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Rizvi I, Solipuram D, Kaur N, Komel A, Batool S, Wang J. The enigma of sickle cell hepatopathy: Pathophysiology, clinical manifestations and therapy. Br J Haematol 2024. [PMID: 38978231 DOI: 10.1111/bjh.19620] [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: 03/27/2024] [Accepted: 06/19/2024] [Indexed: 07/10/2024]
Abstract
Sickle cell disease (SCD) is one of the most common genetic disorders in the world predominantly affecting economically disadvantaged populations. There is a notable discrepancy between the growing adult SCD population and available diagnostic and therapeutic interventions for SCD. Sickle cell hepatopathy (SCH) is an all-inclusive term to describe the acute and chronic liver manifestations of SCD. The pathophysiology of SCH follows no defined pattern or sequence that poses challenges to clinicians and researchers alike. Evidence is lacking for this underreported disease at various levels from diagnostic to therapeutic options. This paper reviews the basic pathophysiology, clinical features, biochemical and radiological findings of various SCH manifestations and outlines the management of each condition. Old and new therapy options in SCD including hydroxyurea, red blood cell exchange transfusion, ursodeoxycholic acid, voxelotor, l-glutamine and crizanlizumab have been reviewed to investigate the role of these options in treating SCH. The role of liver transplant, haematopoietic stem cell transplant and gene therapy in SCH patients have been reviewed.
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Affiliation(s)
- Insia Rizvi
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Divya Solipuram
- Internal Medicine, Nassau University Medical Center, East Meadow, New York, USA
| | - Navneet Kaur
- Internal Medicine, North Alabama Medical Center, Florence, Alabama, USA
| | - Aqsa Komel
- Internal Medicine, Nishtar Medical College and Hospital, Multan, Punjab, Pakistan
| | - Saba Batool
- Internal Medicine, Carle Health Methodist Hospital, Peoria, Illinois, USA
| | - Jennifer Wang
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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2
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Dasiah YSP, Saeid M, Ahmed F. Intrahepatic Cholestasis in a Pregnant Patient With Sickle Cell Disease: A Case Report. Cureus 2024; 16:e60611. [PMID: 38894784 PMCID: PMC11185666 DOI: 10.7759/cureus.60611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2024] [Indexed: 06/21/2024] Open
Abstract
Sickle cell intrahepatic cholestasis (SCIC) is a potentially fatal complication of sickle cell disease (SCD) with a high mortality rate, observed mainly in patients with homozygous SCD. Intrahepatic cholestasis of pregnancy is a known complication in pregnancy and usually presents in the late second or third trimester with itching, elevated bile acids, and elevated liver enzymes. Intrahepatic cholestasis in a pregnant patient with homozygous SCD is a rare occurrence. We present the case of a patient who was diagnosed with homozygous SCD during her second pregnancy and developed cholestasis with abnormal levels of liver enzymes at 25 weeks gestation, requiring delivery at 30 weeks gestation due to very high bile acid and liver enzyme levels. The patient was successfully managed.
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Affiliation(s)
| | - Martina Saeid
- Internal Medicine, New Medical Center (NMC) Royal Women's Hospital, Abu Dhabi, ARE
| | - Fatmaelzahraa Ahmed
- Obstetrics and Gynaecology, New Medical Center (NMC) Royal Women's Hospital, Abu Dhabi, ARE
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3
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Edwards CL, Scott S, Boggan M, Meek J, Alston K, Pearson A, McDougald A, Broadnax M, Wood M, Barker CS, Miller J, Whitworth E, James O, Sollers Iii JJ, Bryson WJ, Thorpe R, Byrd G, Whitfield KE, Sudhakar S, Parker DO, Livingston J, Shah N, Railey K. Intrahepatic cholestasis in sickle cell disease: A review of diagnostic criteria, treatments, and case reports. J Natl Med Assoc 2023; 115:26-37. [PMID: 36599744 DOI: 10.1016/j.jnma.2022.12.004] [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: 06/12/2022] [Revised: 09/15/2022] [Accepted: 12/07/2022] [Indexed: 01/04/2023]
Abstract
Objective To delineate the etiology, symptomatology, and treatment of sickle cell intrahepatic cholestasis (SCIC). Sickle cell disease (SCD) is the most frequently inherited hematologic disease, and SCIC is one rare and often fatal complication and comorbid disease. The literature contains only a small number of case reports involving SCIC and hence limited guidance can be obtained. Methods We reviewed the scientific literature to evaluate the science of SCIC to determine if there were consistencies in presentation, evaluation, treatment, and clinical outcomes. Results We reviewed 6 case reports and a limited number of clinical papers on SCIC. We reported consistencies in clinical presentation and treatment outcomes among cases as well as serological and hematological finding. Conclusions While there is some consistency in the symptom presentation of individuals with SCIC, reliable evaluation and clinical procedures were not demonstrated in what we reviewed. Further research is needed to delineate the attributes of this complicated disease that occurs within SCD.
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Affiliation(s)
- Christopher L Edwards
- North Carolina Central University, 1801 Fayetteville St., Durham, NC 27707, United States; NCCU Debra O. Parker Research Incubator, United States.
| | - Sharena Scott
- North Carolina Central University, 1801 Fayetteville St., Durham, NC 27707, United States; NCCU Debra O. Parker Research Incubator, United States
| | - Michaela Boggan
- North Carolina Central University, 1801 Fayetteville St., Durham, NC 27707, United States; NCCU Debra O. Parker Research Incubator, United States
| | - Jordan Meek
- North Carolina Central University, 1801 Fayetteville St., Durham, NC 27707, United States; NCCU Debra O. Parker Research Incubator, United States
| | - Kiera Alston
- North Carolina Central University, 1801 Fayetteville St., Durham, NC 27707, United States; NCCU Debra O. Parker Research Incubator, United States
| | - Aiden Pearson
- North Carolina Central University, 1801 Fayetteville St., Durham, NC 27707, United States; NCCU Debra O. Parker Research Incubator, United States
| | | | | | - Mary Wood
- Duke University Medical Center, United States
| | | | | | | | - Osaffo James
- North Carolina Central University, 1801 Fayetteville St., Durham, NC 27707, United States
| | - John J Sollers Iii
- North Carolina Central University, 1801 Fayetteville St., Durham, NC 27707, United States; NCCU Debra O. Parker Research Incubator, United States
| | | | | | | | | | - Shiv Sudhakar
- Internal Medicine and Infectious Disease, College of Medicine, California Northstate University, 9700 W. Taron Dr. Elk Grove, CA 95757, United States
| | - Debra O Parker
- North Carolina Central University, 1801 Fayetteville St., Durham, NC 27707, United States; NCCU Debra O. Parker Research Incubator, United States
| | - Jonathan Livingston
- North Carolina Central University, 1801 Fayetteville St., Durham, NC 27707, United States; NCCU Debra O. Parker Research Incubator, United States
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4
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Trivedi K, Abbas A, Kazmi R, Shaaban H, Miller R. Hyperhemolytic Crisis Following Transfusion in Sickle Cell Disease With Acute Hepatic Crisis: A Case Report. Cureus 2022; 14:e27844. [PMID: 36110470 PMCID: PMC9461243 DOI: 10.7759/cureus.27844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 11/05/2022] Open
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5
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Khan A, Nashed B, Issa M, Khan MZ. Sickle Cell Intrahepatic Cholestasis: Extremely Rare but Fatal Complication of Sickle Cell Disease. Cureus 2022; 14:e22050. [PMID: 35295370 PMCID: PMC8916923 DOI: 10.7759/cureus.22050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 11/09/2022] Open
Abstract
Sickle cell intrahepatic cholestasis (SCIC) is a rare but potentially fatal complication of sickle cell disease (SCD), with high mortality, observed mainly in patients with homozygous sickle cell anemia. Herein, we have reported a case of severe SCIC with a poor outcome despite aggressive measures including exchange transfusion and use of vasopressors. The patient was admitted with generalized weakness, confusion, rigors, chills, and signs of hepatic failure, such as hyperbilirubinemia, hypoalbuminemia, and coagulopathy. There was no evidence of viral hepatitis or biliary obstruction. The patient received two exchange transfusions, but he continued to deteriorate clinically despite exchange transfusion and developed hemorrhagic shock and multiorgan failure. The patient was made comfort care as per family wishes. This case emphasizes the importance of early diagnosis of sickle cell intrahepatic cholestasis and poor prognosis despite aggressive measures.
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6
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Oliveira LRD, Costa ALC, Almeida PV, Zago LBR, Silva VAD, Soares-Silva S. Dengue fever as a potential cause of sickle cell intrahepatic cholestasis: A report of two cases. Rev Soc Bras Med Trop 2021; 54:e00102021. [PMID: 34259758 PMCID: PMC8282252 DOI: 10.1590/0037-8682-0010-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 06/15/2021] [Indexed: 11/29/2022] Open
Abstract
Sickle cell intrahepatic cholestasis is a potentially fatal syndrome characterized by jaundice, painful hepatomegaly, and organ dysfunction. Two cases of sickle cell intrahepatic cholestasis associated with dengue fever were described. Endothelial damage/dysfunction is a mechanism involved in severe hepatobiliary complications related to sickle cell diseases. However, the reasons for the lack of increase in the admission of patients with sickle cell disease having severe acute hepatobiliary complications triggered by endothelial damage/dysfunction due to dengue fever remain unknown. This study describes the first association between sickle cell intrahepatic cholestasis and dengue fever.
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Affiliation(s)
| | - Ana Laura Castro Costa
- Universidade Federal do Triângulo Mineiro, Serviço de Hematologia e Hemoterapia, Uberaba, MG, Brasil
| | - Paula Veloso Almeida
- Universidade Federal do Triângulo Mineiro, Serviço de Hematologia e Hemoterapia, Uberaba, MG, Brasil
| | | | - Vanessa Afonso da Silva
- Universidade Federal do Triângulo Mineiro, Serviço de Hematologia e Hemoterapia, Uberaba, MG, Brasil
| | - Sheila Soares-Silva
- Universidade Federal do Triângulo Mineiro, Serviço de Hematologia e Hemoterapia, Uberaba, MG, Brasil
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7
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Abstract
Sickle hepatopathy is an umbrella term describing various pattern of liver injury seen in patients with sickle cell disease. The disease is not uncommon in India; in terms of prevalence, India is second only to Sub-Saharan Africa where sickle cell disease is most prevalent. Hepatic involvement in sickle cell disease is not uncommon. Liver disease may result from viral hepatitis and iron overload due to multiple transfusions of blood products or due to disease activity causing varying changes in vasculature. The clinical spectrum of disease ranges from ischemic injury due to sickling of red blood cells in hepatic sinusoids, pigment gall stones, and acute/chronic sequestration syndromes. The sequestration syndromes are usually episodic and self-limiting requiring conservative management such as antibiotics and intravenous fluids or packed red cell transfusions. However, rarely these episodes may present with coagulopathy and encephalopathy like acute liver failure, which are life-threatening, requiring exchange transfusions or even liver transplantation. However, evidence for their benefits, optimal indications, and threshold to start exchange transfusion is limited. Similarly, there is paucity of the literature regarding the end point of exchange transfusion in this scenario. Liver transplantation may also be beneficial in end-stage liver disease. Hydroxyurea, the antitumor agent, which is popularly used to prevent life-threatening complications such as acute chest syndrome or stroke in these patients, has been used only sparingly in hepatic sequestrations. The purpose of this review is to provide insights into epidemiology of sickle cell disease in India and pathogenesis and classification of hepatobiliary involvement in sickle cell disease. Finally, various management options including exchange transfusion, liver transplantation, and hydroxyurea in hepatic sequestration syndromes will be discussed in brief.
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Key Words
- AASLD, American Association for the Study of Liver Diseases
- ACLF, Acute on chronic liver failure
- ALF, Acute liver failure
- ALT, Alanine transaminase
- AST, Aspartate transaminase
- FFP, Fresh frozen plasma
- GIT, Gastrointestinal tract
- HAV, Hepatitis A virus
- HBV, Hepatitis B virus
- HCV, Hepatitis C virus
- HEV, Hepatitis E virus
- HIC, Hepatic iron content
- HbS, Sickle hemoglobin
- HbSS, Sickle cell disease homozygous
- INR, International normalized ratio
- PT, Prothrombin time
- RUQ, Right upper quadrant
- SC, Scheduled caste
- SCD, Sickle cell disease
- SCIC, Sickle cell intrahepatic cholestasis
- ST, Scheduled tribe
- TJLB, Transjugular liver biopsy
- UDCA, Ursodeoxycholic acid
- cholelithiasis
- intrahepatic cholestasis
- sickle cell hepatopathy
- sickle cholangiopathy
- sickle hepatic crisis
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Affiliation(s)
| | - Anil C. Anand
- Address for correspondence. Anil C Anand, Professor and Head, Department of Gastroenterology & Hepatology, Kalinga Institute of Medical Sciences, Bhubneshwar, India.
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8
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Martí-Carvajal AJ, Martí-Amarista CE. Interventions for treating intrahepatic cholestasis in people with sickle cell disease. Cochrane Database Syst Rev 2020; 6:CD010985. [PMID: 32567054 PMCID: PMC7388850 DOI: 10.1002/14651858.cd010985.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Sickle cell disease is the most common hemoglobinopathy occurring worldwide and sickle cell intrahepatic cholestasis is a complication long recognized in this population. Cholestatic liver diseases are characterized by impaired formation or excretion (or both) of bile from the liver. There is a need to assess the clinical benefits and harms of the interventions used to treat intrahepatic cholestasis in people with sickle cell disease. This is an update of a previously published Cochrane Review. OBJECTIVES To assess the benefits and harms of the interventions for treating intrahepatic cholestasis in people with sickle cell disease. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched the LILACS database (1982 to 21 January 2020), the WHO International Clinical Trials Registry Platform Search Portal and ClinicalTrials.gov (21 January 2020). Date of last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register: 25 November 2019. SELECTION CRITERIA We searched for published or unpublished randomised controlled trials. DATA COLLECTION AND ANALYSIS Each author intended to independently extract data, assess the risk of bias of the trials by standard Cochrane methodologies and assess the quality of the evidence using the GRADE criteria; however, no trials were included in the review. MAIN RESULTS We did not identify any randomised controlled trials. AUTHORS' CONCLUSIONS This updated Cochrane Review did not identify any randomised controlled trials assessing interventions for treating intrahepatic cholestasis in people with sickle cell disease. Randomised controlled trials are needed to establish the optimum treatment for this condition.
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Affiliation(s)
- Arturo J Martí-Carvajal
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE (Cochrane Ecuador), Quito, Ecuador
- School of Medicine, Universidad Francisco de Vitoria (Cochrane Madrid), Madrid, Spain
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9
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Adkins BD, Savani BN, Booth GS. Management of Sickle Cell Intrahepatic Cholestasis: An Argument in Favor of Automated Exchange Transfusion. Clin Hematol Int 2019; 1:127-133. [PMID: 34595422 PMCID: PMC8432363 DOI: 10.2991/chi.d.190630.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/23/2019] [Indexed: 11/17/2022] Open
Abstract
Sickle cell disease patients are commonly treated at transfusion medicine services, and understanding of the hepatic manifestations of the disease is key for optimal management, specifically, in individuals presenting with sickle cell intrahepatic cholestasis (SCIC). SCIC represents a rare, severe hepatic crisis wherein sinusoidal red cell sickling leads to massive hepatocyte dysfunction and cholestatic laboratory findings. Acute SCIC is defined by abdominal pain with progressive hepatic injury associated with hyperbilirubinemia, renal failure, encephalopathy, and coagulopathy. Patients are generally managed with red blood cell exchange transfusion (RBCEx), when available, as this is a potentially fatal condition. Simple transfusion may be utilized in resource-poor environment or when patients refuse RBCEx. As less than 50 adult cases have been described in the literature, many of them with limited follow-up, randomized clinical trials comparing RBCEx with other treatments are currently unfeasible. Likewise, a chronic form exists, but is less well characterized, and is associated with persistent bilirubinemia and a variable course in terms of progressive hepatic disease. We undertake a brief review of the literature and discuss two cases of SCIC managed with RBCEx at our institution.
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Affiliation(s)
- Brian D Adkins
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bipin N Savani
- Department of Internal Medicine, Division of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Garrett S Booth
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
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10
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Abstract
Patients with sickle cell disease can develop liver disease as a result of intrahepatic sickling of erythrocytes, viral hepatitis and iron overload secondary to multiple blood transfusions, and gallstone disease as a result of chronic hemolysis. The spectrum of clinical liver disease is wide and often multifactorial. Some patients develop cirrhosis that may progress to end-stage liver failure. Limited evidence exists for medical treatments. Exchange blood transfusions may improve outcomes in the acute liver syndromes. Liver transplantation may be an option for chronic liver disease. The role for prophylactic cholecystectomy in preventing complications of gallstone disease is controversial.
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Affiliation(s)
- Eleni Theocharidou
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK
| | - Abid R Suddle
- Institute of Liver Studies, King's College Hospital NHS Foundation Trust, Denmark Hill, London SE5 9RS, UK.
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11
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Duncan CN, Talano JAM, McArthur JA. Care of the Critically Ill Pediatric Sickle Cell Patient. CRITICAL CARE OF THE PEDIATRIC IMMUNOCOMPROMISED HEMATOLOGY/ONCOLOGY PATIENT 2019. [PMCID: PMC7122989 DOI: 10.1007/978-3-030-01322-6_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sickle cell disease is the most common inherited disease in the United States. Through the effects of hemolysis and vaso-occlusion, it has the potential to incite critical illness involving multiple organ systems. Children with sickle cell disease are at risk of multiple types of shock resulting in a need for ICU care. Our youngest patients with sickle cell disease are at highest risk of infection due to lack of splenic function, and this can present with septic shock. Hypovolemic shock can occur secondary to severe acute anemia as seen with splenic sequestration or a delayed transfusion reaction. As one ages, the risk of cardiac dysfunction – diastolic and systolic dysfunction as well as pulmonary hypertension – can result in cardiogenic shock. In addition to shock, patients with sickle cell disease are at risk for respiratory failure from acute chest syndrome as well as acute neurologic deterioration from stroke. For these reasons, critical care physicians must be familiar with the unique management of sickle cell complications in order to provide the best possible care for this vulnerable population.
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Affiliation(s)
| | - Julie-An M. Talano
- Children’s Hospital of Wisconsin-Milwaukee, Medical College of Wisconsin, Milwaukee, WI USA
| | - Jennifer A. McArthur
- Department of Pediatric Medicine, St. Jude Children’s Research Hospital, Memphis, TN USA
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12
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Otrock ZK, Thibodeaux SR, Jackups R. Vascular access for red blood cell exchange. Transfusion 2018; 58 Suppl 1:569-579. [DOI: 10.1111/trf.14495] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Zaher K. Otrock
- Department of Pathology and Laboratory Medicine; Henry Ford Hospital; Detroit Michigan
| | - Suzanne R. Thibodeaux
- Department of Pathology and Immunology; Washington University School of Medicine; St. Louis Missouri
| | - Ronald Jackups
- Department of Pathology and Immunology; Washington University School of Medicine; St. Louis Missouri
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13
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Martí‐Carvajal AJ, Martí‐Amarista CE. Interventions for treating intrahepatic cholestasis in people with sickle cell disease. Cochrane Database Syst Rev 2017; 7:CD010985. [PMID: 28759700 PMCID: PMC6483462 DOI: 10.1002/14651858.cd010985.pub3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Sickle cell disease is the most common hemoglobinopathy occurring worldwide and sickle cell intrahepatic cholestasis is a complication long recognized in this population. Cholestatic liver diseases are characterized by impaired formation or excretion (or both) of bile from the liver. There is a need to assess the clinical benefits and harms of the interventions used to treat intrahepatic cholestasis in people with sickle cell disease. This is an update of a previously published Cochrane Review. OBJECTIVES To assess the benefits and harms of the interventions for treating intrahepatic cholestasis in people with sickle cell disease. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched the LILACS database (1982 to 23 May 2017), the WHO International Clinical Trials Registry Platform Search Portal (23 May 2017) and ClinicalTrials.gov.Date of last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register: 12 April 2017. SELECTION CRITERIA We searched for published or unpublished randomised controlled trials. DATA COLLECTION AND ANALYSIS Each author intended to independently extract data and assess the risk of bias of the trials by standard Cochrane methodologies; however, no trials were included in the review. MAIN RESULTS There were no randomised controlled trials identified. AUTHORS' CONCLUSIONS This updated Cochrane Review did not identify any randomised controlled trials assessing interventions for treating intrahepatic cholestasis in people with sickle cell disease. Randomised controlled trials are needed to establish the optimum treatment for this condition.
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14
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Guimarães JAD, Silva LCDS. Sickle cell intrahepatic cholestasis unresponsive to exchange blood transfusion: a case report. Rev Bras Hematol Hemoter 2017; 39:163-166. [PMID: 28577654 PMCID: PMC5457482 DOI: 10.1016/j.bjhh.2017.02.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 02/13/2017] [Accepted: 02/15/2017] [Indexed: 12/20/2022] Open
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15
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Martí-Carvajal AJ, Simancas-Racines D. Interventions for treating intrahepatic cholestasis in people with sickle cell disease. Cochrane Database Syst Rev 2015:CD010985. [PMID: 25769029 DOI: 10.1002/14651858.cd010985.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Sickle cell disease is the most common hemoglobinopathy occurring worldwide and sickle cell intrahepatic cholestasis is a complication long recognized in this population. Cholestatic liver diseases are characterized by impaired formation or excretion (or both) of bile from the liver. There is a need to assess the clinical benefits and harms of the interventions used to treat intrahepatic cholestasis in people with sickle cell disease. OBJECTIVES To assess the benefits and harms of the interventions for treating intrahepatic cholestasis in people with sickle cell disease. SEARCH METHODS We searched the Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register, which comprises references identified from comprehensive electronic database searches and handsearching of relevant journals and abstract books of conference proceedings. We also searched the LILACS database (1982 to 7 July 2014) and the WHO International Clinical Trials Registry Platform Search Portal (7 July 2014).Date of last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register: 10 October 2014. SELECTION CRITERIA We searched for published or unpublished randomised controlled trials. DATA COLLECTION AND ANALYSIS Each author intended to independently extract data and assess the risk of bias of the trials by standard Cochrane Collaboration methodologies; however, no trials were included in the review. MAIN RESULTS There were no randomised controlled trials identified. AUTHORS' CONCLUSIONS This Cochrane Review did not identify any randomised controlled trials assessing interventions for treating intrahepatic cholestasis in people with sickle cell disease. Randomised controlled trials are needed to establish the optimum treatment for this condition.
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16
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Hosiriluck N, Rassameehiran S, Argueta E, Tijani L. Reversal of liver function without exchange transfusion in sickle cell intrahepatic cholestasis. Proc (Bayl Univ Med Cent) 2014; 27:361-3. [PMID: 25484513 DOI: 10.1080/08998280.2014.11929160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Sickle cell intrahepatic cholestasis (SCIC) is a rare but fatal complication of sickle cell disease. It is found mainly in homozygous sickle cell disease. To date, there are no standard diagnostic criteria or well-established therapeutic approaches to this condition. Herein, we report this case of a 48-year-old man with sickle cell anemia and a total bilirubin of 78.5 mg/dL without evidence of extrahepatic biliary obstruction or viral hepatitis. The patient had a hemoglobin S level of 87.9%, acute renal failure, and mild coagulopathy. Despite the disease severity, he refused exchange transfusion (ET) with packed red blood cells. He was transfused with 2 units of blood and treated mainly with supportive measures. His total bilirubin levels trended down to normal days after discharge. Multiple studies have shown a significant decrease in the mortality rate in SCIC after ET. To date, only two reported adult cases have survived SCIC without aggressive treatment. Our case is the third case that demonstrates recovery of severe SCIC without ET.
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Affiliation(s)
- Nattamol Hosiriluck
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Supannee Rassameehiran
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Erwin Argueta
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Lukman Tijani
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
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17
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Abstract
Sickle cell disease (SCD) has evolved into a debilitating disorder with emerging end-organ damage. One of the organs affected is the liver, causing "sickle hepatopathy," an umbrella term for a variety of acute and chronic pathologies. Prevalence of liver dysfunction in SCD is unknown, with estimates of 10%. Dominant etiologies include gallstones, hepatic sequestration, viral hepatitis, and sickle cell intrahepatic cholestasis (SCIC). In addition, causes of liver disease outside SCD must be identified and managed. SCIC is an uncommon, severe subtype, with outcome of its acute form having vastly improved with exchange blood transfusion (EBT). In its chronic form, there is limited evidence for EBT programs as a therapeutic option. Liver transplantation may have a role in a subset of patients with minimal SCD-related other organ damage. In the transplantation setting, EBT is important to maintain a low hemoglobin S fraction peri- and posttransplantation. Liver dysfunction in SCD is likely to escalate as life span increases and patients incur incremental transfusional iron overload. Future work must concentrate on not only investigating the underlying pathogenesis, but also identifying in whom and when to intervene with the 2 treatment modalities available: EBT and liver transplantation.
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18
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Abstract
Systemic causes of cholestasis constitute a diverse group of diseases across organ systems. The pathophysiology of cholestasis in systemic disease can be a consequence of direct involvement of a disease process within the liver or extrahepatic biliary system or secondary to immune-mediated changes in bile flow. Evaluating a patient with cholestasis for a systemic cause requires an understanding of the patient's risk factors, clinical setting (eg, hospitalized or immunosuppressed patient), clinical features, and pattern of laboratory abnormalities.
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Affiliation(s)
- Andrew S. deLemos
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA 02114, USA,Harvard Medical School, Boston, MA 02115, USA
| | - Lawrence S. Friedman
- Gastrointestinal Unit, Massachusetts General Hospital, Boston, MA 02114, USA,Harvard Medical School, Boston, MA 02115, USA,Tufts University School of Medicine, Boston, MA 02111, USA,Department of Medicine, Newton-Wellesley Hospital, Newton, MA 02462, USA,Corresponding author. Department of Medicine, Newton-Wellesley Hospital, 2014 Washington Street, Newton, MA 02462.
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Ballas SK, Kesen MR, Goldberg MF, Lutty GA, Dampier C, Osunkwo I, Wang WC, Hoppe C, Hagar W, Darbari DS, Malik P. Beyond the definitions of the phenotypic complications of sickle cell disease: an update on management. ScientificWorldJournal 2012; 2012:949535. [PMID: 22924029 PMCID: PMC3415156 DOI: 10.1100/2012/949535] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 04/01/2012] [Indexed: 12/25/2022] Open
Abstract
The sickle hemoglobin is an abnormal hemoglobin due to point mutation (GAG → GTG) in exon 1 of the β globin gene resulting in the substitution of glutamic acid by valine at position 6 of the β globin polypeptide chain. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of sickle cell disease in general and sickle cell anemia in particular. The disease itself is chronic in nature but many of its complications are acute such as the recurrent acute painful crises (its hallmark), acute chest syndrome, and priapism. These complications vary considerably among patients, in the same patient with time, among countries and with age and sex. To date, there is no well-established consensus among providers on the management of the complications of sickle cell disease due in part to lack of evidence and in part to differences in the experience of providers. It is the aim of this paper to review available current approaches to manage the major complications of sickle cell disease. We hope that this will establish another preliminary forum among providers that may eventually lead the way to better outcomes.
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Affiliation(s)
- Samir K Ballas
- Cardeza Foundation and Department of Medicine, Thomas Jefferson University, 1015 Walnut Street, Philadelphia, PA 19107, USA.
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