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Melvin RG, Liederman Z, Arya S, Rotin L, Lee CM. A Case of Fat Embolism Syndrome with Cerebral Involvement in Sickle Cell Anemia. Hemoglobin 2021; 45:269-273. [PMID: 34749584 DOI: 10.1080/03630269.2021.1990081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Fat embolism syndrome (FES) is a rare condition that can occur as a complication of sickle cell disease. We describe a case of a patient with sickle cell disease (homozygous Hb S or HBB: c.20A>T) presenting with initial signs and symptoms consistent with a vaso-occlusive crisis (VOC). Within 24 hours, the patient developed evidence of coagulopathy, multi organ failure and a reduced level of consciousness (LOC) prompting intubation. A diagnosis of FES was made on the basis of the patient's clinical presentation, in conjunction with magnetic resonance imaging (MRI) of the brain revealing innumerable tiny foci of restricted diffusion, intracytoplasmic microvesicular fat on Sudan Red staining of bronchoalveolar lavage samples and evidence of a pulmonary shunt on echocardiogram bubble study. Red blood cell (RBC) exchange transfusion was initiated 3 days following initial presentation and no further exchange transfusions were needed on the basis of subsequent Hb S (HBB: c.20A>T) levels. The LOC gradually improved and the patient was extubated 12 days following presentation. Neurological improvement was slow, with mild cognitive impairment initially evident at 3 months and no cognitive or neurological deficits remaining within 6 months of admission. This case highlights the importance of understanding the pathophysiology and clinical presentation of FES, as early exchange transfusion may improve survival in patients with sickle cell disease and FES.
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Affiliation(s)
- Rochelle G Melvin
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Zachary Liederman
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Medical Oncology and Hematology, University Health Network, University of Toronto, Toronto General Hospital, Toronto, ON, Canada
| | - Sumedha Arya
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Lianne Rotin
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Christie M Lee
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Interdepartmental Division of Critical Care Medicine, University of Toronto, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
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Bachmeyer C, Lionnet F, Stojanovic KS, Moguelet P, Aractingi S. Unusual cutaneous lesions indicating fat embolism syndrome in homozygous sickle cell disease. Am J Hematol 2014; 89:233. [PMID: 23733451 DOI: 10.1002/ajh.23493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 05/17/2013] [Accepted: 05/20/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Claude Bachmeyer
- Service de Médecine Interne - Centre de la Drépanocytose, Hôpital Tenon (AP-HP); Paris France
| | - François Lionnet
- Service de Médecine Interne - Centre de la Drépanocytose, Hôpital Tenon (AP-HP); Paris France
| | | | - Philippe Moguelet
- Service d'Anatomie Pathologique, Hôpital Tenon (AP-HP); Paris France
| | - Sélim Aractingi
- Service de Dermatologie, Hôpital Cochin (AP-HP); Paris France
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Bone marrow necrosis and fat embolism syndrome in sickle cell disease: Increased susceptibility of patients with non-SS genotypes and a possible association with human parvovirus B19 infection. Blood Rev 2014; 28:23-30. [DOI: 10.1016/j.blre.2013.12.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 12/30/2013] [Indexed: 11/19/2022]
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