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Obeagu EI, Obeagu GU. Managing gastrointestinal challenges: Diarrhea in sickle cell anemia. Medicine (Baltimore) 2024; 103:e38075. [PMID: 38701274 PMCID: PMC11062666 DOI: 10.1097/md.0000000000038075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 04/10/2024] [Indexed: 05/05/2024] Open
Abstract
Sickle cell anemia (SCA), a hereditary hemoglobinopathy, is characterized by the presence of abnormal hemoglobin and has long been associated with a wide range of complications. While much attention has been given to the condition hematological aspects, gastrointestinal complications, particularly diarrhea, have been relatively understudied and often overlooked. This publication delves into the management of gastrointestinal challenges, with a focus on diarrhea, in individuals living with SCA. The pathophysiology of SCA is intrinsically linked to gastrointestinal complications, and diarrhea is a common manifestation of this condition. This abstract publication outlines the key elements discussed in the full-length work, which includes the clinical presentation of diarrhea in these patients, the diagnostic tools used to evaluate the condition, and various management strategies to alleviate symptoms and enhance the overall quality of life for affected individuals. The paper emphasizes the importance of patient education, offering healthcare professionals valuable insights into how to inform and support patients in managing their conditions effectively. It also highlights the need for continued research to further our understanding of gastrointestinal challenges in SCA and to identify potential areas for future therapeutic interventions. Ultimately, the comprehensive management of diarrhea in individuals with SCA is vital for their overall well-being. This publication serves as a valuable resource for healthcare providers, researchers, and caregivers in addressing the gastrointestinal challenges that accompany SCA, ultimately working toward a better quality of life for those affected by this condition.
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A Presumed Sickle Cell Anemia Crisis Revealed To Be Medium Vessel Vasculitis. Cureus 2023; 15:e36993. [PMID: 37012982 PMCID: PMC10066570 DOI: 10.7759/cureus.36993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2023] [Indexed: 04/03/2023] Open
Abstract
A 24-year-old male sickle cell anemia patient presented with acute abdominal pain. Computed tomography (CT) demonstrated signs of bowel ischemia about the terminal ilium. He underwent bowel resection and anastomosis. Pathology of the resected bowel showed acute inflammation at the site of bowel perforation. This was thought to be secondary to bowel infarction from sickle cell vasculopathy. Despite the surgical intervention, the patient’s symptoms continued to worsen. He also developed bilateral toe pain during the same hospital stay. Reviewing the patient’s CT lower extremity runoff revealed no vascular thrombosis but rather medium vessel changes. The intra-abdominal arterial branches and the lower extremity vessels showed intermittent areas of vascular narrowing, wall thickening, and associated micro-aneurysms mainly of the distal hepatic arterial branches. These vascular changes posed a diagnostic dilemma as it is inconsistent with sickle cell anemia, which is known to cause vascular angiopathy as the underlying etiology of vaso-occlusive crisis. The literature lacked reports of any specific intra-abdominal vascular findings by imaging in sickle cell anemia. With the continued worsening of the patient’s condition, vasculitis was considered as an alternative diagnosis. The patient was empirically treated with steroids after which his symptoms improved. Unfortunately, he passed away after developing a large intracranial hematoma days after the initiation of steroid therapy. This report highlights the diagnostic dilemma of vaso-occlusive crisis versus vasculitis in sickle cell anemia patients.
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Gastrointestinal Vasoocclusive Crisis in a Woman with Hemoglobin SC Disease. Am J Med 2022; 135:592-594. [PMID: 35026137 DOI: 10.1016/j.amjmed.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/03/2021] [Accepted: 12/05/2021] [Indexed: 11/21/2022]
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Kinger NP, Moreno CC, Miller FH, Mittal PK. Abdominal Manifestations of Sickle Cell Disease. Curr Probl Diagn Radiol 2020; 50:241-251. [PMID: 32564896 DOI: 10.1067/j.cpradiol.2020.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/24/2020] [Accepted: 05/26/2020] [Indexed: 12/24/2022]
Abstract
Sickle cell disease is a debilitating hematologic process that affects the entire body. Disease manifestations in the abdomen most commonly result from vaso-occlusion, hemolysis, or infection due to functional asplenia. Organ specific manifestations include those involving the liver (eg, hepatopathy, iron deposition), gallbladder (eg, stone formation), spleen (eg, infarction, abscess formation, sequestration), kidneys (eg, papillary necrosis, infarction), pancreas (eg, pancreatitis), gastrointestinal tract (eg, infarction), reproductive organs (eg, priapism, testicular atrophy), bone (eg, marrow changes, avascular necrosis), vasculature (eg, vasculopathy), and lung bases (eg, acute chest syndrome, infarction). Imaging provides an important clinical tool for evaluation of acute and chronic disease manifestations and complications. In summary, there are multifold abdominal manifestations of sickle cell disease. Recognition of these sequela helps guide management and improves outcomes. The purpose of this article is to review abdominal manifestations of sickle cell disease and discuss common and rare complications of the disease within the abdomen.
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Affiliation(s)
- Nikhar P Kinger
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA.
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Pardeep K Mittal
- Department of Radiology and Imaging, Medical College of Georgia, Augusta, GA
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Olson MC, Fletcher JG, Nagpal P, Froemming AT, Khandelwal A. Mesenteric ischemia: what the radiologist needs to know. Cardiovasc Diagn Ther 2019; 9:S74-S87. [PMID: 31559155 DOI: 10.21037/cdt.2018.09.06] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Acute mesenteric ischemia (AMI) is a life-threatening condition that often presents with abdominal pain. Early diagnosis with contrast-enhanced computed tomography and revascularization can reduce the overall mortality in AMI. This article reviews practical etiological classification, pathophysiology of imaging manifestations and common pitfalls in intestinal ischemia.
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Affiliation(s)
| | | | - Prashant Nagpal
- Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Sickle cell disease is associated with higher mortality among patients hospitalized with ischemic bowel disease. Eur J Gastroenterol Hepatol 2018; 30:1027-1032. [PMID: 29957616 DOI: 10.1097/meg.0000000000001181] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is the most common inheritable hematologic disorder in the USA and is associated with ischemic organ diseases. SCD-associated ischemic bowel disease is increasing being recognized, and studies on the hospitalization outcomes of such patients are limited. OBJECTIVE This study aimed to compare the inpatient outcomes of ischemic bowel disease among patients with SCD compared with patients without SCD. MATERIALS AND METHODS This is a case-control study using data from the National Inpatient Sample Database (2007-2014). We analyzed and compared outcomes between cases (ischemic bowel disease with SCD) and controls (ischemic bowel disease without SCD), matched in a 1 : 5 ratio. The primary outcome was in-hospital mortality, and the secondary outcomes were healthcare resource utilization including mechanical ventilation, hemodialysis, transfusion, length of stay, and hospital charges. RESULTS Of the 194 262 patients admitted with ischemic bowel disease, 98 had a diagnosis of SCD and were matched successfully to the controls. In multivariate analysis, patients with SCD had twice the mortality odds of those without (adjusted odds ratio=2.06, 95% confidence intervals: 1.13-3.74). They were more likely to require mechanical ventilation and blood transfusion, and to be discharged to secondary health facilities [1.68 (1.02-2.76), 3.32 (2.15-5.12), and 1.84 (1.02-3.35)]. Patients with SCD also had a higher frequency of pneumonia, acute respiratory failure, and hemodialysis for acute renal failure. There was no significant difference in the length of stay or the total hospital charge between the two groups. CONCLUSION In patients hospitalized with ischemic bowel disease, SCD is associated with significantly increased mortality and healthcare burden.
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Acute multi-visceral thrombosis and ischemia in a 3-year-old child. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.04.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Sins JWR, Fijnvandraat K, Rijneveld AW, Boom MB, Kerkhoffs JLH, van Meurs AH, de Groot MR, Heijboer H, Dresse MF, Lê PQ, Hermans P, Vanderfaeillie A, Van Den Neste EW, Benghiat FS, Kesse-Adu R, Delannoy A, Efira A, Azerad MA, de Borgie CA, Biemond BJ. Effect of N-acetylcysteine on pain in daily life in patients with sickle cell disease: a randomised clinical trial. Br J Haematol 2017. [PMID: 28643376 DOI: 10.1111/bjh.14809] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Joep W R Sins
- Department of Paediatric Haematology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands.,Department of Haematology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Karin Fijnvandraat
- Department of Paediatric Haematology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - Anita W Rijneveld
- Department of Haematology, Erasmus MC, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Martine B Boom
- Department of Paediatric Haematology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands.,Department of Haematology, Academic Medical Centre, Amsterdam, the Netherlands
| | | | | | - Marco R de Groot
- Department of Haematology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Harriët Heijboer
- Department of Paediatric Haematology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - Marie-Françoise Dresse
- Department of Paediatric Haemato-oncology, Centre Hospitalier Régional de la Citadelle, Liège, Belgium
| | - Phu Quoc Lê
- Department of Haemato-oncology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Brussels, Belgium
| | - Philippe Hermans
- Department of Haemato-oncology, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Anna Vanderfaeillie
- Department of Paediatrics, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Eric W Van Den Neste
- Department of Haematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Fleur S Benghiat
- Department of Haemato-oncolocy, Hôpital Erasme, Brussels, Belgium
| | - Rachel Kesse-Adu
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - André Delannoy
- Department of Haematology, Hôpital de Jolimont, Haine-St-Paul, Belgium
| | - André Efira
- Department of Haemato-oncology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
| | - Marie-Agnès Azerad
- Department of Haemato-oncology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium.,Department of Haematology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | | | - Bart J Biemond
- Department of Haematology, Academic Medical Centre, Amsterdam, the Netherlands
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CT abdominal imaging findings in patients with sickle cell disease: acute vaso-occlusive crisis, complications, and chronic sequelae. Abdom Radiol (NY) 2016; 41:2524-2532. [PMID: 27600384 DOI: 10.1007/s00261-016-0890-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Sickle cell disease (SCD) is the most prevalent hemoglobinopathy. Survival in patients with SCD has improved over the past few decades. These patients experience a lifetime of repeated acute pain crises, which are thought to result from sickling and microvascular occlusions; acute abdominal pain is common. Moreover, repeated crises often lead to organ dysfunction, such as asplenia, hepatic failure, and renal failure. The spleen, liver, biliary system, kidneys, and gastrointestinal tract can all be affected. Patients may undergo CT to further direct clinical management. We review the spectrum of CT imaging findings of abdominal manifestations in patients with SCD, from the acute microvascular occlusive pain crisis to the potential complications and chronic sequelae.
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