Postpartum acute splenic sequestration in sickle cell disease

Splenic sequestration in the adult: cross sectional imaging appearance of an uncommon diagnosis

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.

Adverse outcome of acute splenic sequestration crisis in pregnancy

Background

Acute splenic sequestration crisis, characterized by abrupt fall in hemoglobin, splenomegaly, hypovolemia, and often thrombocytopenia, occurs infrequently in adults with sickle cell disease and extremely rarely during pregnancy.

Case

A 25-year-old woman with HbSC presented at 33 weeks' gestation with vaso-occlusive pain. Sudden worsening of abdominal pain and non-reassuring fetal surveillance on day 3 of admission led to emergent delivery. Acute splenic sequestration crisis was the diagnosis of exclusion based on clinical presentation and intra-operative hemoglobin of 37 g/L. Five- and 10-minute Apgar scores were 4. Neonatal brain magnetic resonance imaging revealed significant diffuse white matter abnormalities.

Conclusion

Acute splenic sequestration crisis in pregnancy must be considered in the differential diagnosis for this patient population as it can evolve rapidly and lead to maternal and fetal compromise.

Acute splenic sequestration in a pregnant woman with homozygous sickle-cell anemia

CONTEXT

Homozygous (SS) sickle-cell anemia complicated by acute splenic sequestration in adults is a rare event, and it has never been reported during pregnancy.

CASE REPORT

A 25-year-old woman with homozygous (SS) sickle-cell disease was hospitalized at 32 weeks' of gestation presenting weakness, abdominal pain, fever and hemoglobin of 2.4 g/dl. Abnormal fetal heart rate was detected by means of cardiotocography, and 5 units of packed red cells were transfused. Cesarean was performed at 37 weeks. Both mother and baby were discharged in a good general condition.

CONCLUSION

This case report demonstrates the importance of immediate blood transfusion for treatment of fetal distress in cases of splenic sequestration during pregnancy. This treatment is essential for avoiding maternal and fetal complications.