The adolescent with sickle cell anemia.
Adolescence is a time of intense change and turmoil. Helping patients with sickle cell disease have a smooth transition from the pediatric to adult health care environment is an important and meaningful experience. Facilitating the patient's transition, however, takes time and effort. Pediatricians must compile accurate medical summaries transmitting the details and nuances of the patient's history and care. Effort must be expended to ensure that details related to alloimmunization are not omitted. The pediatrician must be careful that the transfer does not create feelings of rejection and abandonment in the patient and the family. Physicians accepting the patient in transfer must devote time to educating and counseling the new patient. A relationship of trust and respect must be built. The physician should work with the patient to explore feelings of distrust and to uncover any concerns and fears, which should be dealt with proactively to avoid major conflicts later. Working closely with the adolescent patient can have many rewards, including helping the patient through a difficult period of adjustment. Helping the patient negotiate this difficult period can have many positive consequences. It is essential that both the pediatrician and internist work closely with the patient and family during the transfer process. Failure to do so can have disastrous consequences. When the collaboration is successful, however, the rewards for patients, families, and providers are great.
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