A 22-year-old Afro-Caribbean woman who is 30 weeks pregnant with known sickle cell disease
presents via A&E with a two-day history of progressively worsening cough, fever, excruciating
bilateral chest pain and shortness of breath. This is her first pregnancy and it has been uneventful so
far. She has had serial scans from 24 weeks of gestation, which have been normal.
Her observations are a blood pressure of 100/60 mmHg and pulse rate of 118 bpm. Her respiratory
rate is regular at 32 per minute and temperature is 38.2°C. Oxygen saturation is 84% on air, chest
auscultation reveals mild bilateral basal crepitations but no wheeze. There is no calf tenderness.
• white blood cells = 19.8
• haemoglobin = 93 g/l
• platelets = 325
What would be the most appropriate treatment for her?
• reticulocytes = 16.2%
• ESR = 35
• CRP = 80
• chest X-ray: PA view - pulmonary infiltrates were seen bilaterally
• VQ scan normal
• ECG sinus rhythm, 118 bpm