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Misra A, Halas R, Kobayashi D, Walters HL, Bondarenko I, Thomas R, Vener DF, Aggarwal S, Safa R. Outcomes of Patients with Sickle Cell Disease and Trait Following Congenital Heart Disease Surgery. Ann Thorac Surg 2022; 115:1494-1502. [PMID: 35483424 DOI: 10.1016/j.athoracsur.2022.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 03/12/2022] [Accepted: 04/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sickle cell disease (SCD) is a hemoglobinopathy which can cause multi-organ dysfunction. The objective of our paper was to assess the perioperative outcomes of patients undergoing surgery for congenital heart disease who had either SCD or sickle cell trait (SCT). METHODS We performed a retrospective review of patients with SCD and SCT who had records in the Society of Thoracic Surgeons Congenital Heart Surgery Database between 2014 and 2019. The primary outcome was operative mortality; secondary outcomes included post-operative complications. One-to-one propensity score matching was performed between the SCD and SCT groups and the control group for further analysis. RESULTS Our study population consisted of 73, 411, and 36501 patients in the SCD, SCT, and control groups respectively. Median age at surgery in years (25-75% interquartile range) was 2.8(0.4, 9.7), 0.60(0.2, 3.1), and 0.70(0.2, 6.4) years in the SCD, SCT, and control cohort respectively. Operative mortality, surgery duration, cardiopulmonary bypass time, and cross clamp time were not significantly different among the three groups. The SCD group had a higher rate of post-surgical cardiac arrest than its propensity score matched control group (5.5% vs 0%, p<0.05); otherwise there were no statistically significant differences in the outcomes between the SCD and SCT groups and their respective matched control groups. CONCLUSIONS Operative mortality following cardiothoracic procedures in patients with SCD and SCT appeared similar to our control patients. While these patients may require unique peri-operative management, they can undergo cardiac surgery without an observed increase in mortality.
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Affiliation(s)
- Amrit Misra
- Department of Cardiology, Boston Children's Hospital, Boston, MA.
| | - Ryan Halas
- Division of Cardiology, Children's Hospital of Michigan, Department of Pediatrics, Central Michigan University College of Medicine, Detroit, MI
| | - Daisuke Kobayashi
- Division of Cardiology, Children's Hospital of Michigan, Department of Pediatrics, Central Michigan University College of Medicine, Detroit, MI
| | - Henry L Walters
- Department of Cardiovascular Surgery, Children's Hospital of Michigan, Department of Surgery, Wayne State University School of Medicine, MI
| | - Igor Bondarenko
- Department of Cardiovascular Surgery, Children's Hospital of Michigan, Department of Surgery, Wayne State University School of Medicine, MI
| | - Ronald Thomas
- Division of Cardiology, Children's Hospital of Michigan, Department of Pediatrics, Central Michigan University College of Medicine, Detroit, MI
| | - David F Vener
- Department of Anesthesiology, Baylor College of Medicine; Pediatric and Congenital Cardiac Anesthesia, Texas Children's Hospital, Texas
| | - Sanjeev Aggarwal
- Division of Cardiology, Children's Hospital of Michigan, Department of Pediatrics, Central Michigan University College of Medicine, Detroit, MI
| | - Raya Safa
- Division of Cardiology, Children's Hospital of Michigan, Department of Pediatrics, Central Michigan University College of Medicine, Detroit, MI; Division of Critical Care, Children's Hospital of Michigan, Central Michigan College of Medicine, Detroit, MI
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Edwin F, Aniteye E, Tettey M, Tamatey M, Entsua-Mensah K, Ofosu-Appiah E, Sereboe L, Gyan B, Adzamli I, Frimpong-Boateng K. Hypothermic cardiopulmonary bypass without exchange transfusion in sickle-cell patients: a matched-pair analysis. Interact Cardiovasc Thorac Surg 2014; 19:771-6. [DOI: 10.1093/icvts/ivu249] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lang JE, Hossain J, Blake K, Mercado A, Lima JJ. Sickle-Cell Trait and Atopic and Inflammatory Disease in Children. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2013; 26:11-17. [PMID: 35927845 DOI: 10.1089/ped.2012.0205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Roughly 9% of African-Americans carry 1 copy of the sickle β-globin allele [sickle-cell trait (SCT)]. The sickle allele may affect the host responses in a way that protects against sequelae of malaria. Besides the association with sporadic episodes of erythrocyte sickling, acute chest syndrome, and sudden death, the SCT is generally regarded as asymptomatic. Separately, and for unclear reasons, the African-Americans have an elevated risk compared to whites for several immune-mediated diseases, including asthma, eczema, and other respiratory conditions. We propose to determine whether the SCT contributes to the elevated risk of these inflammatory conditions. We performed a retrospective cohort study of children with and without the sickle trait to assess the risk for common immune-mediated conditions. The cohorts were individually matched, and multiple logistic regression was used with variables selected using a backward stepwise approach. A second approach (case-control design) assessed the odds of the SCT among African-Americans with and without asthma. We found 2,481 children with and 4,962 matched patients without the SCT in the cohort design. The sickle trait was associated with greater odds for several immune-mediated conditions in a multivariable analysis, but not associated with asthma (odds ratio, OR=1.10, P=0.212). In an adjusted case-control analysis (n=20,000), the sickle trait was weakly associated with asthma [adjusted odds ratio (aOR)=1.46, 1.01-2.13]. In both the designs and in all statistical models used, we found that the SCT was associated with bronchitis (aOR=1.71, 1.09-2.67) and eczema (aOR=1.74, 1.23-2.46). The SCT may contribute to an increased risk for eczema and asthma-like symptoms in the African-American children.
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Affiliation(s)
- Jason E Lang
- Division of Pulmonary and Sleep Medicine, Nemours Children's Hospital, Orlando, Florida
- Center for Pharmacogenomics & Translational Research, Nemours Children's Clinic, Jacksonville, Florida
| | - Jobayer Hossain
- Department of Food and Resource Economics, University of Delaware, Newark, Delaware
- Center for Pediatric Research, Alfred I. DuPont Hospital of Children, Wilmington, Delaware
| | - Kathryn Blake
- Center for Pharmacogenomics & Translational Research, Nemours Children's Clinic, Jacksonville, Florida
| | - Arnel Mercado
- Center for Pharmacogenomics & Translational Research, Nemours Children's Clinic, Jacksonville, Florida
| | - John J Lima
- Center for Pharmacogenomics & Translational Research, Nemours Children's Clinic, Jacksonville, Florida
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Murtuza B, Gupta P, Lall KS. The acute chest syndrome of sickle cell disease following aortic valve replacement. Interact Cardiovasc Thorac Surg 2009; 9:746-7. [PMID: 19596703 DOI: 10.1510/icvts.2009.207670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The acute chest syndrome (ACS) of sickle cell disease (SCD) is a leading cause of death in SCD, with a high incidence following surgery, though only one case has been reported following cardiac surgery. We present a case of ACS in an adult undergoing aortic valve replacement (AVR) despite instituting established peri-operative optimization measures to prevent sickling. Early diagnosis of this condition in our patient as a distinct clinical entity facilitated appropriate, specific therapy and a good subsequent postoperative recovery. Greater recognition of this syndrome in the growing number of adult sickle cell patients presenting for cardiac surgery may help improve their outcome.
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Affiliation(s)
- Bari Murtuza
- Department of Cardiothoracic Surgery, St Bartholomew's Hospital, London EC1A 7BE, UK.
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Kepron C, Somers GR, Pollanen MS. Sickle cell trait mimicking multiple inflicted injuries in a 5-year-old boy. J Forensic Sci 2009; 54:1141-5. [PMID: 19570047 DOI: 10.1111/j.1556-4029.2009.01098.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sickle cell disease (SCD) and sickle cell trait (SCT) can be associated with sudden unexpected death in the pediatric population, usually due to pulmonary complications occurring within the acute chest syndrome (ACS). Musculoskeletal complications can occur and are classically limited to bone infarcts. The occurrence of bone pathology centered upon the epiphyseal growth plate in SCD/SCT is extremely rare, and multiple such injuries in a single patient have not been previously reported. Herein, we describe a case of sudden unexpected death in a 5-year-old child with undiagnosed SCT due to the ACS, with widespread epiphyseal and periosteal bone lesions mimicking multiple inflicted injuries at autopsy. This case highlights the importance of clinicopathological correlation and is the first to describe SCT pathology as a mimic of nonaccidental injury.
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Affiliation(s)
- Charis Kepron
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
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Dourakis SP, Alexopoulou A, Papageorgiou C, Kaloterakis A, Hadziyannis SJ. Acute chest syndrome in sickle-cell trait; Two case reports in persons of Mediterranean origin and review of the literature. Eur J Intern Med 2004; 15:248-250. [PMID: 15288680 DOI: 10.1016/j.ejim.2004.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2003] [Revised: 02/19/2004] [Accepted: 03/18/2004] [Indexed: 11/28/2022]
Abstract
Sickle-cell trait has been characterized as a benign condition. However, life-threatening complications sometimes develop. Acute chest syndrome (ACS) is usually described in homozygous sickle cell disease, but it rarely develops in individuals with sickle-cell trait. Two cases of ACS in patients with sickle-cell trait are reported here. Factors such as advanced age at the time of presentation and absent past medical and family history can be misleading. Although ACS in sickle-cell trait has thus far only been reported in persons of Afro-American origin, persons of Mediterranean origin can, on rare occasions, also experience the syndrome.
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Affiliation(s)
- Spyros P. Dourakis
- Academic Department of Medicine, Hippokration General Hospital, Athens, Greece
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Scott-Conner CE, Brunson CD. The pathophysiology of the sickle hemoglobinopathies and implications for perioperative management. Am J Surg 1994; 168:268-74. [PMID: 8080066 DOI: 10.1016/s0002-9610(05)80200-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Patients with sickle hemoglobinopathies are at risk for unique postoperative complications and increased mortality. Understanding the pathophysiology of these disorders is important for safe perioperative management. Because there is no animal model for sickle cell disease, understanding has progressed through in vitro studies and clinical observations. This review describes the clinical manifestations of the sickle hemoglobinopathies with special emphasis on current knowledge of pathophysiology. It also discusses issues of preoperative screening, transfusion, and postoperative care.
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Affiliation(s)
- C E Scott-Conner
- Department of Surgery, University of Mississippi School of Medicine, Jackson
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Dorez D, Marrast AM, Lepape A, Mercatello A, Banssillon V, Moskovtchenko JF. [Acute respiratory insufficiency in sickle cell disease]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 1992; 11:209-13. [PMID: 1503296 DOI: 10.1016/s0750-7658(05)80015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Two cases are reported of acute respiratory failure occurring during sickling crises. In the first one, the crisis was characterised by priapism, and in the other one, by abdominal pain. The different causes of these respiratory effects are discussed: infection, fat embolism, pulmonary infarct, haemodynamic pulmonary oedema, as was probably the case in the first patient, or non haemodynamic pulmonary oedema due to sickling, as during conventional treatment of a sickling crisis (oxygen, antibiotics, blood transfusion, cytapheresis). Invasive investigations may contribute to keeping up the clinical picture, because of hypoxic sickling. The water equilibrium of these patients must be monitored with great care. Worsening of the patient's condition despite 48 h of correct treatment must lead to the search for a specific cause.
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Affiliation(s)
- D Dorez
- Service d'Anesthésie-Réanimation, Hôpital Edouard-Herriot, Lyon
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Hasleton PS, O'Driscoll BR, Lynch P, Webster A, Kalra SJ, Gattamaneini HR, Woodcock AA, Poulter LW. Late BCNU lung: a light and ultrastructural study on the delayed effect of BCNU on the lung parenchyma. J Pathol 1991; 164:31-6. [PMID: 2056387 DOI: 10.1002/path.1711640106] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We describe eight patients who developed interstitial pulmonary fibrosis following BCNU (carmustine) therapy for cerebral tumours. The fibrosis presented 12-17 (mean 14) years after exposure to the drug. A distinctive pattern of pulmonary fibrosis with involvement of the apices and subpleural areas was seen in one patient dying of the disease. Light microscopy showed interstitial elastosis and intra-alveolar fibrosis which was often focal with an associated mild lymphoplasmacytic infiltrate, intra-alveolar oedema, macrophages, and some neutrophils. Ultrastructural studies showed electron lucency of type I pneumocytes, with breaks in the cytoplasmic membranes leaving a bare basement membrane. Degenerative change was also seen in endothelial cell cytoplasm along with lipofuscin deposition. While BCNU pulmonary fibrosis has been described up to 2 years after treatment, this complication so late after therapy, though rare, has important implications for the follow-up of patients receiving this drug.
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Affiliation(s)
- P S Hasleton
- Department of Pathology, Wythenshawe Hospital, Manchester, U.K
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O'Driscoll BR, Hasleton PS, Taylor PM, Poulter LW, Gattameneni HR, Woodcock AA. Active lung fibrosis up to 17 years after chemotherapy with carmustine (BCNU) in childhood. N Engl J Med 1990; 323:378-82. [PMID: 2370889 DOI: 10.1056/nejm199008093230604] [Citation(s) in RCA: 172] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Carmustine (BCNU) is an anticancer drug known to produce pulmonary fibrosis as a side effect within three years of treatment. It is not known whether pulmonary fibrosis can appear later. METHODS To investigate the clinical range of this side effect, we studied the survivors among 31 children treated with carmustine for brain tumors between 1972 and 1976. Fourteen had died of their tumor; of the remaining 17, 6 had died of lung fibrosis--2 within 3 years of treatment and 4 from 8 to 13 years after treatment. This report focuses primarily on the 11 survivors, 8 of whom were available for detailed study 13 to 17 years (mean, 14) after treatment. RESULTS Of the eight survivors studied, six had abnormal chest radiographs showing predominantly upper-zone fibrotic changes. These patients also had abnormal CT scans, showing a previously undescribed pattern of upper-zone fibrosis. All the survivors studied had restrictive spirometric defects (mean [+/- SD] vital capacity, 54 +/- 19 percent of the predicted value). Bronchoalveolar-lavage fluid contained abnormal proportions of specific macrophage subgroups. Light and electron microscopy in six patients revealed interstitial fibrosis and elastosis with damage to epithelial and endothelial cells. Four patients had symptoms (shortness of breath, cough, or both). CONCLUSIONS Carmustine chemotherapy in childhood causes lung fibrosis that may remain asymptomatic for many years or become symptomatic at any time.
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Affiliation(s)
- B R O'Driscoll
- Northwest Regional Cardiothoracic Unit, Wythenshawe Hospital, Manchester, United Kingdom
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