Abstract Anchoring bias occurs when individuals rely excessively on initial information during the early stages of the decision-making process. This reliance can distort the interpretation of subsequent information and adversely affect later decisions. Concentrating on acute chest syndrome (ACS) in a patient with sickle cell disease (SCD) while neglecting other potential etiologies of signs and symptoms, such as pneumonia, may hinder early diagnosis and timely treatment. A 32-year-old woman with past medical history of SCD complicated by chronic transfusions and bilateral lower extremity venous ulcers was admitted for debridement of venous ulcers and pain management. She subsequently developed chest pain, acute anemia, and leukocytosis prompting a transfer to an inpatient medicine team for suspected acute pain crisis. Her hemoglobin dropped to 5 g/dL, necessitating the initiation of transfusions and hematology consultation. Chest X-ray revealed patchy opacities attributed to ACS, and she was started on a narrow spectrum antibiotic despite profound leukocytosis (48K). The patient then developed acute hypoxic respiratory failure and signs of severe sepsis, leading to a critical care consultation. While the multidisciplinary team continued to suspect acute chest syndrome as the leading diagnosis, a computed tomography angiography (CTA) of the chest was obtained and unexpectedly revealed a cavitary lesion in the right upper lung with no evidence of pulmonary embolism. Antibiotics were broadened to include anaerobic coverage. Acid-fast bacillus (AFB) smear and cultures were negative, ruling out tuberculosis. Further infectious workup, including respiratory culture, Fungitell, galactomannan, and serologies for Histoplasma and Coccidioides, were all negative. A bronchoscopy yielded negative results. The patient ultimately recovered with appropriate broadened antibiotic therapy. ACS is a leading cause of mortality in SCD, occurring in roughly 25% of cases. Its prevalence often leads clinicians to anchor on ACS when SCD patients present with chest pain, hypoxemia, or radiologic changes, potentially overlooking other serious etiologies. In this case, anchoring bias delayed the recognition and treatment of a severe infection. Despite profound leukocytosis and respiratory failure, the initial narrow-spectrum approach reflected diagnostic overshadowing. The discovery of a cavitary lung lesion underscored the importance of maintaining a broad differential and initiating empiric antibiotics, including anaerobic coverage, when infection is suspected. Clinicians must remain vigilant against cognitive biases to ensure timely, accurate diagnoses and improve outcomes in complex SCD presentations. This abstract is funded by: None
Deb et al. (Fri,) studied this question.