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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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Solomon N, Segaran N, Badawy M, Elsayes KM, Pellerito JS, Katz DS, Moshiri M, Revzin MV. Manifestations of Sickle Cell Disorder at Abdominal and Pelvic Imaging. Radiographics 2022; 42:1103-1122. [PMID: 35559660 DOI: 10.1148/rg.210154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Sickle cell disorder (SCD) refers to a spectrum of hematologic disorders that cause a characteristic clinical syndrome affecting the entire body. It is the most prevalent monogenetic hemoglobinopathy worldwide, with a wide range of focal and systemic expressions. Hemoglobin gene mutation leads to the formation of abnormal sickle-shaped red blood cells, which cause vascular occlusion and result in tissue and organ ischemia and infarction. Recurrent episodes of acute illness lead to progressive multisystem organ damage and dysfunction. Vaso-occlusion, hemolysis, and infection as a result of functional asplenia are at the core of the disease manifestations. Imaging plays an essential role in the diagnosis and management of SCD-related complications in the abdomen and pelvis. A thorough understanding of the key imaging findings of SCD complications involving hepatobiliary, gastrointestinal, genitourinary, and musculoskeletal systems is crucial to timely recognition and accurate diagnosis. The authors aim to familiarize the radiologist with the SCD spectrum, focusing on the detection and evaluation of manifestations that may appear at imaging of the abdomen and pelvis. The topics the authors address include (a) the pathophysiology of the disease, (b) the placement of SCD among hemoglobinopathies, (c) the clinical presentation of SCD, (d) the role of imaging in the evaluation and diagnosis of patients with SCD who present with abdominal and pelvic manifestations in addition to extraperitoneal manifestations detectable at abdominal or pelvic imaging, (e) imaging features associated with common and uncommon sequelae of SCD in abdominal and pelvic imaging studies, and (f) a brief overview of management and treatment of patients with SCD. Online supplemental material is available for this article. ©RSNA, 2022.
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Affiliation(s)
- Nadia Solomon
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - Nicole Segaran
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - Mohamed Badawy
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - Khaled M Elsayes
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - John S Pellerito
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - Douglas S Katz
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - Mariam Moshiri
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
| | - Margarita V Revzin
- From the Department of Radiology and Biomedical Imaging, 333 Cedar Street, PO Box 208042 Room TE-2, New Haven, CT 06520 (N. Solomon, M.V.R.); Stanford University, Stanford, Calif (N. Segaran); Department of Imaging Physics (M.B.) and Department of Abdominal Imaging (K.M.E.), University of Texas MD Anderson Cancer Center, Houston, Tex; Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, N.Y. (J.S.P.); Department of Radiology, NYU Winthrop University Hospital, Mineola, N.Y. (D.S.K.); and Department of Radiology, University of Washington Medical Center, Seattle Wash. (M.M.)
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Esterson YB, Sheth S, Kawamoto S. Splenic sequestration in the adult: cross sectional imaging appearance of an uncommon diagnosis. Clin Imaging 2020; 69:369-373. [PMID: 33070084 DOI: 10.1016/j.clinimag.2020.10.016] [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: 07/20/2020] [Revised: 08/23/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
Acute splenic sequestration crisis, the sudden pooling of red blood cells in the spleen, is an emergent process typically seen in children with homozygous sickle cell disease. Splenic sequestration has rarely been reported in adults with heterozygous sickle cell conditions, including sickle cell beta(+)-thalassemia disease (HbS/β+-thalassemia). Here we present a case of a 32-year-old man with HbS/β+-thalassemia who suffered an acute splenic sequestration crisis. We review the CT and ultrasound appearance of splenic sequestration, which include splenic enlargement and an irregular rim of hypoenhancing or hypoechoic tissue at the periphery of the spleen, and discuss imaging differential considerations. To our knowledge, this is only the nineteenth case of acute splenic sequestration to be reported in an adult with HbS/β+-thalassemia in the English literature, and only the second case in which ultrasound findings are reported.
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Affiliation(s)
- Yonah B Esterson
- Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline Street, Baltimore, MD 21287, USA.
| | - Sheila Sheth
- Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline Street, Baltimore, MD 21287, USA
| | - Satomi Kawamoto
- Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, 601 N Caroline Street, Baltimore, MD 21287, USA
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Gilyard SN, Hamlin SL, Johnson JO, Herr KD. Imaging review of sickle cell disease for the emergency radiologist. Emerg Radiol 2020; 28:153-164. [PMID: 32734483 DOI: 10.1007/s10140-020-01828-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/21/2020] [Indexed: 02/08/2023]
Abstract
Sickle cell disease (SCD), one of the most common inherited genetic syndromes in the USA, is characterized by recurring episodes of acute illness and progressive multisystem organ injury. Individuals with SCD frequently present to the emergency department for a spectrum of complications, such as vaso-occlusive crises, infection, cholecystitis, and stroke. Imaging correlates for most of these presentations exist, positioning the emergency radiologist to play a pivotal role in facilitating patient care. Using a systems-based approach, we describe the acute and chronic imaging manifestations of SCD that an emergency radiologist can expect to encounter in most practice settings, highlighting the unique pathophysiology of this disorder that typically underlies the imaging findings.
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Affiliation(s)
- Shenise N Gilyard
- Emory University School of Medicine, Atlanta, USA. .,Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE Suite #D112, Atlanta, USA.
| | - Scott L Hamlin
- Emory University School of Medicine, Atlanta, USA.,Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE Suite #D112, Atlanta, USA
| | - Jamlik-Omari Johnson
- Emory University School of Medicine, Atlanta, USA.,Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE Suite #D112, Atlanta, USA
| | - Keith D Herr
- Emory University School of Medicine, Atlanta, USA.,Division of Emergency and Trauma Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital, 1364 Clifton Road NE Suite #D112, Atlanta, USA
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Targueta EP, Hirano ACDG, de Campos FPF, Martines JADS, Lovisolo SM, Felipe-Silva A. Bone marrow necrosis and fat embolism syndrome: a dreadful complication of hemoglobin sickle cell disease. Autops Case Rep 2017; 7:42-50. [PMID: 29259931 PMCID: PMC5724055 DOI: 10.4322/acr.2017.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 11/23/2017] [Indexed: 11/23/2022]
Abstract
Sickle cell disease encompasses a wide range of genotypic presentation with particular clinical features. The entity affects millions of people, particularly those whose ancestors came from sub-Saharan Africa and other countries in the Western Hemisphere, Saudi Arabia, and India. Currently, the high frequency of S and C genes reflects natural selection through the protection of heterozygotes against severe malaria, the high frequency of consanguineous marriages, improvement of some public health policies and the nutritional standards in the poorer countries where newborns are now living long enough to present for diagnosis and management. Although there is a high burden of the disease, in many countries, the new-born sickle cell screening test is being performed and is rendering an early diagnosis; however, it is still difficult for sickle cell patients to find proper treatment and adequate follow-up. Moreover, in many countries, patients are neither aware of their diagnosis nor the care they should receive to prevent complications; also, they do not receive adequate genetic counseling. Hemoglobin SC (HbSC) disease is the most frequent double sickle cell heterozygosis found in Brazil. The clinical course tends to be more benign with fewer hospitalizations compared with double homozygotic SS patients. However, HbSC patients may present severe complications with a fatal outcome. We report the case of a 36-year-old man who presented to the emergency care facility with symptoms consistent with the diagnosis of sickling crisis. The outcome was unfavorable and death occurred just hours after admission. The autopsy revealed a generalized vaso-occlusive crisis by sickled red cells, bone marrow necrosis, and fat embolism syndrome.
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Affiliation(s)
| | | | | | | | - Silvana Maria Lovisolo
- University of São Paulo (USP), Hospital Universitário, Anatomic Pathology Department. São Paulo, SP, Brazil
| | - Aloisio Felipe-Silva
- University of São Paulo (USP), Hospital Universitário, Anatomic Pathology Department. São Paulo, SP, Brazil.,University of São Paulo (USP), Faculty of Medicine, Anatomic Pathology Department. São Paulo, SP, Brazil
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