patients with neurological symptoms should be admitted to the hospital. The possibility of a cerebrovascular accident should always be considered and verified or ruled out with an emergency Computerized Tomography and an MRI/MRA when available. Blood transfusion should not be delayed awaiting tests if a stroke is considered likely. A spinal tap for febrile patients may be indicated. Exchange transfusion should be considered, and we should be notified of such a situation immediately.

Contact Dr. [name of doctor] is available at telephone number [doctor phone number]​ during regular business hours to provide further information about individual patients, to answer any questions, and to screen calls for appropriate physicians.

During other times, or if you need to speak to the on-call hematologist, the hospital switchboard can page one of our physicians 24 hours a day at [on-call hematologist phone number].

This template is provided courtesy of the University of San Francisco, Benioff Children's Hospital Oakland Sickle Cell Center.​