1
|
Nelson M, Noisette L, Pugh N, Gordeuk V, Hsu LL, Wun T, Shah N, Glassberg J, Kutlar A, Hankins JS, King AA, Brambilla D, Kanter J. The clinical spectrum of HbSC sickle cell disease-not a benign condition. Br J Haematol 2024; 205:653-663. [PMID: 38898714 PMCID: PMC11315634 DOI: 10.1111/bjh.19523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/28/2024] [Indexed: 06/21/2024]
Abstract
Sickle cell disease (SCD) includes a group of heterogenous disorders that result in significant morbidities. HbSS is the most common type of SCD and HbSC is the second most common type of SCD. The prevalence of HbSC disease in the United States and United Kingdom is ~1 in 7174 births and 1 in 6174 births respectively. Despite its frequency, however, HbSC disease has been insufficiently studied and was historically categorized as a more 'mild' form of SCD. We conducted this study of HbSC disease as part of the NHLBI funded Sickle Cell Disease Implementation Consortium (SCDIC). The SCDIC registry included 2282 individuals with SCD, ages 15-45 years of whom 502 (22%) had HbSC disease. Compared with people with sickle cell anaemia (SCA), the study found that people with HbSC disease had a higher frequency of splenomegaly (n (%) = 169 (33.7) vs. 392 (22.1)) and retinopathy (n (%) = 116 (23.1) vs. 189 (10.6)). A Many people with HbSC also had avascular necrosis (n (%) = 112 (22.3)), pulmonary embolism (n (%) = 43 (8.6)) and acute chest syndrome (n (%) = 228 (45.4)) demonstrating significant disease severity. HbSC disease is more clinically severe than was previously recognized and deserves additional evaluation and targeted treatments.
Collapse
Affiliation(s)
- M Nelson
- Division of Hematology/Center for Sickle Cell Disease, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - L Noisette
- Division of Pediatric Hematology and Oncology, Children's Mercy Hospital, Kansas City, Missouri, USA
| | - N Pugh
- Division of Biostatistics and Epidemiology, RTI International, North, Carolina, USA
| | - V Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - L L Hsu
- Division of Pediatric Hematology-Oncology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - T Wun
- Division of Hematology and Oncology, Department of Medicine, UC Davis, Sacramento, California, USA
| | - N Shah
- Pediatric Hematology/Oncology, Duke University, Durham, North Carolina, USA
| | - J Glassberg
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - A Kutlar
- Sickle Cell Center, Augusta University, Augusta, Georgia, USA
| | - J S Hankins
- Department of Global Pediatric Medicine and Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - A A King
- Division of Pediatric Hematology and Oncology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - D Brambilla
- Division of Biostatistics and Epidemiology, RTI International, North, Carolina, USA
| | - J Kanter
- Department of Medicine, University of Alabama, Birmingham, Alabama, USA
| |
Collapse
|
2
|
Allard P, Tagliaferri L, Weru V, Cario H, Lobitz S, Grosse R, Bleeke M, Oevermann L, Hakimeh D, Jarisch A, Kopp-Schneider A, Kulozik AE, Kunz JB. The German sickle cell disease registry reveals a surprising risk of acute splenic sequestration and an increased transfusion requirement in patients with compound heterozygous sickle cell disease HbS/β-thalassaemia and no or low HbA expression. Eur J Haematol 2024. [PMID: 38946051 DOI: 10.1111/ejh.14259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024]
Abstract
Patients with sickle cell disease (SCD) in Germany exhibit a substantial genetic diversity in the β-globin genotype. Data collected by the national German SCD registry reflect this diversity and allowed us to analyze the phenotypes associated with different SCD genotypes. Our study focused on 90 patients with HbS/β-thalassaemia (HbS/β-thal) and compared these to patients with HbSS and HbSC. Patients with HbS/β-thal were classified into three groups: HbS/β0-thal (no HbA), HbS/β+-thal (HbA < 14%), and HbS/β++-thal (HbA≥14%). In comparison to HbSS, patients with HbS/β++-thal had higher Hb-levels, lower hemolytic activity and rarely required red blood cell transfusions. HbS/β0-thal and HbS/β+-thal closely resembled each other and are jointly referred to as HbS/β0/+-thal. Compared to HbSS, patients with HbS/β0/+-thal experienced a similar frequency of vasoocclusive crises and degree of hemolysis. However, the frequency of red blood cell transfusions (0.6 vs. 0.39/year, p = .0049) and splenic sequestration crises (42.4 vs. 15.5% of patients, p = 3.799e-05) was higher in HbS/β0/+-thal than in HbSS, but close to zero in HbS/β++-thal. In conclusion, the level of HbA expression determines the phenotype of HbS/β+-thal. HbS/β-thal expressing no or little HbA is hematologically similar to HbSS, but causes a previously unknown high risk of splenic sequestration.
Collapse
Affiliation(s)
- Pierre Allard
- Department of Pediatric Oncology, Haematology and Immunology, Hopp-Children's Cancer Center (KiTZ) Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Laura Tagliaferri
- Department of Pediatric Oncology, Haematology and Immunology, Hopp-Children's Cancer Center (KiTZ) Heidelberg, University of Heidelberg, Heidelberg, Germany
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
| | - Vivienn Weru
- Abteilung Biostatistik, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Germany
| | - Holger Cario
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendmedizin, Pädiatrische Hämatologie und Onkologie, Ulm, Germany
| | - Stephan Lobitz
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
- Gemeinschaftsklinikum Mittelrhein, Kemperhof, Pädiatrische Hämatologie und Onkologie, Koblenz, Germany
| | - Regine Grosse
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
| | - Matthias Bleeke
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
- Universitätsklinikum Hamburg-Eppendorf, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin, Klinik und Poliklinik für Pädiatrische Hämatologie und Onkologie, Hamburg, Germany
| | - Lena Oevermann
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
- Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Pädiatrie m.S. Onkologie/Hämatologie/KMT, Berlin, Germany
| | - Dani Hakimeh
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
- Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Klinik für Pädiatrie m.S. Onkologie/Hämatologie/KMT, Berlin, Germany
| | - Andrea Jarisch
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
- Klinikum der Johann-Wolfgang-Goethe Universität, Zentrum für Kinder- und Jugendmedizin, Schwerpunkt Stammzelltransplantation und Immunologie, Frankfurt am Main, Germany
| | | | - Andreas E Kulozik
- Department of Pediatric Oncology, Haematology and Immunology, Hopp-Children's Cancer Center (KiTZ) Heidelberg, University of Heidelberg, Heidelberg, Germany
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
| | - Joachim B Kunz
- Department of Pediatric Oncology, Haematology and Immunology, Hopp-Children's Cancer Center (KiTZ) Heidelberg, University of Heidelberg, Heidelberg, Germany
- GPOH Konsortium Sichelzellkrankheit, Berlin/Frankfurt/Hamburg/Heidelberg/Koblenz/Ulm, Germany
| |
Collapse
|
3
|
Grishin E, Soudack M, Levy-Mendelovich S, Bezalel Y, Lubetsky A, Cohen O, Brutman-Barazani T, Efros O, Kenet G, Barg AA. Pediatric splenic infarction: Assessment of associated clinical conditions and outcome. Pediatr Blood Cancer 2024; 71:e30939. [PMID: 38462782 DOI: 10.1002/pbc.30939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/14/2024] [Accepted: 02/22/2024] [Indexed: 03/12/2024]
Abstract
Pediatric splenic infarction (SI) is rare yet clinically significant. Publications regarding this complication are mostly limited to case reports. This is a retrospective study examining SI etiology, clinical presentation, management, and outcomes among children. Twenty-two patients (median age: 7.9 years) were included, mostly with pre-existing hematological diseases. Splenomegaly (72%), thrombocytopenia, and anemia were common. Most of the patients did not receive antithrombotic therapy yet only two patients experienced recurrences. During follow up 36% of patients died, however no fatalities were attributed to thrombotic or bleeding complications.
Collapse
Affiliation(s)
- Evgeny Grishin
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michalle Soudack
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Imaging Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Sarina Levy-Mendelovich
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
- Talpiot Sheba Leadership Program, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Bezalel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Pulmonology and National CF Center, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Israel
| | - Aharon Lubetsky
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Omri Cohen
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Tami Brutman-Barazani
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Orly Efros
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Gili Kenet
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
| | - Assaf A Barg
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Hemophilia Center, Coagulation Unit and Amalia Biron Research Institute of Thrombosis and Hemostasis, Sheba Medical Center, Ramat Gan, Israel
- Departmnet of Pediatric Hematology-Oncology, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|
4
|
Scheuer J, Lehman A, Howard C, Greengard E, Boucher AA. Multifocal Bone Pain, Fevers, and an Enhancing Clavicular Lesion in an 11-year-old Liberian Boy. Pediatr Rev 2021; 42:147-150. [PMID: 33648993 DOI: 10.1542/pir.2020-0034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | - Cynthia Howard
- Department of Pediatrics, Division of Global Pediatrics, and
| | - Emily Greengard
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Minnesota Medical School, Minneapolis, MN
| | - Alexander A Boucher
- Department of Pediatrics, Division of Pediatric Hematology and Oncology, University of Minnesota Medical School, Minneapolis, MN
| |
Collapse
|
5
|
Massive Splenic Infarction in a Child With Sickle Cell Disease on Chronic Transfusion Therapy. J Pediatr Hematol Oncol 2019; 41:e79-e82. [PMID: 30499910 DOI: 10.1097/mph.0000000000001356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Massive splenic infarction (MSI) is a rare complication of sickle cell disease, as the spleen generally atrophies within the first few years of life. We report a case of MSI in a 12-year-old boy with homozygous sickle cell anemia (Hb SS) whose chronic transfusion therapy resulted in hypersplenism. The occurrence of a complicated MSI in our patient should perhaps further encourage elective splenectomy in such patients, despite known potential perioperative complications and postsplenectomy risks of infection and thrombosis.
Collapse
|
6
|
Rezende PV, Santos MV, Campos GF, Vieira LL, Souza MB, Belisário AR, Silva CM, Viana MB. Clinical and hematological profile in a newborn cohort with hemoglobin SC. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
7
|
Clinical and hematological profile in a newborn cohort with hemoglobin SC. J Pediatr (Rio J) 2018; 94:666-672. [PMID: 29195085 DOI: 10.1016/j.jped.2017.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 09/09/2017] [Accepted: 09/27/2017] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Hemoglobin SC is the second most common variant of sickle-cell disease worldwide, after hemoglobin SS. The objectives of the study were to describe the clinical and laboratory characteristics of hemoglobin SC disease in children from a newborn screening program and treated at a blood center. METHODOLOGY This study assessed a cohort of 461 infants born between 01/01/1999 and 12/31/2012 and followed-up until 12/31/2014. Clinical events were expressed as rates for 100 patient-years, with 95% confidence intervals. Kaplan-Meier survival curves were created. RESULTS The median age of patients was 9.2 years; 47.5% were female. Mean values of blood tests were: hemoglobin, 10.5g/dL; reticulocytes, 3.4%; white blood cells, 11.24×109/L; platelets, 337.1×109/L; and fetal hemoglobin, 6.3%. Clinical events: acute splenic sequestration in 14.8%, blood transfusion 23.4%, overt stroke in 0.2%. The incidence of painful vaso-occlusive episodes was 51 (48.9-53.4) per 100 patient-years and that of infections, 62.2 episodes (59.8-64.8) per 100 patient-years. Transcranial Doppler ultrasonography (n=71) was normal given the current reference values for SS patients. Hydroxyurea was given to ten children, all of whom improvement of painful crises. Retinopathy was observed in 20.3% of 59 children who underwent ophthalmoscopy. Avascular necrosis was detected in seven of 12 patients evaluated, predominantly in the left femur. Echocardiogram compatible with pulmonary hypertension was recorded in 4.6% of 130 children, with an estimated average systolic pulmonary artery pressure of 33.5mmHg. The mortality rate from all causes was 4.3%. CONCLUSIONS Clinical severity is variable in SC hemoglobinopathy. Several children have severe manifestations similar to those with SS disease.
Collapse
|
8
|
Pecker LH, Schaefer BA, Luchtman-Jones L. Knowledge insufficient: the management of haemoglobin SC disease. Br J Haematol 2016; 176:515-526. [PMID: 27982424 DOI: 10.1111/bjh.14444] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although haemoglobin SC (HbSC) accounts for 30% of sickle cell disease (SCD) in the United States and United Kingdom, evidence-based guidelines for genotype specific management are lacking. The unique pathology of HbSC disease is complex, characterized by erythrocyte dehydration, intracellular sickling and increased blood viscosity. The evaluation and treatment of patients with HbSC is largely inferred from studies of SCD consisting mostly of haemoglobin SS (HbSS) patients. These studies are underpowered to allow definitive conclusions about HbSC. We review the pathophysiology of HbSC disease, including known and potential differences between HbSS and HbSC, and highlight knowledge gaps in HbSC disease management. Clinical and translational research is needed to develop targeted treatments and to validate management recommendations for efficacy, safety and impact on quality of life for people with HbSC.
Collapse
Affiliation(s)
- Lydia H Pecker
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA.,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Beverly A Schaefer
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lori Luchtman-Jones
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
9
|
Lebensburger JD, Patel RJ, Palabindela P, Bemrich-Stolz CJ, Howard TH, Hilliard LM. Hydroxyurea decreases hospitalizations in pediatric patients with Hb SC and Hb SB+ thalassemia. J Blood Med 2015; 6:285-90. [PMID: 26719735 PMCID: PMC4687721 DOI: 10.2147/jbm.s97405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patients with hemoglobin SC (Hb SC) and hemoglobin SB+ (Hb SB+) thalassemia suffer from frequent hospitalizations yet strong evidence of a clinical benefit of hydroxyurea (HU) in this population is lacking. Patients with recurrent hospitalizations for pain crisis are offered HU at our institution based on small cohort data and anecdotal benefit. This study identifies outcomes from a large cohort of patients with Hb SC and SB+ thalassemia who were treated with HU for 2 years. MATERIALS AND METHODS A retrospective review was conducted of 32 patients with Hb SC and SB+ thalassemia who were treated with HU. We reviewed the number, and reasons for hospitalization in the 2 years prior to, and 2 years post-HU treatment as well as laboratory changes from baseline, over 1 year. RESULTS Patients with Hb SC and SB+ thalassemia started on HU for frequent pain, had a significant reduction in hospitalizations over 2 years as compared to the 2 years prior to HU initiation (mean total hospitalizations/year: pre-HU: 1.6 vs post-HU 0.4 hospitalizations, P<0.001; mean pain hospitalizations/year: pre-HU 1.5 vs post-HU 0.3 hospitalizations, P<0.001). Patients demonstrated hematologic changes including an increase in percent fetal hemoglobin (%HbF) pre-post HU (4.5% to 7.7%, P=0.002), mean corpuscular volume (74 to 86 fL, P<0,0001), and decrease in absolute neutrophil count (5.0 to 3.2×10(9)/L, P=0.007). Patients with higher doses of HU demonstrated the greatest reduction in hospitalizations but this was unrelated to absolute neutrophil count. CONCLUSION This cohort of patients with Hb SC and SB+ thalassemia provides additional support for using HU in patients with recurrent hospitalizations for pain. A large randomized multicenter trial of HU to reduce pain admissions should be conducted to confirm these data and provide much needed evidence based recommendations for this population.
Collapse
Affiliation(s)
- Jeffrey D Lebensburger
- Division of Pediatric Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rakeshkumar J Patel
- Division of Pediatric Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | - Thomas H Howard
- Division of Pediatric Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lee M Hilliard
- Division of Pediatric Hematology Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
10
|
Brousse V, Buffet P, Rees D. The spleen and sickle cell disease: the sick(led) spleen. Br J Haematol 2014; 166:165-76. [DOI: 10.1111/bjh.12950] [Citation(s) in RCA: 148] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Accepted: 03/31/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Valentine Brousse
- Department of Paediatrics; Reference Centre for Sickle Cell Disease; Hôpital Universitaire Necker-Enfants Malades; APHP; Paris France
- Université Paris Descartes; Paris France
- Laboratory of Excellence GR-Ex; Paris France
| | - Pierre Buffet
- Laboratory of Excellence GR-Ex; Paris France
- Centre d'Immunologie et des Maladies Infectieuses de Paris; CIMI-PARIS; U 1135 INSERM/UPMC Université Paris VI; Paris France
- Service de Parasitologie; AP-HP; Hôpital Pitié-Salpêtrière; Paris France
| | - David Rees
- Department of Paediatric Haematology; King's College Hospital NHS Foundation Trust; King's Health Partners; Denmark Hill London UK
| |
Collapse
|
11
|
Brousse V, Elie C, Benkerrou M, Odièvre MH, Lesprit E, Bernaudin F, Grimaud M, Guitton C, Quinet B, Dangiolo S, de Montalembert M. Acute splenic sequestration crisis in sickle cell disease: cohort study of 190 paediatric patients. Br J Haematol 2012; 156:643-8. [DOI: 10.1111/j.1365-2141.2011.08999.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
12
|
Micel L, Nuss R, Fenton L, Lovell M, Silliman CC. Non-palpable splenic enlargement as the etiology of abdominal pain in an adolescent with hemoglobin SC disease. Pediatr Blood Cancer 2011; 57:352-3. [PMID: 21584930 DOI: 10.1002/pbc.23076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 01/14/2011] [Indexed: 11/08/2022]
|
13
|
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]
|
14
|
Lesher AP, Kalpatthi R, Glenn JB, Jackson SM, Hebra A. Outcome of splenectomy in children younger than 4 years with sickle cell disease. J Pediatr Surg 2009; 44:1134-8; discussion 1138. [PMID: 19524729 DOI: 10.1016/j.jpedsurg.2009.02.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Accepted: 02/17/2009] [Indexed: 11/19/2022]
Abstract
PURPOSE Removal of the spleen in patients younger than 4 years has been reported to carry an increased risk of postsplenectomy sepsis and has not been universally accepted. We reviewed our experience with splenectomy in children with acute splenic sequestration crisis (ASSC) younger than 4 years. METHODS The study involved retrospective review of demographic and operative data, number of ASSC, operative complications, infections, and death. RESULTS From 1993 to 2008, 53 patients (28 males, 25 females) younger than 4 years had open (43.8%) or laparoscopic (56.6%) splenectomy after one or more events of ASSC. Six (11.3%) were younger than 18 months, 28 (52.8%) were 18 to 24 months old, and 21 (39.6%) were 24 to 48 months old. Operative complications were diaphragm laceration (laparoscopy, n = 3; 5.7%) and reoperation for bleeding (open, n = 1; 1.8%). Length of stay was similar for laparoscopic (3.6 days) vs open (3.8 days) splenectomy. Mean postoperative follow-up was 5.6 years. In 353 postsplenectomy admissions, 3 (5.7%) patients had positive blood cultures requiring treatment. Three (5.7%) patients died within the 15-year study period; one (1.8%) had documented pneumococcal sepsis. DISCUSSION The advantage of early splenectomy may outweigh the risks of long-term transfusion. Splenectomy in young children with sickle cell disease carries a low risk of postsplenectomy sepsis with appropriate vaccination and prophylactic antibiotics. We conclude that splenectomy in young children with ASSC is safe and effective, especially with penicillin prophylaxis and improved vaccination strategies.
Collapse
Affiliation(s)
- Aaron P Lesher
- Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | | | | | | | | |
Collapse
|
15
|
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.
Collapse
Affiliation(s)
- Karthi Subbannan
- Department of Medicine, Section of Hematology/Oncology, Sickle Cell Center, Medical College of Georgia, Augusta, Georgia 30912, USA
| | | | | | | | | | | | | | | |
Collapse
|
16
|
|
17
|
Modrykamien A, Upegui J, Narayanswami G. A 21-Year-Old Man With Hemoglobin SC Disease and Acute Shortness of Breath With Left Upper Abdominal Pain. Chest 2007; 132:1084-7. [PMID: 17873205 DOI: 10.1378/chest.07-0213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Ariel Modrykamien
- Department of Medicine, St. Luke's Roosevelt Hospital Center, Columbia University College of Physicians and Surgeons, 1111 Amsterdam Ave at 114th St, New York, NY 10025, USA.
| | | | | |
Collapse
|
18
|
Cueto González AM, Díaz Conradi A, Fábrega Sabaté J, Mate García MA, Solé Heuberger E, Villalba Hernández T, Tobeña Boada L. [Two splenic sequestrations in an infant with homozygous sickle cell anemia]. An Pediatr (Barc) 2007; 66:322-3. [PMID: 17349264 DOI: 10.1016/s1695-4033(07)70403-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
19
|
MESH Headings
- Acute Disease
- Adolescent
- Adult
- Age Factors
- Analgesics, Non-Narcotic/administration & dosage
- Analgesics, Non-Narcotic/therapeutic use
- Analgesics, Opioid/administration & dosage
- Analgesics, Opioid/therapeutic use
- Anemia, Sickle Cell/complications
- Anemia, Sickle Cell/diagnosis
- Anemia, Sickle Cell/drug therapy
- Anemia, Sickle Cell/epidemiology
- Anemia, Sickle Cell/genetics
- Anemia, Sickle Cell/physiopathology
- Anemia, Sickle Cell/therapy
- Antibiotic Prophylaxis
- Antisickling Agents/administration & dosage
- Antisickling Agents/therapeutic use
- Blood Transfusion
- Child
- Child, Preschool
- Diagnosis, Differential
- Female
- Genotype
- Hematopoietic Stem Cell Transplantation
- Hospitalization
- Humans
- Hydroxyurea/administration & dosage
- Hydroxyurea/therapeutic use
- Ibuprofen/administration & dosage
- Ibuprofen/therapeutic use
- Immunization
- Infant
- Infant, Newborn
- Male
- Morphine/administration & dosage
- Morphine/therapeutic use
- Pain/diagnosis
- Pain/drug therapy
- Pain/etiology
- Pain Measurement
- Penicillins/administration & dosage
- Penicillins/therapeutic use
- Risk Factors
- Stroke/epidemiology
- Stroke/prevention & control
- Time Factors
- Treatment Outcome
Collapse
Affiliation(s)
- Rupa Redding-Lallinger
- Division of Hematology/Oncology, Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA
| | | |
Collapse
|
20
|
Wang-Gillam A, Lee RSM, Hsi ED, Brotman DJ. Acute Splenic Sequestration Crisis Resembling Sepsis in an Adult with Hemoglobin SC Disease. South Med J 2004; 97:413-5. [PMID: 15108841 DOI: 10.1097/01.smj.0000078682.47398.33] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Acute splenic sequestration crisis (ASSC) is a common complication of sickle cell anemia in children. ASSC is generally not seen in adults with the SS genotype but occasionally can be seen in adults with the SC genotype. We present a case of fulminant ASSC in an adult with hemoglobin SC who developed high fever, intense abdominal pain, leukocytosis, and jaundice.
Collapse
Affiliation(s)
- Andrea Wang-Gillam
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
| | | | | | | |
Collapse
|
21
|
Abstract
Homozygous HbC gene results only in mild hemolytic anemia. In HbSC disease red cells contain equal levels of HbS and HbC. It is a paradox that HbSC exhibit a moderately severe phenotype in spite of being a mixture of HbS trait and HbC trait, neither of which has significant pathology. Why does the combination of these two Hbs result in a serious disease? The short answer is that HbC enhances, by dehydrating the SC red cell, the pathogenic properties of HbS, resulting in a clinically significant disorder, but somewhat milder that sickle cell anemia (SCA). Nevertheless, retinnitis proliferans, osteonecrosis, and acute chest syndrome have equal or higher incidence in HbSC disease compared to SCA. This pathogenic trick is accomplished by HbC inducing, by mechanisms not fully understood, an increase in the activity of K:Cl cotransport that induces the lost of K(+) and consequently of intracellular water. This event creates a sufficient increase of MCHC, so that the lower levels of HbS found in SC red cells can polymerize rapidly and effectively. This situation offers a unique opportunity: if we could inhibit the effect of HbC on K(+) transport we can cure the disease.
Collapse
Affiliation(s)
- Ronald L Nagel
- Division of Hematology, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, The Bronx, NY, USA
| | | | | |
Collapse
|
22
|
Powars DR, Hiti A, Ramicone E, Johnson C, Chan L. Outcome in hemoglobin SC disease: a four-decade observational study of clinical, hematologic, and genetic factors. Am J Hematol 2002; 70:206-15. [PMID: 12111766 DOI: 10.1002/ajh.10140] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Over the past 40 years, we observed 284 subjects with hemoglobin SC disease (Hb SC) for 2,837 person-years. We examined the association of the course of clinical events with hematologic and genetic factors. The mean entry age was 21 years, although 15% entered before one year of age. The mean Hb concentration was 11.3 g/dL, the mean fetal hemoglobin was 2.5%, and the mean MCV was 84.4 fL. Twenty-five subjects died at a median age of 37 years. Chronic organ-specific complications occurred in 112 subjects (39.4%), with advanced retinopathy in 65 subjects (22.9%) and osteonecrosis (avascular necrosis) in 42 subjects (14.8%). We identified the beta-globin haplotypes in 82 subjects and the alpha-gene status in 79. Twenty-nine percent had alpha-thalassemia-2. The beta(CI) haplotype was present in 85.4%. We found a decreased incidence of retinopathy in the beta(CI) subjects compared to the non-beta(CI) subjects (33% vs. 67%; P = 0.049) with a later mean onset age (29 years vs. 21 years; log-rank test, P= 0.026). We also found a consistent pattern of decreased morbidity in subjects who had alpha-thalassemia-2 in comparison to those who did not. We found a reduced risk of chronic organ-specific complications (log-rank test, P= 0.003), lower incidence of sickle crisis (48% vs. 80%, P= 0.001), later onset of gallbladder disease (age of onset: 55 years vs. 34 years; P= 0.055), and lower risk of osteonecrosis (log-rank test, P= 0.024). Our findings suggest that Hb SC subjects who have not inherited alpha-thalassemia-2 might benefit from erythrocyte rehydration therapy.
Collapse
Affiliation(s)
- Darleen R Powars
- Department of Pediatrics, Division of Hematology, University of Southern California, Keck School of Medicine, Los Angeles, California 90033, USA.
| | | | | | | | | |
Collapse
|
23
|
Zimmerman SA, Ware RE. Palpable splenomegaly in children with haemoglobin SC disease: haematological and clinical manifestations. CLINICAL AND LABORATORY HAEMATOLOGY 2000; 22:145-50. [PMID: 10931162 DOI: 10.1046/j.1365-2257.2000.00304.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to investigate the prevalence of palpable splenomegaly in children with haemoglobin SC (Hb SC) disease, and to determine the haematological and clinical manifestations of splenomegaly in this patient population. We performed a retrospective chart review of 100 patients with Hb SC over 2 years of age followed by the Duke University Paediatric Sickle Cell Program with serial physical examinations and laboratory measurements. Palpable splenomegaly was present in 34% of patients and was more common in males (P = 0.029). Children with splenomegaly had a significantly lower average haemoglobin concentration (10.3 vs. 10.8 g/dl, P = 0.011) and lower platelet count (237 vs. 314 x 109/l, P < 0.001) than those without splenomegaly. Children with measurements both before and after the onset of splenomegaly had a significant decrease in the platelet count (279 vs. 216 x 109/l, P < 0.001) and white blood cell count (9.1 vs. 7.9 x 109/l, P = 0.04) after splenomegaly was identified. Clinical complications included acute splenic sequestration in 12% of children (median age 5.4 years), and hypersplenism with chronic thrombocytopenia in another 10% of patients (median age 10.6 years). Splenomegaly is a common physical finding in children with Hb SC disease and is often associated with mild cytopenias. Clinical complications of splenomegaly include acute splenic sequestration in younger patients and hypersplenism with chronic thrombocytopenia in older children.
Collapse
Affiliation(s)
- S A Zimmerman
- Paediatric Sickle Cell Program and the Division of Paediatric Hematology/Oncology, Department of Paediatrics, Duke University Medical Center, Durham, North Carolina 27710, USA.
| | | |
Collapse
|
24
|
|