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Feugray G, Grall M, Dumesnil C, Brunel V, Benhamou Y, Quillard Muraine M, Billoir P. Lipid and hemolysis parameters predicting acute chest syndrome in adulthood with sickle cell disease. Lipids Health Dis 2024; 23:140. [PMID: 38755670 PMCID: PMC11100209 DOI: 10.1186/s12944-024-02135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
Sickle cell disease (SCD) is a lifelong blood disorder affecting approximately 100,000 people in the United States and is one of the most common monogenic diseases. A serious complication of SCD is acute chest syndrome (ACS). ACS is a condition with a high rate of morbidity and mortality. The aim of the study was to assess hemolysis and lipid parameters in a cohort of confirmed SCD patients to predict ACS development in the following year.Standard lipid were performed (triglycerides, total cholesterol, high-density cholesterol, low-density cholesterol) panel to calculate of non-HDL-C, large buoyant LDL cholesterol (lbLDL-C) and small dense LDL cholesterol (sdLDL-C) with Sampson equation. Hemolysis and hematologic parameters were also evaluated.Among 91 patients included between September 2018 and June 2021, thirty-seven patients had history of ACS and 6 patients developed ACS during following year. In unadjusted logistic regression, total bilirubin was associated with ACS occurrence (RR: 1.2 [1.05-1.51] p = 0.013). Concerning lipid profile, non-HDL-C (RR: 0.87 [0.0.67-0.99] p = 0.04) and sdLDL-C (RR: 0.78 [0.49-0.96] p = 0.03) were associated with ACS occurrence decrease. C-reactive protein was associated with ACS occurrence (RR: 1.27 [1.065-1.85] p = 0.011).Based on these findings, this study demonstrated that several biomarker easily available can be used at steady state to predict ACS in the following year. The validation of these results are required to ensure the reproducibility of the findings.
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Affiliation(s)
- Guillaume Feugray
- Department of General Biochemistry, Normandie Univ, UNIROUEN, INSERM U1096 EnVI, CHU Rouen, Rouen, F-76000, France.
- Service de Biochimie, Centre hospitalier Universitaire Charles Nicolle, 1 rue de Germont, Rouen, 76031, France.
| | - Maximilien Grall
- Department of Internal Medicine, CHU Rouen, Rouen, F-76000, France
| | - Cécile Dumesnil
- Department of Pediatric Onco-Hematology, CHU Rouen, Rouen, F-76000, France
| | - Valéry Brunel
- Department of General Biochemistry, CHU Rouen, Rouen, F-76000, France
| | - Ygal Benhamou
- Department of Internal Medicine, Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Rouen, F-76000, France
| | - Muriel Quillard Muraine
- Department of General Biochemistry, Normandie Univ, UNIROUEN, INSERM U1404 INSERMU1073 ADEN, CHU Rouen, CIC-CRB, Rouen, F-76000, France
| | - Paul Billoir
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, CHU Rouen, Vascular Hemostasis Unit, Rouen, F-76000, France
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Patel NN, Ebubechukwu U, Saith SE, Ugoala OS, Kahn AB, McFarlane SI, John S. Crisis in the Chest: Acute Chest Syndrome as a Sequela of Tricuspid Valve Endocarditis. Cureus 2024; 16:e61061. [PMID: 38915989 PMCID: PMC11195809 DOI: 10.7759/cureus.61061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2024] [Indexed: 06/26/2024] Open
Abstract
The management of acute chest syndrome (ACS) in sickle cell disease occurring concurrently with pulmonary embolism resulting from tricuspid valve endocarditis poses an atypical challenge. We present a case in which this complex interaction occurs and the prompt interventions that were utilized to give the best possible outcome.
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Affiliation(s)
- Nishal N Patel
- Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Ugochukwu Ebubechukwu
- Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Sunil E Saith
- Cardiology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Onyinye S Ugoala
- Internal Medicine, Texas Tech University Health Sciences Center, Amarillo, USA
| | - Alexa B Kahn
- Cardiology, Brookdale University Hospital and Medical Center, Brooklyn, USA
| | - Samy I McFarlane
- Internal Medicine, State University of New York Downstate Health Sciences University, Brooklyn, USA
| | - Sabu John
- Cardiology, State University of New York Downstate Health Sciences University, Brooklyn, USA
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Levy M, Naudin J, Geslain G, Maroni A, Koehl B, Le Bourgeois F, Poncelet G, Chomton M, Deho A, Julliand S, Dauger S, Sommet J. Factors associated with adverse outcome among children with sickle cell disease admitted to the pediatric intensive care unit: an observational cohort. Ann Intensive Care 2024; 14:55. [PMID: 38594419 PMCID: PMC11003929 DOI: 10.1186/s13613-024-01283-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/27/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is one of the most frequent inherited diseases in the world. Over the last decades, in high-income countries, an important decrease in mortality have been observed due to the improvement of care. However, children with SCD can become critically ill and require admission in Pediatric Intensive Care Units (PICU). The purpose of this study was to describe the epidemiology of children with SCD admitted to PICU for acute crisis and to identify factors associated with adverse outcome (AO). METHODS We conducted a retrospective study in a Tertiary Hospital in France including all consecutive children with SCD admitted to PICU between January 1st, 2009 and December 31, 2019. We collected baseline patient's characteristics, clinical and biological data as well as treatments and life sustaining therapies used in the PICU. Patients were defined as experiencing AO in case of death during stay and/or need for invasive mechanical ventilation (MV) and/or for non-invasive ventilation (NIV) for more than 3 days and/or need for vasopressors and/or need for renal replacement therapy. RESULTS We included 579 admissions in 395 patients, mainly of SS genotype (90%) with a median age of 9.2 years [5.5-13.4] and a median baseline hemoglobin of 8.0 g/dl (7.5-8.8). The two main reasons for admission were acute chest syndrome (ACS) (n = 331, 57%) and vaso-occlusive crisis refractory to first line therapy (n = 99, 17%). Half of patients required NIV and 47 (8%) required MV. The overall length of stay was 3 days [1-4] and seven (1%) patients died during PICU stay.There was a total of 113 (20%) admissions with AO and on multivariable analysis, baseline hemoglobin < 8 g/dL, history of bronchial obstruction and admission for ACS were associated with AO. There was no difference in the proportion of hydroxyurea treatment or exchange transfusion program between patients with AO and the other patients. CONCLUSIONS Baseline hemoglobin < 8 g/dL, history of bronchial obstruction and admission for ACS were the strongest risk factors for severe evolution in SCD children admitted to PICU. These factors could be taken into consideration when choosing the adequate therapeutic options.
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Affiliation(s)
- Michaël Levy
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France.
| | - Jérôme Naudin
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Guillaume Geslain
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Arielle Maroni
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Bérengère Koehl
- Reference Center for Sickle-Cell Disease, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Inserm U1134, Université Paris Cité, Paris, France
| | - Fleur Le Bourgeois
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Géraldine Poncelet
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Maryline Chomton
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Anna Deho
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Sébastien Julliand
- Pediatric Mobile Emergency Unit, Robert-Debré University Hospital, Assistance Publique- Hôpitaux de Paris, Université Paris Cité, Paris, France
| | - Stéphane Dauger
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
| | - Julie Sommet
- Pediatric Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, Robert-Debré University Hospital, Université Paris Cité, Paris, France
- General Pediatrics, Pediatric infectious disease and Internal Medicine, Robert-Debré University Hospital, Assistance Publique-Hôpitaux de Paris, ECEVE UMR 1123, Paris, France
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Alghamdi FA, Al-Kasim F, Alshhada F, Ghareeb E, Azmet FR, Almudaibigh A, Baitalmal L, Alnawfal B, Alluqmani R. Risk factors for acute chest syndrome among children with sickle cell anemia hospitalized for vaso-occlusive crises. Sci Rep 2024; 14:5978. [PMID: 38472301 DOI: 10.1038/s41598-023-48527-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 03/14/2024] Open
Abstract
Sickle cell anemia (SCA) is a globally prevalent inherited condition, with acute chest syndrome (ACS) being one of its most severe complications. ACS frequently leads to hospitalization, requires intensive care unit (ICU) admission, and can even result in death. This study aimed to discern the early indicators of impending ACS in children with SCA who were initially hospitalized due to painful vaso-occlusive crises (VOC). This was a retrospective, case‒control investigation of 120 patients aged 1-14 years seen at the King Saud Medical City in Riyadh, Saudi Arabia from January 2021 to December 2022. Patients were classified into cases and controls: those who developed and did not develop ACS during hospital stay, respectively. Demographic factors, laboratory results, vital and clinical signs, and treatment protocols were compared between these groups. The following were significant predictors of impending ACS: previous diagnosis of asthma, history of ACS, recent upper respiratory tract symptoms prior to admission, and need for a blood transfusion within the first 24 h of admission due to a drop in hemoglobin levels. Further regression analysis indicated that elevated steady-state mean corpuscular volume, leukocyte count, total bilirubin, and an increased absolute neutrophil count level 24 h after admission also foreshadowed impending ACS among patients admitted for VOC. The location of pain was also significant; the incidence of ACS was higher in patients with back pain, but lower in those with pain confined to the limbs. The ACS group had a longer average duration of hospital stay compared to those with VOC alone, (7.6 vs. 5.8 days). Among patients initially admitted for VOC, 15.7% were diagnosed with ACS. Most ACS cases were managed with transfusions and antibiotics, and nearly one-third of patients needed admission to an ICU or a high-dependency area.
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Affiliation(s)
- Faisal A Alghamdi
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Fawaz Al-Kasim
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Forat Alshhada
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
- Medical Specialized Center, Riyadh, Saudi Arabia
| | - Eatedal Ghareeb
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Fauzia R Azmet
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Adel Almudaibigh
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Lobna Baitalmal
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bedah Alnawfal
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rehab Alluqmani
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
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Morrone K, Andreca M, Silver EJ, Xiang A, Strumph K, Manwani D, Rinke ML, Kurian J, Orentlicher R, Liszewski MC. Associating a standardized reporting tool for chest radiographs with clinical complications in pediatric acute chest syndrome. Pediatr Pulmonol 2023; 58:3139-3146. [PMID: 37671823 DOI: 10.1002/ppul.26634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/07/2023] [Accepted: 07/29/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND Acute chest syndrome (ACS) is an important cause of morbidity in sickle cell disease (SCD). A standardized tool for reporting chest radiographs in pediatric SCD patients did not previously exist. OBJECTIVE To analyze the interobserver agreement among pediatric radiologists' interpretations for pediatric ACS chest radiographs utilizing a standardized reporting tool. We also explored the association of radiographic findings with ACS complications. METHODS This was a retrospective cohort study of pediatric ACS admissions from a single institution in 2019. ICD-10 codes identified 127 ACS admissions. Two radiologists independently interpreted the chest radiographs utilizing a standardized reporting tool, a third radiologist adjudicated discrepancies, and κ analysis assessed interobserver agreement. Clinical outcomes were correlated with chest radiograph findings utilizing Pearsons' χ2 , t tests, and Mann-Whitney U tests. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. RESULTS Interobserver agreement was moderate to near-perfect across variables, with κ analysis showing near-perfect agreement for opacity reported in the right upper lobe (0.84), substantial agreement for right lower lobe (0.63), and vertebral bony changes (0.72), with moderate agreement for all other reported variables. On the initial chest radiograph, an opacity located in the left lower lobe (LLL) correlated with pediatric intensive care unit transfer (p = .03). Pleural effusion on the initial chest radiograph had a 3.98 OR (95% CI: 1.35-11.74) of requiring blood products and a 10.67 OR (95% CI: 3.62-31.39) for noninvasive ventilation. CONCLUSION The standardized reporting tool showed moderate to near-perfect agreement between radiologists. LLL opacity, and pleural effusion were associated with increased risk of ACS complications.
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Affiliation(s)
- Kerry Morrone
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mihai Andreca
- Department of Radiology, Yale New Haven Health, New Haven, Connecticut, USA
| | - Ellen J Silver
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Angell Xiang
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Kaitlin Strumph
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michael L Rinke
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jessica Kurian
- Department of Radiology, Westchester Medical Center, Valhalla, New York, USA
| | - Rona Orentlicher
- Department of Radiology, Mount Sinai Hospital, New York, New York, USA
| | - Mark C Liszewski
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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Zhang X, Han J, Shah BN, Saraf SL, Gordeuk VR. Platelet count decline and high neutrophil count within the first day of admission for painful sickle cell vaso-occlusive episodes predict severe complications. Br J Haematol 2023; 202:e20-e23. [PMID: 37248069 DOI: 10.1111/bjh.18898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Xu Zhang
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jin Han
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Binal N Shah
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Santosh L Saraf
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Victor R Gordeuk
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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Bhasin N, Sarode R. Acute Chest Syndrome in Sickle Cell Disease. Transfus Med Rev 2023; 37:150755. [PMID: 37741793 DOI: 10.1016/j.tmrv.2023.150755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023]
Abstract
Acute chest syndrome (ACS) is the leading cause of mortality among individuals with sickle cell disease (SCD) accounting for 25% of all deaths. The etiologies and clinical manifestations of ACS are variable among children and adults, with a lack of clear risk stratification guidelines for the practicing clinician. In addition, the management of ACS is based on limited evidence and is currently guided primarily by expert opinion. This manuscript reviews the pathophysiology, risk factors, and current management strategies for ACS through a review of published data on this subject between 1988 and 2022. Blood transfusion is often used as a therapeutic intervention for ACS to increase blood's oxygen-carrying capacity and reduce complications by reducing hemoglobin S (HbS) percentage, based on the very low quality of the evidence about its efficacy. The benefit of RBC transfusion for ACS has been described in case series and observational studies, but randomized studies comparing simple transfusion vs. exchange transfusions for ACS are lacking. In this review, we conclude that the development of clinical and laboratory risk stratification is necessary to further study an optimal management strategy for individuals with ACS to avoid transfusion-related complications while minimizing mortality.
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Affiliation(s)
- Neha Bhasin
- Division of Hematology, Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, USA.
| | - Ravi Sarode
- Department of Pathology and Internal Medicine (Hematology/Oncology), UT Southwestern Medical Center, USA
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8
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Mohan B, N P K, Choudhury A, Bairwa M. Acute Chest Syndrome Masquerading As Sepsis: A Rare Presentation of Sickle Cell Anemia Complication. Cureus 2022; 14:e30208. [DOI: 10.7759/cureus.30208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
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Haptoglobin 1 allele predicts higher serum haptoglobin concentration and lower multiorgan failure risk in sickle cell disease. Blood Adv 2022; 6:6242-6248. [PMID: 36006620 PMCID: PMC9792396 DOI: 10.1182/bloodadvances.2022007980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/22/2022] [Accepted: 08/14/2022] [Indexed: 12/31/2022] Open
Abstract
Haptoglobin (HP) is an acute-phase protein and the main scavenger of cell-free hemoglobin. When HP is depleted, as observed in hemolytic conditions such as sickle cell disease (SCD), cell-free hemoglobin can lead to acute organ damage. The impact of the HP 1-1, 2-1, and 2-2 isoforms on HP and cell-free hemoglobin concentrations and SCD-related complications is unclear. In a longitudinal cohort of patients with SCD, the HP 1 allele was associated with higher HP and lower cell-free hemoglobin concentrations at a routine clinic visit as well as during hospitalization for a vaso-occlusive episode or acute chest syndrome. With a median follow-up of 6.8 years, acute chest syndrome occurred in 42% (n = 163) and multiorgan failure in 14% (n = 53) of 391 patients with SCD with a minimum follow-up of 6 months. The HP 1 allele was independently associated with lower risk of developing multiorgan failure during acute chest syndrome (additive model hazard ratio, 0.5; P < .001). Future studies assessing the regulation of HP concentrations and ability to bind cell-free hemoglobin according to the HP genotype may help to identify patients with SCD at high risk for multiorgan failure and to guide interventions, such as rapid initiation of exchange transfusion or HP replacement therapy.
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Koehl JL, Koyfman A, Hayes BD, Long B. High risk and low prevalence diseases: Acute chest syndrome in sickle cell disease. Am J Emerg Med 2022; 58:235-244. [PMID: 35717760 DOI: 10.1016/j.ajem.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 05/31/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Acute chest syndrome (ACS) in sickle cell disease (SCD) is a serious condition that carries with it a high rate of morbidity and mortality. OBJECTIVE This review highlights the pearls and pitfalls of ACS in SCD, including diagnosis and management in the emergency department (ED) based on current evidence. DISCUSSION ACS is defined by respiratory symptoms and/or fever and a new radiodensity on chest imaging in a patient with SCD. There are a variety of inciting causes, including infectious and non-infectious etiologies. Although ACS is more common in those with homozygous SCD, clinicians should consider ACS in all SCD patients, as ACS is a leading cause of death in SCD. Patients typically present with or develop respiratory symptoms including fever, cough, chest pain, and shortness of breath, which can progress to respiratory failure requiring mechanical ventilation in 20% of adult patients. However, the initial presentation can vary. While the first line imaging modality is classically chest radiograph, lung ultrasound has demonstrated promise. Further imaging to include computed tomography may be necessary. Management focuses on analgesia, oxygen supplementation, incentive spirometry, bronchodilators, rehydration, antibiotics, consideration for transfusion, and specialist consultation. Empiric antibiotics that cover atypical pathogens are necessary along with measures to increase oxygen-carrying capacity in those with hypoxemia such as simple transfusion or exchange transfusion. CONCLUSIONS An understanding of ACS can assist emergency clinicians in diagnosing and managing this potentially deadly disease.
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Affiliation(s)
- Jennifer L Koehl
- Department of Pharmacy, Massachusetts General Hospital, Boston, MA, USA.
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, TX, USA
| | - Bryan D Hayes
- Department of Emergency Medicine, Division of Medical Toxicology, Harvard Medical School, Boston, MA, USA
| | - Brit Long
- SAUSHEC, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, TX, USA.
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Sustainability of low maternal mortality in pregnant women with SCD in a low-resource setting. Blood Adv 2022; 6:1977-1980. [PMID: 35196384 PMCID: PMC9006302 DOI: 10.1182/bloodadvances.2021005942] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/30/2022] [Indexed: 11/20/2022] Open
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Klings ES, Steinberg MH. Acute chest syndrome of sickle cell disease: genetics, risk factors, prognosis and management. Expert Rev Hematol 2022; 15:117-125. [PMID: 35143368 DOI: 10.1080/17474086.2022.2041410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IntroductionSickle cell disease, one of the world's most prevalent Mendelian disorders, is a chronic hemolytic anemia punctuated by acute vasoocclusive events. Both hemolysis and vasoocclusion lead to irreversible organ damage and failure. Among the many sub-phenotypes of sickle cell disease is the acute chest syndrome (ACS) characterized by combinations of chest pain, cough, dyspnea, fever, abnormal lung exam, leukocytosis, hypoxia, and new radiographic opacities. ACS is a major cause of morbidity and mortality.Area coveredWe briefly review the diagnosis, epidemiology, etiology, and current treatments for ACS and focus on understanding and estimating the risks for developing this complication, how prognosis and outcomes might be improved and the genetic elements that might impact the risk of ACS.Expert opinionThe clinical heterogeneity of ACS has hindered our understanding of risk stratification. Lacking controlled clinical trials most treatment is based on expert opinion. Fetal hemoglobin levels and coexistent α thalassemia affect the incidence of ACS; other genetic associations are tenuous. Transfusions, whose use not innocuous, should be targeted to the severity and likelihood of ACS progression. Stable, non-hypoxic patients with favorable hematologic and radiographic findings usually do not need transfusion; severe progressive ACS is best managed with exchange transfusion.
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Affiliation(s)
- Elizabeth S Klings
- Sections of Pulmonary, Allergy, Sleep and Critical Care Medicine, Boston University School of Medicine, Boston, USA
| | - Martin H Steinberg
- Hematology and Medical Oncology, Center of Excellence for Sickle Cell Disease, Boston University School of Medicine and Boston Medical Center, Boston, USA
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13
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P-selectin-deficient mice to study pathophysiology of sickle cell disease. Blood Adv 2021; 4:266-273. [PMID: 31968076 DOI: 10.1182/bloodadvances.2019000603] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/23/2019] [Indexed: 12/15/2022] Open
Abstract
Key PointsP-selectin–deficient SCD mice are protected from lung vaso-occlusion. P-selectin–deficient SCD mice will be useful in assessing the benefits of anti–P-selectin therapy in diverse complications of SCD.
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14
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Abstract
Sickle cell disease is an umbrella term for a group of hemoglobinopathies characterized by the presence of 2 β-globin gene mutations or deletions, at least 1 of which is the point mutation that leads to the production of hemoglobin S. Sickle cell disease is associated with hemolytic anemia, significant chronic end-organ damage, and early death. In high-income countries, at least 95% of children with the disease survive into adulthood, resulting in a growing population of affected adults with significant comorbidities, complex medical issues, and not enough specialists to provide care. Hydroxyurea is the primary therapy, and recent advances in understanding disease pathophysiology have led to new therapies; progress in bone marrow transplant and gene editing has resulted in cure in some patients. The purpose of this review is to provide an overview of the diagnosis, common acute and chronic clinical manifestations, and best practices for management of sickle cell disease.
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Affiliation(s)
- Lydia H Pecker
- Johns Hopkins University School of Medicine, Baltimore, Maryland (L.H.P., S.L.)
| | - Sophie Lanzkron
- Johns Hopkins University School of Medicine, Baltimore, Maryland (L.H.P., S.L.)
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15
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Razazi K, Gendreau S, Cuquemelle E, Khellaf M, Guillaud C, Godeau B, Melica G, Moutereau S, Gomart C, Fourati S, De Prost N, Carteaux G, Brun-Buisson C, Bartolucci P, Habibi A, Mekontso Dessap A. Procalcitonin to Reduce Antibiotic Exposure during Acute Chest Syndrome in Adult Patients with Sickle-Cell Disease. J Clin Med 2020; 9:jcm9113718. [PMID: 33228148 PMCID: PMC7699579 DOI: 10.3390/jcm9113718] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 01/11/2023] Open
Abstract
Acute chest syndrome (ACS) is a major complication of sickle-cell disease. Bacterial infection is one cause of ACS, so current guidelines recommend the routine use of antibiotics. We performed a prospective before–after study in medical wards and an intensive-care unit (ICU). During the control phase, clinicians were blinded to procalcitonin concentration results. We built an algorithm using the obtained measurements to hasten antibiotic cessation after three days of treatment if bacterial infection was not documented, and procalcitonin concentrations were all <0.5 μg/L. During the intervention period, the procalcitonin algorithm was suggested to physicians as a guide for antibiotic therapy. The primary endpoint was the number of days alive without antibiotics at Day 21. One-hundred patients were analyzed (103 ACS episodes, 60 in intervention phase). Possible or proven lung infection was diagnosed during 13% of all ACS episodes. The number of days alive without antibiotics at Day 21 was higher during the intervention phase: 15 [14–18] vs. 13 [13,14] days (p = 0.001). More patients had a short (≤3 days) antibiotic course during intervention phase: 31% vs 9% (p = 0.01). There was neither infection relapse nor pulmonary superinfection in the entire cohort. A procalcitonin-guided strategy to prescribe antibiotics in patients with ACS may reduce antibiotic exposure with no apparent adverse outcomes.
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Affiliation(s)
- Keyvan Razazi
- DHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; (S.G.); (E.C.); (N.D.P.); (G.C.); (C.B.-B.); (A.M.D.)
- IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
- Correspondence: ; Tel.: +33-1-4981-2391; Fax: +33-1-4981-4943
| | - Ségolène Gendreau
- DHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; (S.G.); (E.C.); (N.D.P.); (G.C.); (C.B.-B.); (A.M.D.)
- IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Elise Cuquemelle
- DHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; (S.G.); (E.C.); (N.D.P.); (G.C.); (C.B.-B.); (A.M.D.)
- IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Mehdi Khellaf
- Service d’Accueil des Urgences, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France;
| | - Constance Guillaud
- Département d’Aval des Urgences, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France;
| | - Bertrand Godeau
- Service de Médecine Interne, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France;
| | - Giovanna Melica
- Service d’Immunologie Clinique et Maladies Infectieuses, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France;
| | - Stéphane Moutereau
- Service de Biochimie, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France;
| | - Camille Gomart
- Département de Virologie, Bactériologie, Parasitologie-Mycologie, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; (C.G.); (S.F.)
| | - Slim Fourati
- Département de Virologie, Bactériologie, Parasitologie-Mycologie, AP-HP Hôpitaux Universitaires Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France; (C.G.); (S.F.)
| | - Nicolas De Prost
- DHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; (S.G.); (E.C.); (N.D.P.); (G.C.); (C.B.-B.); (A.M.D.)
- IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
- Unité U955, INSERM, Université Paris Est, 94010 Créteil, France; (P.B.); (A.H.)
| | - Guillaume Carteaux
- DHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; (S.G.); (E.C.); (N.D.P.); (G.C.); (C.B.-B.); (A.M.D.)
- IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
- Unité U955, INSERM, Université Paris Est, 94010 Créteil, France; (P.B.); (A.H.)
| | - Christian Brun-Buisson
- DHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; (S.G.); (E.C.); (N.D.P.); (G.C.); (C.B.-B.); (A.M.D.)
- IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Pablo Bartolucci
- Unité U955, INSERM, Université Paris Est, 94010 Créteil, France; (P.B.); (A.H.)
- French Sickle Cell Referral Center, Laboratory of Excellence GR-Ex, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - Anoosha Habibi
- Unité U955, INSERM, Université Paris Est, 94010 Créteil, France; (P.B.); (A.H.)
- French Sickle Cell Referral Center, Laboratory of Excellence GR-Ex, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France
| | - Armand Mekontso Dessap
- DHU A-TVB, Service de Médecine Intensive Réanimation, 51 Avenue du Maréchal de Lattre de Tassigny, AP-HP Hôpitaux Universitaires Henri Mondor, 94010 Créteil, France; (S.G.); (E.C.); (N.D.P.); (G.C.); (C.B.-B.); (A.M.D.)
- IMRB, GRC CARMAS, Faculté de Santé de Créteil, Université Paris Est Créteil, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France
- Unité U955, INSERM, Université Paris Est, 94010 Créteil, France; (P.B.); (A.H.)
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16
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End points for sickle cell disease clinical trials: renal and cardiopulmonary, cure, and low-resource settings. Blood Adv 2020; 3:4002-4020. [PMID: 31809537 DOI: 10.1182/bloodadvances.2019000883] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/07/2019] [Indexed: 01/19/2023] Open
Abstract
To address the global burden of sickle cell disease and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to patient-reported outcome, pain (non-patient-reported outcomes), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the end-organ considerations, measurement of cure, and low-resource settings panels as well as relevant findings and recommendations from the biomarkers panel.
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17
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Noun P, Ibrahim A, Hodroj MH, Bou-Fakhredin R, Taher AT. COVID-19 in benign hematology: emerging challenges and special considerations for healthcare professionals. Expert Rev Hematol 2020; 13:1081-1092. [DOI: 10.1080/17474086.2020.1819785] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Peter Noun
- Division of Pediatric Hematology-Oncology, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Ahmad Ibrahim
- Division of Hematology and Oncology, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
- Middle East Institute of Health, Lebanese University, Beirut, Lebanon
| | - Mohammad Hassan Hodroj
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayan Bou-Fakhredin
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali T. Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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18
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Brzoska T, Vats R, Bennewitz MF, Tutuncuoglu E, Watkins SC, Ragni MV, Neal MD, Gladwin MT, Sundd P. Intravascular hemolysis triggers ADP-mediated generation of platelet-rich thrombi in precapillary pulmonary arterioles. JCI Insight 2020; 5:139437. [PMID: 32544100 DOI: 10.1172/jci.insight.139437] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/11/2020] [Indexed: 12/17/2022] Open
Abstract
Patients with hereditary or acquired hemolytic anemias have a high risk of developing in situ thrombosis of the pulmonary vasculature. While pulmonary thrombosis is a major morbidity associated with hemolytic disorders, the etiological mechanism underlying hemolysis-induced pulmonary thrombosis remains largely unknown. Here, we use intravital lung microscopy in mice to assess the pathogenesis of pulmonary thrombosis following deionized water-induced acute intravascular hemolysis. Acute hemolysis triggered the development of αIIbβ3-dependent platelet-rich thrombi in precapillary pulmonary arterioles, which led to the transient impairment of pulmonary blood flow. The hemolysis-induced pulmonary thrombosis was phenocopied with intravascular ADP- but not thrombin-triggered pulmonary thrombosis. Consistent with a mechanism involving ADP release from hemolyzing erythrocytes, the inhibition of platelet P2Y12 purinergic receptor signaling attenuated pulmonary thrombosis and rescued blood flow in the pulmonary arterioles of mice following intravascular hemolysis. These findings are the first in vivo studies to our knowledge to suggest that acute intravascular hemolysis promotes ADP-dependent platelet activation, leading to thrombosis in the precapillary pulmonary arterioles, and that thrombin generation most likely does not play a significant role in the pathogenesis of acute hemolysis-triggered pulmonary thrombosis.
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Affiliation(s)
- Tomasz Brzoska
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ravi Vats
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Margaret F Bennewitz
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, West Virginia, USA
| | - Egemen Tutuncuoglu
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Simon C Watkins
- Center for Biologic Imaging, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Margaret V Ragni
- Department of Medicine, University of Pittsburgh, Hemophilia Center of Western Pennsylvania, Pittsburgh, Pennsylvania, USA
| | | | - Mark T Gladwin
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Prithu Sundd
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Division of Pulmonary Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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19
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Vats R, Brzoska T, Bennewitz MF, Jimenez MA, Pradhan-Sundd T, Tutuncuoglu E, Jonassaint J, Gutierrez E, Watkins SC, Shiva S, Scott MJ, Morelli AE, Neal MD, Kato GJ, Gladwin MT, Sundd P. Platelet Extracellular Vesicles Drive Inflammasome-IL-1β-Dependent Lung Injury in Sickle Cell Disease. Am J Respir Crit Care Med 2020; 201:33-46. [PMID: 31498653 PMCID: PMC6938158 DOI: 10.1164/rccm.201807-1370oc] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/06/2019] [Indexed: 01/07/2023] Open
Abstract
Rationale: Intraerythrocytic polymerization of Hb S promotes hemolysis and vasoocclusive events in the microvasculature of patients with sickle cell disease (SCD). Although platelet-neutrophil aggregate-dependent vasoocclusion is known to occur in the lung and contribute to acute chest syndrome, the etiological mechanisms that trigger acute chest syndrome are largely unknown.Objectives: To identify the innate immune mechanism that promotes platelet-neutrophil aggregate-dependent lung vasoocclusion and injury in SCD.Methods:In vivo imaging of the lung in transgenic humanized SCD mice and in vitro imaging of SCD patient blood flowing through a microfluidic system was performed. SCD mice were systemically challenged with nanogram quantities of LPS to trigger lung vasoocclusion.Measurements and Main Results: Platelet-inflammasome activation led to generation of IL-1β and caspase-1-carrying platelet extracellular vesicles (EVs) that bind to neutrophils and promote platelet-neutrophil aggregation in lung arterioles of SCD mice in vivo and SCD human blood in microfluidics in vitro. The inflammasome activation, platelet EV generation, and platelet-neutrophil aggregation were enhanced by the presence of LPS at a nanogram dose in SCD but not control human blood. Inhibition of the inflammasome effector caspase-1 or IL-1β pathway attenuated platelet EV generation, prevented platelet-neutrophil aggregation, and restored microvascular blood flow in lung arterioles of SCD mice in vivo and SCD human blood in microfluidics in vitro.Conclusions: These results are the first to identify that platelet-inflammasome-dependent shedding of IL-1β and caspase-1-carrying platelet EVs promote lung vasoocclusion in SCD. The current findings also highlight the therapeutic potential of targeting the platelet-inflammasome-dependent innate immune pathway to prevent acute chest syndrome.
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Affiliation(s)
- Ravi Vats
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tomasz Brzoska
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute
| | - Margaret F. Bennewitz
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, West Virginia; and
| | - Maritza A. Jimenez
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Jude Jonassaint
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute
- Division of Hematology and Oncology
| | - Edgar Gutierrez
- Department of Physics, University of California San Diego, La Jolla, California
| | | | - Sruti Shiva
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute
| | | | | | | | - Gregory J. Kato
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute
- Division of Hematology and Oncology
| | - Mark T. Gladwin
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Prithu Sundd
- Pittsburgh Heart, Lung, and Blood Vascular Medicine Institute
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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20
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Garnier M, Hafiani EM, Arbelot C, Blayau C, Labbe V, Stankovic-Stojanovic K, Lionnet F, Bonnet F, Fulgencio JP, Fartoukh M, Quesnel C. Morpho-functional evaluation of lung aeration as a marker of sickle-cell acute chest syndrome severity in the ICU: a prospective cohort study. Ann Intensive Care 2019; 9:109. [PMID: 31565756 PMCID: PMC6766460 DOI: 10.1186/s13613-019-0583-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 09/21/2019] [Indexed: 01/11/2023] Open
Abstract
Background Acute chest syndrome (ACS) is the main cause of morbi-mortality in patients with sickle-cell disease in the intensive care unit (ICU). ACS definition encompasses many types of lung damage, making early detection of the most severe forms challenging. We aimed to describe ACS-related lung ultrasound (LU) patterns and determine LU performance to assess ACS outcome. Results We performed a prospective cohort study including 56 ICU patients hospitalized for ACS in a tertiary university hospital (Paris, France). LU and bedside spirometry were performed at admission (D0) and after 48 h (D2). Complicated outcome was defined by the need for transfusion of ≥ 3 red blood cell units, mechanical ventilation, ICU length-of-stay > 5 days, or death. A severe loss of lung aeration was observed in all patients, predominantly in inferior lobes, and was associated with decreased vital capacity (22 [15–33]% of predicted). The LU Score was 24 [20–28] on D0 and 20 [15–24] on D2. Twenty-five percent of patients (14/56) had a complicated outcome. Neither oxygen supply, pain score, haemoglobin, LDH and bilirubin values at D0; nor their change at D2, differed regarding patient outcome. Conversely, LU re-aeration score and spirometry change at D2 improved significantly more in patients with a favourable outcome. A negative LU re-aeration score at D2 was an independent marker of severity of ACS in ICU. Conclusions ACS is associated with severe loss of lung aeration, whose resolution is associated with favourable outcome. Serial bedside LU may accurately and early identify ACS patients at risk of complicated outcome.
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Affiliation(s)
- Marc Garnier
- Département d'Anesthésie et Réanimation, APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France. .,Service de Réanimation Médico-Chirurgicale, APHP Hôpital Tenon, Paris, France. .,Université Pierre et Marie Curie Sorbonne Université, Paris, France.
| | - El Mahdi Hafiani
- Département d'Anesthésie et Réanimation, APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Service de Réanimation Médico-Chirurgicale, APHP Hôpital Tenon, Paris, France
| | - Charlotte Arbelot
- Département d'Anesthésie et Réanimation, APHP Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Clarisse Blayau
- Département d'Anesthésie et Réanimation, APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Service de Réanimation Médico-Chirurgicale, APHP Hôpital Tenon, Paris, France
| | - Vincent Labbe
- Service de Réanimation Médico-Chirurgicale, APHP Hôpital Tenon, Paris, France
| | - Katia Stankovic-Stojanovic
- Service de Médecine Interne et Centre de Référence de la Drépanocytose, APHP Hôpital Tenon, Paris, France
| | - François Lionnet
- Service de Médecine Interne et Centre de Référence de la Drépanocytose, APHP Hôpital Tenon, Paris, France
| | - Francis Bonnet
- Département d'Anesthésie et Réanimation, APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Université Pierre et Marie Curie Sorbonne Université, Paris, France
| | - Jean-Pierre Fulgencio
- Département d'Anesthésie et Réanimation, APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Service de Réanimation Médico-Chirurgicale, APHP Hôpital Tenon, Paris, France
| | - Muriel Fartoukh
- Service de Réanimation Médico-Chirurgicale, APHP Hôpital Tenon, Paris, France.,Université Pierre et Marie Curie Sorbonne Université, Paris, France
| | - Christophe Quesnel
- Département d'Anesthésie et Réanimation, APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.,Université Pierre et Marie Curie Sorbonne Université, Paris, France
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21
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Martí-Carvajal AJ, Conterno LO, Knight-Madden JM. Antibiotics for treating acute chest syndrome in people with sickle cell disease. Cochrane Database Syst Rev 2019; 9:CD006110. [PMID: 31531967 PMCID: PMC6749554 DOI: 10.1002/14651858.cd006110.pub5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The clinical presentation of acute chest syndrome is similar whether due to infectious or non-infectious causes, thus antibiotics are usually prescribed to treat all episodes. Many different pathogens, including bacteria, have been implicated as causative agents of acute chest syndrome. There is no standardized approach to antibiotic therapy and treatment is likely to vary from country to country. Thus, there is a need to identify the efficacy and safety of different antibiotic treatment approaches for people with sickle cell disease suffering from acute chest syndrome. This is an update of a Cochrane Review first published in 2007, and most recently updated in 2015. OBJECTIVES To determine whether an empirical antibiotic treatment approach (used alone or in combination):1. is effective for acute chest syndrome compared to placebo or standard treatment;2. is safe for acute chest syndrome compared to placebo or standard treatment;Further objectives are to determine whether there are important variations in efficacy and safety:3. for different treatment regimens,4. by participant age, or geographical location of the clinical trials. SEARCH METHODS We searched The Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched the LILACS database (1982 to 23 October 2017), African Index Medicus (1982 to 23 October 2017) and trial registries (23 October 2017).Date of most recent search of the Haemoglobinopathies Trials Register: 10 July 2019. SELECTION CRITERIA We searched for published or unpublished randomised controlled trials. DATA COLLECTION AND ANALYSIS Each author intended to independently extract data and assess trial quality by standard Cochrane methodologies, but no eligible randomised controlled trials were identified. MAIN RESULTS For this update, we were unable to find any randomised controlled trials on antibiotic treatment approaches for acute chest syndrome in people with sickle cell disease. AUTHORS' CONCLUSIONS This update was unable to identify randomised controlled trials on efficacy and safety of the antibiotic treatment approaches for people with sickle cell disease suffering from acute chest syndrome. While randomised controlled trials are needed to establish the optimum antibiotic treatment for this condition, we do not envisage further trials of this intervention will be conducted, and hence the review will no longer be regularly updated.
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22
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Ruhl AP, Sadreameli SC, Allen JL, Bennett DP, Campbell AD, Coates TD, Diallo DA, Field JJ, Fiorino EK, Gladwin MT, Glassberg JA, Gordeuk VR, Graham LM, Greenough A, Howard J, Kato GJ, Knight-Madden J, Kopp BT, Koumbourlis AC, Lanzkron SM, Liem RI, Machado RF, Mehari A, Morris CR, Ogunlesi FO, Rosen CL, Smith-Whitley K, Tauber D, Terry N, Thein SL, Vichinsky E, Weir NA, Cohen RT. Identifying Clinical and Research Priorities in Sickle Cell Lung Disease. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2019; 16:e17-e32. [PMID: 31469310 PMCID: PMC6812163 DOI: 10.1513/annalsats.201906-433st] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Pulmonary complications of sickle cell disease (SCD) are diverse and encompass acute and chronic disease. The understanding of the natural history of pulmonary complications of SCD is limited, no specific therapies exist, and these complications are a primary cause of morbidity and mortality.Methods: We gathered a multidisciplinary group of pediatric and adult hematologists, pulmonologists, and emergency medicine physicians with expertise in SCD-related lung disease along with an SCD patient advocate for an American Thoracic Society-sponsored workshop to review the literature and identify key unanswered clinical and research questions. Participants were divided into four subcommittees on the basis of expertise: 1) acute chest syndrome, 2) lower airways disease and pulmonary function, 3) sleep-disordered breathing and hypoxia, and 4) pulmonary vascular complications of SCD. Before the workshop, a comprehensive literature review of each subtopic was conducted. Clinically important questions were developed after literature review and were finalized by group discussion and consensus.Results: Current knowledge is based on small, predominantly observational studies, few multicenter longitudinal studies, and even fewer high-quality interventional trials specifically targeting the pulmonary complications of SCD. Each subcommittee identified the three or four most important unanswered questions in their topic area for researchers to direct the next steps of clinical investigation.Conclusions: Important and clinically relevant questions regarding sickle cell lung disease remain unanswered. High-quality, multicenter, longitudinal studies and randomized clinical trials designed and implemented by teams of multidisciplinary clinician-investigators are needed to improve the care of individuals with SCD.
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23
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Ghosh S, Flage B, Weidert F, Ofori-Acquah SF. P-selectin plays a role in haem-induced acute lung injury in sickle mice. Br J Haematol 2019; 186:329-333. [PMID: 30809798 DOI: 10.1111/bjh.15807] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Samit Ghosh
- Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Translational and International Hematology, Vascular Medicine Institute, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bethany Flage
- Center for Translational and International Hematology, Vascular Medicine Institute, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Frances Weidert
- Center for Translational and International Hematology, Vascular Medicine Institute, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Solomon F Ofori-Acquah
- Division of Hematology/Oncology, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Center for Translational and International Hematology, Vascular Medicine Institute, Department of Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
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Sundd P, Gladwin MT, Novelli EM. Pathophysiology of Sickle Cell Disease. ANNUAL REVIEW OF PATHOLOGY-MECHANISMS OF DISEASE 2018; 14:263-292. [PMID: 30332562 DOI: 10.1146/annurev-pathmechdis-012418-012838] [Citation(s) in RCA: 312] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since the discovery of sickle cell disease (SCD) in 1910, enormous strides have been made in the elucidation of the pathogenesis of its protean complications, which has inspired recent advances in targeted molecular therapies. In SCD, a single amino acid substitution in the β-globin chain leads to polymerization of mutant hemoglobin S, impairing erythrocyte rheology and survival. Clinically, erythrocyte abnormalities in SCD manifest in hemolytic anemia and cycles of microvascular vaso-occlusion leading to end-organ ischemia-reperfusion injury and infarction. Vaso-occlusive events and intravascular hemolysis promote inflammation and redox instability that lead to progressive small- and large-vessel vasculopathy. Based on current evidence, the pathobiology of SCD is considered to be a vicious cycle of four major processes, all the subject of active study and novel therapeutic targeting: ( a) hemoglobin S polymerization, ( b) impaired biorheology and increased adhesion-mediated vaso-occlusion, ( c) hemolysis-mediated endothelial dysfunction, and ( d) concerted activation of sterile inflammation (Toll-like receptor 4- and inflammasome-dependent innate immune pathways). These molecular, cellular, and biophysical processes synergize to promote acute and chronic pain and end-organ injury and failure in SCD. This review provides an exhaustive overview of the current understanding of the molecular pathophysiology of SCD, how this pathophysiology contributes to complications of the central nervous and cardiopulmonary systems, and how this knowledge is being harnessed to develop current and potential therapies.
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Affiliation(s)
- Prithu Sundd
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA; .,Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA.,Sickle Cell Center of Excellence, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA
| | - Mark T Gladwin
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA; .,Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA.,Sickle Cell Center of Excellence, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA
| | - Enrico M Novelli
- Pittsburgh Heart, Lung and Blood Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA.,Sickle Cell Center of Excellence, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA.,Division of Hematology/Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania 15261, USA
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Shome DK, Jaradat A, Mahozi AI, Sinan AS, Ebrahim A, Alrahim M, Ebraheem MS, Mansoor EJ, Majed KS, Azeez Pasha SA. The Platelet Count and its Implications in Sickle Cell Disease Patients Admitted for Intensive Care. Indian J Crit Care Med 2018; 22:585-590. [PMID: 30186009 PMCID: PMC6108298 DOI: 10.4103/ijccm.ijccm_49_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background and Aims In sickle cell disease (SCD) patients admitted for intensive care, evaluation of platelet counts in different types of sickle cell complications and its prognostic relevance are not well-studied. Illuminating these aspects were the objectives of this study. Materials and Methods A chart review of 136 adult SCD patients consecutively admitted to our Intensive Care Unit (ICU) was done. The prognosis on day 1 was assessed by Acute Physiology and Chronic Health Evaluation (APACHE II) and multiple organ dysfunction scores (MODS). Receiver operating characteristic (ROC) curves evaluated the ability of platelet counts, MODS, and APACHE II scores to predict survival. Results The most common types of crises were severe pain (n = 53), acute chest syndrome (n = 40), and infection (n = 18); 17 patients were nonsurvivors. Platelet counts varied widely (range, 19-838 × 109/L) with thrombocytopenia (n = 30) and thrombocytosis (n = 11). Counts correlated directly with leukocytes and reticulocytes; inversely with lactate dehydrogenase, APACHE, and MODS scores. Areas under ROC curve for platelets, MODS, and APACHE scores to predict survival were 0.73, 0.85, and 0.93, respectively. Conclusions In severe sickle cell crisis thrombocytopenia is more common than thrombocytosis. In the ICU, day 1 platelet counts correlate inversely with prognostic scores and are significantly reduced in multi-organ failure and nonsurvivors. A platelet count above 175 × 109/L predicts patient survival with high specificity and positive predictive value but lacks sensitivity.
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Affiliation(s)
- Durjoy K Shome
- Department of Pathology, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ahmed Jaradat
- Department of Family and Community Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ahmed I Mahozi
- Department of Pathology, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ali S Sinan
- Department of Pathology, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Ali Ebrahim
- Department of Pathology, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mohammed Alrahim
- Department of Pathology, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Mohammad S Ebraheem
- Department of Pathology, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain
| | - Eman J Mansoor
- Department of Pathology, Salmaniya Medical Complex, Manama, Bahrain
| | - Kameela S Majed
- Department of Pathology, Salmaniya Medical Complex, Manama, Bahrain
| | - Sheikh A Azeez Pasha
- Department of ICU and Anesthesiology, Salmaniya Medical Complex, Manama, Bahrain
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Factors Associated With Mechanical Ventilation Use in Children With Sickle Cell Disease and Acute Chest Syndrome. Pediatr Crit Care Med 2018; 19:801-809. [PMID: 29923940 DOI: 10.1097/pcc.0000000000001643] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Acute chest syndrome is the leading cause of death in children with sickle cell disease and is generally due to respiratory failure. Epidemiologic factors for a need for mechanical ventilation in children with acute chest syndrome require further clarification. DESIGN Retrospective observational study. SETTING Nationally representative pediatric inpatient records in the United States by using the Kids' Inpatient Database for the years 2003, 2006, 2009, and 2012. PATIENTS Patients age less than 20 years old with a discharge diagnosis of acute chest syndrome. MEASUREMENTS AND MARIN RESULTS Data were weighted to estimate annual hospitalizations according to hospital characteristics in the United States. Multivariable logistic regression was conducted to ascertain factors associated with use of mechanical ventilation, after adjusting for patient and hospital characteristics. Total hospitalizations for acute chest syndrome were 5,018 in 2003, 6,058 in 2006, 6,072 in 2009, and 6,360 in 2012. Mechanical ventilation use was associated with comorbidities of obesity (odds ratio, 3.35; 95% CI, 1.94-5.78), obstructive sleep apnea (odds ratio, 3.72; 95% CI, 2.23-6.20), and heart disease (odds ratio, 2.19; 95% CI, 1.47-3.27). In addition, nonblack compared with black children (odds ratio, 1.53; 95% CI, 1.02-2.31) and the fall season (p = 0.018) were associated with mechanical ventilation use. CONCLUSIONS Comorbidity of obesity, obstructive sleep apnea, or heart disease could be potentially associated with mechanical ventilation use during an episode of acute chest syndrome. Prospective observational studies would be required to confirm these findings and infer potential interventions for preventing illness severity.
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HMOX1 and acute kidney injury in sickle cell anemia. Blood 2018; 132:1621-1625. [PMID: 30139825 DOI: 10.1182/blood-2018-05-853929] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022] Open
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Abstract
Acute chest syndrome (ACS) is a leading complication of sickle cell disease (SCD) with significant morbidity and mortality. ACS is the most common cause of death and the second most common cause of hospitalization in patients with SCD. Delineating the specific cause of ACS is often difficult, and multiple risk factors that precipitate ACS frequently coexist. The prominent risk factors include infection, hypoxia, bronchial hyperresponsiveness, the SCD genotype, and opioid use. The key to the successful treatment of ACS is early recognition and initiation of treatment without delay. The main goal is to prevent and treat acute respiratory failure and, thus, minimize irreversible lung damage. This review focuses on the risk factors, pathogenesis, clinical presentation, and management of ACS.
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Affiliation(s)
- Sajid Farooq
- a Pulmonary and Critical Care , University of Missouri-Kansas City , Kansas City , MO , USA
| | - Mohannad Abu Omar
- a Pulmonary and Critical Care , University of Missouri-Kansas City , Kansas City , MO , USA
| | - Gary A Salzman
- a Pulmonary and Critical Care , University of Missouri-Kansas City , Kansas City , MO , USA
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Patterson GD, Mashegu H, Rutherford J, Seals S, Josey D, Karlson C, McNaull M, May W, Carroll C, Barr FE, Majumdar S. Recurrent Acute Chest Syndrome in Pediatric Sickle Cell Disease: Clinical Features and Risk Factors. J Pediatr Hematol Oncol 2018; 40:51-55. [PMID: 29200151 PMCID: PMC10182404 DOI: 10.1097/mph.0000000000001012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute chest syndrome (ACS) is a common and serious lung complication in sickle cell disease. A retrospective medical chart review was performed over a 6-year period in all pediatric ACS patients to investigate whether factors during the initial hospitalization were associated with recurrent ACS episodes. There were 386 episodes of ACS: 149 had only 1 episode of ACS, and 76 had >1 episode of ACS; 172 (76.4%) had hemoglobin SS, and 39 (17.3%) had hemoglobin SC. The most common presenting features were fever (83%), pain (70%), and cough (61%), which changed with the number of ACS episodes. Children <4 years old were at greatest risk of recurrent ACS (P=0.018). In addition, history of asthma (adjusted incident rate ratio [IRR]=1.52; 95% confidence interval [CI], 1.22-1.98; P<0.0001), shortness of breath (IRR, 1.29; 95% CI, 1.02-1.62; P=0.033), and length of hospital stay (IRR, 1.04; 95% CI, 1.01-1.08; P=0.017) were significantly associated with prospective ACS events. Multiple episodes of ACS are common in sickle cell disease, and certain risk factors during the initial hospitalization are associated with recurrent ACS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Frederick E Barr
- Division of Pediatric Critical Care, University of Mississippi Medical Center, Jackson, MS
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Jain S, Bakshi N, Krishnamurti L. Acute Chest Syndrome in Children with Sickle Cell Disease. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2017; 30:191-201. [PMID: 29279787 PMCID: PMC5733742 DOI: 10.1089/ped.2017.0814] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 10/11/2017] [Indexed: 02/02/2023]
Abstract
Acute chest syndrome (ACS) is a frequent cause of acute lung disease in children with sickle cell disease (SCD). Patients may present with ACS or may develop this complication during the course of a hospitalization for acute vaso-occlusive crises (VOC). ACS is associated with prolonged hospitalization, increased risk of respiratory failure, and the potential for developing chronic lung disease. ACS in SCD is defined as the presence of fever and/or new respiratory symptoms accompanied by the presence of a new pulmonary infiltrate on chest X-ray. The spectrum of clinical manifestations can range from mild respiratory illness to acute respiratory distress syndrome. The presence of severe hypoxemia is a useful predictor of severity and outcome. The etiology of ACS is often multifactorial. One of the proposed mechanisms involves increased adhesion of sickle red cells to pulmonary microvasculature in the presence of hypoxia. Other commonly associated etiologies include infection, pulmonary fat embolism, and infarction. Infection is a common cause in children, whereas adults usually present with pain crises. Several risk factors have been identified in children to be associated with increased incidence of ACS. These include younger age, severe SCD genotypes (SS or Sβ0 thalassemia), lower fetal hemoglobin concentrations, higher steady-state hemoglobin levels, higher steady-state white blood cell counts, history of asthma, and tobacco smoke exposure. Opiate overdose and resulting hypoventilation can also trigger ACS. Prompt diagnosis and management with intravenous fluids, analgesics, aggressive incentive spirometry, supplemental oxygen or respiratory support, antibiotics, and transfusion therapy, are key to the prevention of clinical deterioration. Bronchodilators should be considered if there is history of asthma or in the presence of acute bronchospasm. Treatment with hydroxyurea should be considered for prevention of recurrent episodes. This review evaluates the etiology, pathophysiology, risk factors, clinical presentation of ACS, and preventive and treatment strategies for effective management of ACS.
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Affiliation(s)
- Shilpa Jain
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Women and Children's Hospital of Buffalo, Hemophilia Center of Western New York, Buffalo, New York
| | - Nitya Bakshi
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Lakshmanan Krishnamurti
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
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Louie JE, Anderson CJ, Fayaz M. Fomani K, Henry A, Killeen T, Mohandas N, Yazdanbakhsh K, Belcher JD, Vercellotti GM, Shi PA. Case series supporting heme detoxification via therapeutic plasma exchange in acute multiorgan failure syndrome resistant to red blood cell exchange in sickle cell disease. Transfusion 2017; 58:470-479. [DOI: 10.1111/trf.14407] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 10/08/2017] [Accepted: 10/08/2017] [Indexed: 01/25/2023]
Affiliation(s)
- James E. Louie
- Long Island Jewish Medical Center, Northwell Health; New Hyde Park New York
| | - Caitlin J. Anderson
- Lindley F. Kimball Research Institute, New York Blood Center; New York New York
| | | | - Alonye Henry
- Lindley F. Kimball Research Institute, New York Blood Center; New York New York
| | - Trevor Killeen
- Department of Hematology, Oncology, and Transplantation; University of Minnesota Medical School; Minneapolis Minnesota
| | - Narla Mohandas
- Lindley F. Kimball Research Institute, New York Blood Center; New York New York
| | - Karina Yazdanbakhsh
- Lindley F. Kimball Research Institute, New York Blood Center; New York New York
| | - John D. Belcher
- Department of Hematology, Oncology, and Transplantation; University of Minnesota Medical School; Minneapolis Minnesota
| | - Gregory M. Vercellotti
- Department of Hematology, Oncology, and Transplantation; University of Minnesota Medical School; Minneapolis Minnesota
| | - Patricia A. Shi
- Lindley F. Kimball Research Institute, New York Blood Center; New York New York
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