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Habibi A, Pirenne F. Les anémies aiguës et la stratégie transfusionnelle chez les drépanocytaires adultes. Rev Med Interne 2023; 44:4S12-4S17. [PMID: 38049241 DOI: 10.1016/s0248-8663(23)01304-8] [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] [Indexed: 12/06/2023]
Abstract
Worsening of anemia is very common in sickle cell disease. It is important to investigate specific complications related to sickle cell disease but also other causes of anemia in general. Transfusions or exchange transfusions are major therapeutic options and are frequently used for acute complications of sickle cell disease but also for primary and secondary prevention of some of the chronic complications. The transfusion strategy has been modified since the awareness of post-transfusion hemolysis by taking into account the transfusion risk score. A strong collaboration between the patient's expert center, the Blood center and the patient's hospitalization unit is required to make decisions. © 2023 Société nationale française de médecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- A Habibi
- Centre de référence des syndromes drépanocytaires majeurs, unité des maladies génétiques du globule rouge, CHU Henri-Mondor, AP-HP, Créteil, France; INSERM-U955, institut Mondor, université Paris-Est Créteil, team 2 Transfusion et maladies du globule rouge, laboratoire d´excellence GR-Ex, Créteil, France.
| | - F Pirenne
- INSERM-U955, institut Mondor, université Paris-Est Créteil, team 2 Transfusion et maladies du globule rouge, laboratoire d´excellence GR-Ex, Créteil, France; Établissement français du sang Île-de-France, Paris, France
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Marcombes C, Lafont E, Jullien V, Flamarion E, Dion J, Costedoat-Chalumeau N, Pouchot J, Arlet JB. [Sickle cell trait complications: A case series of 6 patients]. Rev Med Interne 2020; 41:583-590. [PMID: 32768266 DOI: 10.1016/j.revmed.2020.04.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/19/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Patients with sickle cell trait (SCT) are commonly considered as asymptomatic carriers. However, some clinical manifestations may occur. METHODS Here we present a retrospective descriptive study about SCT subjects with at least one complication diagnosed in a sickle cell disease referral center, in Paris, between 2008 and 2019. We also performed a literature review on the complications of SCT subjects. RESULTS Six patients (between 19 and 65 years old) were included. SCT was already known only for 4 of them at the time of the complication. Four patients presented with a splenic infarct after a stay in high altitude or a plane trip, one of them was associated with papillary necrosis; one patient had isolated papillary necrosis, and the last one had splenic sequestration. These complications happened for most of them after exposure to an unusual situation of hypoxia or deshydratation. Five out of 6 patients had a marked elevated C reactive protein. CONCLUSION SCT may cause acute ischemic complications in a context of prolonged hypoxia or dehydration. The most commonly reported are the splenic infarct and the renal papillary necrosis. A study of hemoglobin should be considered in these clinical situations in patients with compatible ethnic origin.
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Affiliation(s)
- C Marcombes
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - E Lafont
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France; Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - V Jullien
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - E Flamarion
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France
| | - J Dion
- Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - N Costedoat-Chalumeau
- Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France; Département de médecine interne, Hôpital Cochin (AP-HP), rue Saint Jacques, 75014 Paris, France
| | - J Pouchot
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France; Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France
| | - J B Arlet
- Département de médecine interne, Centre de référence des syndromes drépanocytaires majeurs de l'adulte, Hôpital européen Georges Pompidou (AP-HP), 20 rue Leblanc, 75015 Paris, France; Faculté de médecine Paris Descartes, Université de Paris, 15 Rue de l'École de Médecine, 75006 Paris, France.
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Asnani MR, Williams A, Reid M. Splenic enlargement in adults with homozygous sickle cell disease: the Jamaican experience. ACTA ACUST UNITED AC 2013; 18:46-9. [PMID: 23321548 DOI: 10.1179/1607845412y.0000000036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE It is quite rare to find splenomegaly or its various complications in adults with homozygous sickle cell (SS) disease. Splenomegaly in adults may indicate a differential severity of disease, when compared with those who have had 'autosplenectomy'. METHODS We studied the clinical and haematological profiles of all SS patients (n = 25) in our database who have had splenomegaly in their adulthood (group 1) and compared with a random sample of age- and gender-matched persons (n = 75) who did not have splenomegaly in adulthood (group 2). RESULTS Group 1 persons had higher foetal haemoglobin, lower platelets and white blood cells, and greater prevalence of gall bladder disease and hospitalizations. Seven of the 25 persons in group 1 had acute splenic sequestration and the rest had hypersplenism. CONCLUSIONS Splenic enlargement occurring during adulthood may imply lower severity of disease and clinicians should consider this diagnosis even in persons with SS genotype.
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Affiliation(s)
- Monika R Asnani
- Sickle Cell Unit, Tropical Medicine Research Institute, University of the West Indies, Mona, Jamaica, WI0000.
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El Maataoui A, Ouzzif Z. [Haemoglobin C/OArab: About a family]. PATHOLOGIE-BIOLOGIE 2012; 60:320-321. [PMID: 22078176 DOI: 10.1016/j.patbio.2011.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 05/05/2011] [Indexed: 05/31/2023]
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Diagne I, Diagne-Guèye N, Fall A, Déme I, Sylla A, Coly J, Camara B, Sow H. Aspects épidémiologiques et évolutifs de la splénomégalie chez les enfants et adolescents porteurs de syndromes drépanocytaires majeurs au Sénégal. Arch Pediatr 2010; 17:1017-25. [DOI: 10.1016/j.arcped.2010.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 02/20/2010] [Accepted: 04/15/2010] [Indexed: 10/19/2022]
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Arlet JB, Bartolucci P, Habibi A, Ribeil JA, Stankovic K, Lionnet F. [Anemia in adult sickle cell disease]. Rev Med Interne 2009; 30 Suppl 4:S319-22. [PMID: 19836111 DOI: 10.1016/j.revmed.2009.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- J-B Arlet
- Service de médecine interne, centre de référence de la drépanocytose, faculté de médecine Paris-Descartes, hôpital européen Georges-Pompidou, AP-HP, 20, rue Leblanc, 75908 Paris cedex 15, France
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Subbannan K, Ustun C, Natarajan K, Clair B, Daitch L, Fields S, Kutlar F, Kutlar A. Acute splenic complications and implications of splenectomy in hemoglobin SC disease. Eur J Haematol 2009; 83:258-60. [PMID: 19459924 DOI: 10.1111/j.1600-0609.2009.01270.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Splenectomy indications and outcome were evaluated in 124 adults with hemoglobin SC disease (Hb SC). Twelve patients (9.6%) required splenectomy. There was a significant difference between the splenectomy group and the non-splenectomy group, respectively, regarding Hb levels (median 7.2 g/dL vs. 12.5 g/dL, P < 0.0001), platelet counts (median 146 x 10(6)/L vs. 275 x 10(6)/L, P = 0.031), palpable spleen rate (66% vs. 16%, P = 0.0003%), acute chest syndrome frequency (75% vs. 12%P = 0.0004) and cholecystectomy rate (66% vs. 13%, P = 0.0004). No significant morbidity or mortality occurred postsplenectomy. There is a subgroup of Hb SC patients requiring splenectomy, in which splenectomy is effective. Although it appears to be safe regarding short-term complications of surgery, long-term adverse effects such as infections have to be evaluated cautiously.
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Affiliation(s)
- Karthi Subbannan
- Department of Medicine, Section of Hematology/Oncology, Sickle Cell Center, Medical College of Georgia, Augusta, Georgia 30912, USA
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Rivera-Ruiz M, Varon J, Sternbach GL. Acute splenic sequestration in an adult with hemoglobin S-C disease. Am J Emerg Med 2009; 26:1064.e5-8. [PMID: 19091280 DOI: 10.1016/j.ajem.2008.02.031] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 02/23/2008] [Indexed: 12/01/2022] Open
Abstract
Acute splenic sequestration crisis is a common, potentially life-threatening complication of sickle cell anemia in children that is uncommon in adults.We present the case of a 44-year-old gentleman with undiagnosed hemoglobin S-C disease who developed intense back pain, marked abdominal distension, systemic inflammatory response syndrome, and multisystem organ failure that first presented as acute splenic sequestration crisis. The hemoglobinopathy SC is a disease caused by heterozygous-globin chain mutations with over-lapping clinical features of sickle cell disease with changes in the frequency of these manifestations reflected by the combination of characteristics of hemoglobin C and hemoglobin S. In hemoglobin S-C disease, autosplenectomy is rare and splenomegaly usually persists until adulthood;vasoocclusive complications are seen less habitually and become evident at a later time compared with sickle cell disease. The diagnosis of hemoglobin S-C disease is essentially done by exclusion. Transfusion of red blood cells is the treatment of choice, but splenectomy is indicated if transfusion therapy fails. A review of the literature and keypoints for the emergency practitioner are included.
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Entressengle H, Bachmeyer C, Tassart M, Stankovic K, Loko G, Lionnet F. [Acute splenic sequestration in an adult with sickle cell disease]. Presse Med 2008; 37:426-7. [PMID: 18180138 DOI: 10.1016/j.lpm.2007.07.026] [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: 03/21/2007] [Revised: 04/20/2007] [Accepted: 07/04/2007] [Indexed: 10/22/2022] Open
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Koduri PR, Nathan S. Acute splenic sequestration crisis in adults with hemoglobin S-C disease: a report of nine cases. Ann Hematol 2006; 85:239-43. [PMID: 16463155 DOI: 10.1007/s00277-005-0061-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Accepted: 12/01/2005] [Indexed: 11/25/2022]
Abstract
Acute splenic sequestration crisis (ASSC) is a potentially life-threatening complication and one of the leading causes of death in children with sickle cell disease. It is rarely reported in adults with hemoglobin S-C disease and its natural history in these patients has not been well studied. We describe here the clinicopathological features of ASSC in nine adults with hemoglobin S-C disease treated between 1972 and 2000 and followed for a mean period of 9 years (range 0-21 years). ASSC was characterized by acute left upper quadrant abdominal pain, splenomegaly, fever, and a rapid decrease in hematocrit with active erythropoiesis. The hemoglobin decreased by a mean of 4.8 g/dl from the steady state value (range 3.0 to 6.7 g/dl) during ASSC. Two patients failed to respond to transfusion of packed erythrocytes and required urgent splenectomy. There was one fatality-a 76-year-old woman, who died 36 h after admission. There was no recurrence of ASSC in five patients followed for 2, 3, 16, 18, and 21 years, respectively. ASSC in adults is a serious and occasionally, fatal complication of hemoglobin S-C disease. Patients with hemoglobin S-C disease may remain at risk of ASSC into their eighth decade.
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Affiliation(s)
- Prasad Rao Koduri
- The Division of Hematology-Oncology, Cook County Hospital, Chicago, IL 60612, USA.
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