Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Sickle Cell Anemia


Related Terms

  • Anemia-sickle Cell
  • Crescent Cell Anemia
  • Drepanocytic anemia
  • Hemoglobin SS Disease (HB SS)
  • Sickle Cell Disease

Differential Diagnosis

Specialists

  • Hematologist

Comorbid Conditions

  • Dehydration
  • Infection

Factors Influencing Duration

The duration of disability depends on the severity of the chronic anemia, the frequency of sickle cell crises, and the presence of complications, including chronic pain, infections, and permanent complications from any organ damage.

Medical Codes

ICD-9-CM:
282.60 - Sickle-cell Disease, Unspecified; Sickle-cell Anemia NOS
282.61 - Sickle-cell Anemia, Hb-SS Disease without Mention of Crisis
282.62 - Sickle-cell Anemia, Hb-SS Disease with Crisis; Hb-SS Disease with Vaso-occlusive Pain; Sickle-cell Crisis NOS

Overview

Sickle cell anemia is an inherited and congenital form of anemia that occurs when a mutated HBB gene is inherited from both parents (homozygous sickle cell disease). Normally, HBB gene gives instructions for the synthesis of beta-globin, one of the components of the oxygen-carrying molecule (hemoglobin) in red blood cells (RBCs). When this gene is mutated an abnormal hemoglobin called hemoglobin S is produced. Hemoglobin S causes the normally round RBCs to become deformed into a "sickle" shape. This sickle shape causes early destruction of the RBCs (hemolysis), resulting in chronic anemia. It also causes the RBCs to become trapped in small blood vessels, which blocks the circulation and causes severe pain and injury to many organs by interfering with their blood supply. Called sickle cell crisis, this problem occurs when the individual with sickle cell anemia experiences cellular oxygen deprivation. This might occur from overexertion, infection, high altitude, or cold.

The areas most often affected by the blocking action of sickle cells occur in the lungs, liver, bone, muscle, brain, spleen, penis, eyes, and kidneys. The clinical signs and symptoms of sickle cell anemia manifest early in life, usually after 6 months of age. There is no known cure.

Individuals with the sickle cell trait, defined as those who have one mutated HBB gene and one normal HBB gene (heterozygous individuals), may only have symptoms under extreme conditions like low oxygen. If a carrier of the sickle cell trait has a child with another carrier, one-quarter of their children will have sickle cell anemia.

Incidence and Prevalence: Sickle cell anemia disease affects 90,000 to 100,000 people in the US. About 1 in 500 blacks have sickle cell anemia; the prevalence is close to 1 in 36,000 Hispanics (CDC). More than 2 million Americans have the sickle cell trait. The trait occurs in about 1 in every 12 blacks or African Americans (NIH).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Sickle cell anemia is seen most often in blacks, but may also be seen in those of Eastern Mediterranean, East Indian, and Saudi Arabian descent, and among Hispanics whose families originated in the Caribbean, Central America, or South America. The high prevalence among these ethnic groups results, unfortunately, from the protection the sickle cell gives against malaria. Sickle cell anemia is evenly distributed between the sexes (NIH).

Source: Medical Disability Advisor



Diagnosis

History: Individuals with sickle cell anemia manifest the features of chronic anemia, including pale skin and mucous membranes, fatigue, and decreased exercise capacity. In addition, there are usually periodic episodes of severe pain in the joints, muscles, chest, or abdomen (sickle cell crisis). They may also have a yellowing of the eyes and skin (jaundice), frequent infections, poor wound healing, and vision problems. Episodes of constant erection of the penis (priapism) may occur in one-third to two-thirds of men with the condition, and symptoms of stroke are not uncommon.

There are three types of crisis: vaso-occlusive, hematologic, and infectious. Vaso-occlusive crisis is secondary to blood vessels being blocked by RBCs that are sickle shaped. This results in a decreased blood supply leading to pain of the joints and organs such as muscles, skin, spleen, kidney, liver, and brain; this can lead to skin ulcers, avascular necrosis of bone, liver infarcts, and papillary necrosis of the kidney. Hematologic crisis happens if the spleen's outflow of blood is obstructed leading to splenic sequestration of massive amounts of blood and acute splenic enlargement (splenomegaly). Malfunction of the spleen may also make individuals more susceptible to infections from encapsulated organisms such as Haemophilus influenzae type B (Hib), a highly contagious bacterium that causes meningitis, pneumonia, septic arthritis, and cellulitis. Another hematologic crisis, aplastic crisis, can occur when the bone marrow ceases temporarily making RBCs usually due to parvovirus B19 infection. A poorly functioning immune system may result in infectious crisis.

Physical exam: Physical findings may include a pale complexion (pallor), yellowing of the skin (jaundice), fever, elevated respiratory and heart rates, bleeding (hemorrhages) in the retina, and leg ulcers. The spleen is initially enlarged and then becomes abnormally small after repeated infarction (autosplenectomy). A young child may appear small for his or her age, while an older child may experience delayed growth and puberty. The adult is usually thin with long extremities, narrow shoulders and hips, a curved spine, and a barrel chest. Individuals with splenic sequestration may have hypovolemic shock with low blood pressure. They may also exhibit signs of congestive heart failure (CHF) and neurologic deficits.

Tests: A complete blood count (CBC) shows a marked anemia with low numbers of RBCs, together with elevated numbers of white blood cells and platelets. A sickle prep test can demonstrate the sickle shape of the RBCs. A specific blood test (hemoglobin electrophoresis) demonstrates the abnormal hemoglobin. If a stroke is suspected, a computed tomography (CT) or magnetic resonance imaging (MRI) scan of the head is indicated for evaluation. A spinal tap is performed to evaluate for suspected meningitis. A peripheral smear can help in the visualization of blood cells. Arterial blood gas (ABG), electrocardiogram (ECG), chest x-ray (CXR), bone x-ray, bone scan, urinalysis, liver function tests (LFTs), and abdominal ultrasound may also be indicated.

Source: Medical Disability Advisor



Treatment

Except for bone marrow transplantation in carefully selected children, there is no cure for sickle cell anemia, so management focuses on prevention and treatment of sickle crises and complications. Individuals are advised to avoid high altitudes and dehydration, treat infections promptly, and receive preventive vaccinations against pneumococcal pneumonia, Haemophilus influenzae type B, and meningococcus. Children should receive oral penicillin to reduce the incidence of infection and death from pneumococcal infection. For most individuals, the only daily treatment is folic acid supplements, but oral hydroxyurea is sometimes used regularly to reduce the frequency of crises. Treatment of acute crises often requires hospitalization and consists of rest, pain medications given by injection or through a vein (intravenous), intravenous fluids, oxygen, blood transfusions, and individualized treatments for any infections or complications. Genetic counseling is available for those contemplating pregnancy. Bone marrow transplants are currently the only potential cure for sickle cell anemia. In this treatment, the patient's bone marrow (which makes the sickled RBCs) is replaced with bone marrow from another individual without sickle cell disease. However, it is difficult to find the right bone marrow donor, and the drugs needed to make the transplant possible are highly toxic.

Source: Medical Disability Advisor



Prognosis

With the qualified exception of bone marrow transplant, there is no cure for sickle cell anemia, and life expectancy is reduced, with the median age of death being in the forties. Ongoing symptoms of anemia and repeated sickle cell crises can be expected, as can lasting problems caused by permanent organ damage.

Source: Medical Disability Advisor



Complications

Individuals with sickle cell anemia are at risk for damage to major organs because of poor circulation and sickle cell crises. Common complications include gallstones; damage to the spleen (autosplenectomy) with resultant susceptibility to serious infections; damage to the lungs (acute chest syndrome), bones (avascular necrosis), kidneys (papillary necrosis), and heart; strokes; and blindness over time (a result of impaired circulation to the retina and retinal bleeding). All these complications may occur or become worse during pregnancy. Approximately 10% of children with sickle cell disease have a stroke (CDC).

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Chronic anemia can severely limit the individual's exercise tolerance and capacity for physical exertion. Additional restrictions and accommodations would depend on any long-term complications, such as decreased vision or blindness, physical limitations from strokes, respiratory problems, or chronic pain. Extra time off for treatment of sickle crises and infections can be expected.

Risk: No job that follows OSHA standards would be expected to place an anemia patient at increased risk. If the anemia persists despite treatment, then avoiding work at unprotected heights or working at high altitude would be prudent. Ensuring adequate hydration is also needed.

Capacity: This can often be gauged by the level of hemoglobin. A more functional assessment would be the use of metabolic stress testing. If a patient has begun to experience the complications of sickle disease (e.g., into the kidneys, bony/joint damage), then capacity may be limited by these conditions.

Tolerance: Encouragement, counseling, and flexible work hours may be used to assist patients with being in a work environment if their anemia is persistent.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual show signs of chronic anemia, such as pale skin and mucous membranes, fatigue, and decreased exercise capacity?
  • Does individual have jaundice? Experience frequent infections? Do wounds heal poorly?
  • Have sickle cell crises occurred?
  • Did an exam reveal elevated respiratory and heart rates? Hemorrhages in the retina? Leg ulcers?
  • Is spleen abnormally small over time?
  • Was a complete blood count (CBC) done? Did it show a marked anemia, with low numbers of RBCs and elevated numbers of white blood cells and platelets?
  • Did a sickle prep test demonstrate sickle shape of the RBCs?
  • Was a hemoglobin electrophoresis done? Was hemoglobin abnormal?
  • Were other chronic anemias, such as thalassemias or hemoglobin-SC disease, ruled out?

Regarding treatment:

  • Since usually no cure is available for sickle cell anemia, was individual instructed in how to prevent and treat sickle cell crisis and complications?
  • Has individual avoided high altitudes?
  • Are infections being treated promptly?
  • Were vaccinations against pneumococcal pneumonia, Haemophilus influenza type B, and meningococcus given?
  • Does individual take daily folic acid supplements? Oral hydroxyurea?
  • Was hospitalization required for acute crises?

Regarding prognosis:

  • Has permanent organ damage occurred?
  • Have any complications developed, such as gallstones, autosplenectomy, acute chest syndrome, avascular necrosis, papillary necrosis, or damage to the cardiovascular system?
  • Is individual pregnant? Was genetic counseling available?

Source: Medical Disability Advisor



References

Cited

"Explore Sickle Cell Anemia." National Institutes of Health. 28 Sep. 2012. U.S. Department of Health and Human Services. 14 Nov. 2014 <http://www.nhlbi.nih.gov/health/health-topics/topics/sca/atrisk.html>.

"Sickle Cell Disease (SCD)." Centers for Disease Control and Prevention (CDC). 16 Sep. 2011. National Center for Health Statistics. 11 Nov. 2014 <http://www.cdc.gov/ncbddd/sicklecell/data.html>.

Source: Medical Disability Advisor






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