Sickle Cell Anemia and Lab smears

[grinnurse, RN]

Had a pt come in with SCA Crisis. Drew labs and they did blood smears but no sickles from the smear showed up. Repeated the test and again no sickling on the smears!! Is this unusual? Could it be age related?? Pt was 30 yo. Could it be early stages of the disease? Does SCA generally cause a pt to have tremors bilaterally in extremities?? Pt denied using cocaine and marijuana, but tested positive for both on tox screen. Requested pain meds as soon as he knew he could have them. Trying to figure out if he was a drug seeker, having withdrawal symptoms from the drugs or just looking for another high!!

Any help, suggestions appreciated!! Thanks:)