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Pinto VM, De Franceschi L, Gianesin B, Gigante A, Graziadei G, Lombardini L, Palazzi G, Quota A, Russo R, Sainati L, Venturelli D, Forni GL, Origa R. Management of the Sickle Cell Trait: An Opinion by Expert Panel Members. J Clin Med 2023; 12:jcm12103441. [PMID: 37240547 DOI: 10.3390/jcm12103441] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/21/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023] Open
Abstract
The number of individuals with the sickle cell trait exceeds 300 million worldwide, making sickle cell disease one of the most common monogenetic diseases globally. Because of the high frequency of sickle cell disease, reproductive counseling is of crucial importance. In addition, unlike other carrier states, Sickle Cell Trait (SCT) seems to be a risk factor for several clinical complications, such as extreme exertional injury, chronic kidney disease, and complications during pregnancy and surgery. This expert panel believes that increasing knowledge about these clinical manifestations and their prevention and management can be a useful tool for all healthcare providers involved in this issue.
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Affiliation(s)
- Valeria Maria Pinto
- Centro della Microcitemia, Anemie Congenite e Dismetabolismo del Ferro, E.O. Ospedali Galliera, 16128 Genova, Italy
| | | | - Barbara Gianesin
- Centro della Microcitemia, Anemie Congenite e Dismetabolismo del Ferro, E.O. Ospedali Galliera, 16128 Genova, Italy
- ForAnemia Foundation, 16124 Genova, Italy
| | - Antonia Gigante
- ForAnemia Foundation, 16124 Genova, Italy
- Società Italiana Talassemie ed Emoglobinopatie (SITE), 09100 Cagliari, Italy
| | - Giovanna Graziadei
- Centro Malattie Rare Internistiche, Medicina Generale, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milano, Italy
| | - Letizia Lombardini
- Centro Nazionale Trapianti, Istituto Superiore di Sanità, 00161 Roma, Italy
| | - Giovanni Palazzi
- U.O. Oncoematologia Pediatrica, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy
| | | | - Rodolfo Russo
- Clinica Nefrologica, Dialisi e Trapianto, Dipartimento di Medicina Integrata con il Territorio, IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Laura Sainati
- Oncoematologia Pediatrica, Azienda Ospedaliera-Università di Padova, 35128 Padova, Italy
| | - Donatella Venturelli
- Servizio Immunotrasfusionale, Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy
| | - Gian Luca Forni
- Centro della Microcitemia, Anemie Congenite e Dismetabolismo del Ferro, E.O. Ospedali Galliera, 16128 Genova, Italy
| | - Raffaella Origa
- Talassemia, Ospedale Pediatrico Microcitemico 'A.Cao', ASL8, Università di Cagliari, 09121 Cagliari, Italy
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Lee BJH, Yap QV, Low JK, Chan YH, Shelat VG. Cholecystectomy for asymptomatic gallstones: Markov decision tree analysis. World J Clin Cases 2022; 10:10399-10412. [PMID: 36312509 PMCID: PMC9602237 DOI: 10.12998/wjcc.v10.i29.10399] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/13/2022] [Accepted: 09/01/2022] [Indexed: 02/05/2023] Open
Abstract
Gallstones are a common public health problem, especially in developed countries. There are an increasing number of patients who are diagnosed with gallstones due to increasing awareness and liberal use of imaging, with 22.6%-80% of gallstone patients being asymptomatic at the time of diagnosis. Despite being asymptomatic, this group of patients are still at life-long risk of developing symptoms and complications such as acute cholangitis and acute biliary pancreatitis. Hence, while early prophylactic cholecystectomy may have some benefits in selected groups of patients, the current standard practice is to recommend cholecystectomy only after symptoms or complications occur. After reviewing the current evidence about the natural course of asymptomatic gallstones, complications of cholecystectomy, quality of life outcomes, and economic outcomes, we recommend that the option of cholecystectomy should be discussed with all asymptomatic gallstone patients. Disclosure of material information is essential for patients to make an informed choice for prophylactic cholecystectomy. It is for the patient to decide on watchful waiting or prophylactic cholecystectomy, and not for the medical community to make a blanket policy of watchful waiting for asymptomatic gallstone patients. For patients with high-risk profiles, it is clinically justifiable to advocate cholecystectomy to minimize the likelihood of morbidity due to complications.
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Affiliation(s)
- Brian Juin Hsien Lee
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore S308232, Singapore
| | - Qai Ven Yap
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore S117597, Singapore
| | - Jee Keem Low
- Department of General Surgery, Tan Tock Seng Hospital, Singapore S308433, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore S117597, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore S308433, Singapore
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Muroni M, Loi V, Lionnet F, Girot R, Houry S. Prophylactic laparoscopic cholecystectomy in adult sickle cell disease patients with cholelithiasis: A prospective cohort study. Int J Surg 2015; 22:62-6. [PMID: 26278661 DOI: 10.1016/j.ijsu.2015.07.708] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Revised: 07/09/2015] [Accepted: 07/29/2015] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Prophylactic laparoscopic cholecystectomy remains controversial and has been discussed for selected subgroups of patients with asymptomatic cholelithiasis who are at high risk of developing complications such as chronic haemolytic conditions. Cholelithiasis is a frequent condition for patients with sickle cell disease (SCD). Complications from cholelithiasis may dramatically increase morbidity for these patients. Our objective was to evaluate the effectiveness of prophylactic cholecystectomy in SCD patients with asymptomatic gallbladder stones. METHODS From January 2000 to June 2014, we performed 103 laparoscopic cholecystectomies on SCD patients. Fifty-two patients had asymptomatic cholelithiasis. The asymptomatic patients were prospectively enrolled in this study, and all underwent a prophylactic cholecystectomy with an intraoperative cholangiography. The symptomatic patients were retrospectively studied. Upon admission, all patients were administered specific perioperative management including intravenous hydration, antibiotic prophylaxis, oxygenation, and intravenous painkillers, as well as the subcutaneous administration of low-molecular-weight heparin. During the same period, 51 patients with SCD underwent a cholecystectomy for symptomatic cholelithiasis. We compared these 2 groups in terms of postoperative mortality, morbidity, and hospital stay. RESULTS There were no postoperative deaths or injuries to the bile ducts in either group. In the asymptomatic group, we observed 6 postoperative complications (11.5%), and in the symptomatic group, there were 13 (25.5%) postoperative complications. DISCUSSION Regarding the SCD complications, we observed 1 case (2%) of acute chest syndrome in an asymptomatic cholelithiasis patient, while there were 3 cases (6%) in the symptomatic group. Vaso-occlusive crisis was observed in 1 patient (2%) with asymptomatic cholelithiasis, and in 4 patients (8%) in the other group. The mean hospital stay averaged 5.8 (4-17) days for prophylactic cholecystectomy and 7.96 (4-18) days for the comparative symptomatic group. CONCLUSIONS Postoperative complications related to SCD were less frequent for asymptomatic patients who had a laparoscopic prophylactic cholecystectomy. This intervention, if performed with perioperative specific management, is safe and helps avoid emergency operations for acute complications including cholecystitis, choledocholithiasis, and cholangitis. For SCD patients, a prophylactic cholecystectomy reduces hospital stays.
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Affiliation(s)
- Mirko Muroni
- Hôpital Tenon, Department of Surgery, 4 rue de la Chine, 75020, Paris, France.
| | - Valeria Loi
- Hôpital Tenon, Department of Surgery, 4 rue de la Chine, 75020, Paris, France.
| | - François Lionnet
- Hôpital Tenon, Department of Hematology, 4 rue de la Chine, 75020, Paris, France.
| | - Robert Girot
- Hôpital Tenon, Department of Hematology, 4 rue de la Chine, 75020, Paris, France.
| | - Sidney Houry
- Hôpital Tenon, Department of Surgery, 4 rue de la Chine, 75020, Paris, France.
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Papafragkakis H, Ona MA, Changela K, Sadanandan S, Jelin A, Anand S, Duddempudi S. Acute liver function decompensation in a patient with sickle cell disease managed with exchange transfusion and endoscopic retrograde cholangiography. Therap Adv Gastroenterol 2014; 7:217-23. [PMID: 25177368 PMCID: PMC4107698 DOI: 10.1177/1756283x14530781] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Sickle cell intrahepatic cholestasis is a relatively uncommon complication of homozygous sickle cell anemia, which may lead to acute hepatic failure and death. Treatment is mainly supportive, but exchange transfusion is used as salvage therapy in life threatening situations. We describe a case of a 16-year-old female with homozygous sickle cell anemia who presented to the emergency room with fatigue, malaise, dark urine, lower back pain, scleral icterus and jaundice. She was found to have marked hyperbilirubinemia, which persisted after exchange transfusion. Because of the concomitant presence of gallstones and choledocholithiasis, the patient underwent endoscopic ultrasound and laparoscopic cholecystectomy followed by endoscopic retrograde cholangiography and sphincterotomy.
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Affiliation(s)
- Haris Papafragkakis
- Department of Gastroenterology, The Brooklyn Hospital Center, 121 DeKalb Ave, Brooklyn, NY 11201, USA
| | - Mel A. Ona
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Kinesh Changela
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Swayamprabha Sadanandan
- Department of Pediatric Hematology/Oncology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Abraham Jelin
- Department of Pediatric Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sury Anand
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Sushil Duddempudi
- Department of Gastroenterology, The Brooklyn Hospital Center, Brooklyn, NY, USA
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Outcome and challenges of kidney transplant in patients with sickle cell disease. J Transplant 2013; 2013:614610. [PMID: 23691273 PMCID: PMC3649443 DOI: 10.1155/2013/614610] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 02/28/2013] [Accepted: 03/12/2013] [Indexed: 01/11/2023] Open
Abstract
Sickle cell nephropathy is a common presentation in patients with sickle cell disease. End-stage kidney disease is the most severe presentation of sickle cell nephropathy in terms of morbidity and mortality. Sickle cell disease patients with end-stage kidney disease are amenable to renal replacement therapy including kidney transplant. Kidney transplant in these patients has been associated with variable outcome with recent studies reporting short- and long-term outcomes comparable to that of patients with HbAA. Sickle cell disease patients are predisposed to various haematological, cardiorespiratory, and immunological challenges. These challenges have the potential to limit, delay, or prevent kidney transplant in patients with sickle cell disease. There are few reports on the outcome and challenges of kidney transplant in this group of patients. The aim of this review is to highlight the outcome and challenges of kidney transplant in patients with sickle cell disease.
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Bharati S, Das S, Majee P, Mandal S. Anesthetic management of a patient with sickle β thalassemia. Saudi J Anaesth 2011; 5:98-100. [PMID: 21655030 PMCID: PMC3101768 DOI: 10.4103/1658-354x.76496] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Sickle cell disease is a congenital condition and its most common clinical manifestation is anemia due to chronic hemolysis. Persistent and accelerated hemolysis associated with multiple transfusions is a recognized risk factor for the development of cholelithiasis. The occurrence of gallstones is one of the most important manifestations of sickle cell disease in the digestive tract. Most gallstones are pigmented and characteristically occur at younger ages and the prevalence of cholelithiasis increases progressively with age, affecting 50% of young adults. Cholecystectomy is the most common surgical procedure performed in sickle cell disease patients. Anesthesia in this population of patients for major surgeries deserves special attention due to various complications particularly silent infarctions of end organs are common. We are reporting a 14-year-old girl diagnosed with sickle cell anemia and β+ thalassemia with cholelithiasis went for cholecystectomy under general anesthesia. Although the patient has both β+ thalassemia and sickle cell disease component, the latter is of more concern for anesthesia.
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Affiliation(s)
- Saswata Bharati
- Department of Anesthesiology, Midnapore Medical College, West Bengal, India
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Abstract
Cholelithiasis is rarely seen in toddlers and school-aged children, even in the setting of sickle cell anemia. In addition to more common etiologies, such as gastroenteritis, constipation, and urinary tract infection, the differential diagnoses of acute abdominal pain in young children with sickle cell disease include vaso-occlusive pain crisis and splenic sequestration. We describe a case of a toddler with sickle cell disease initially presenting with abdominal pain who was found to have symptomatic cholelithiasis.
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Gastrointestinal and hepatic complications of sickle cell disease. Clin Gastroenterol Hepatol 2010; 8:483-9; quiz e70. [PMID: 20215064 DOI: 10.1016/j.cgh.2010.02.016] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 02/12/2010] [Accepted: 02/21/2010] [Indexed: 02/07/2023]
Abstract
Sickle cell disease (SCD) is an autosomal recessive abnormality of the beta-globin chain of hemoglobin (Hb), resulting in poorly deformable sickled cells that cause microvascular occlusion and hemolytic anemia. The spleen is almost always affected by SCD, with microinfarcts within the first 36 months of life resulting in splenic atrophy. Acute liver disorders causing right-sided abdominal pain include acute vaso-occlusive crisis, liver infarction, and acute hepatic crisis. Chronic liver disease might be due to hemosiderosis and hepatitis and possibly to SCD itself if small, clinically silent microvascular occlusions occur chronically. Black pigment gallstones caused by elevated bilirubin excretion are common. Their small size permits them to travel into the common bile duct but cause only low-grade obstruction, so hyperbilirubinemia rather than bile duct dilatation is typical. Whether cholecystectomy should be done in asymptomatic individuals is controversial. The most common laboratory abnormality is an elevation of unconjugated bilirubin level. Bilirubin and lactate dehydrogenase levels correlate with one another, suggesting that chronic hemolysis and ineffective erythropoiesis, rather than liver disease, are the sources of hyperbilirubinemia. Abdominal pain is very common in SCD and is usually due to sickling, which resolves with supportive care. Computed tomography scans might be ordered for severe or unremitting pain. The liver typically shows sickled erythrocytes and Kupffer cell enlargement acutely and hemosiderosis chronically. The safety of liver biopsies has been questioned, particularly during acute sickling crisis. Treatments include blood transfusions, exchange transfusions, iron-chelating agents, hydroxyurea, and allogeneic stem-cell transplantation.
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Irizarry K, Rossbach HC, Ignacio JRA, Winesett MP, Kaiser GC, Kumar M, Gilbert-Barness E, Wilsey MJ. Sickle cell intrahepatic cholestasis with cholelithiasis. Pediatr Hematol Oncol 2006; 23:95-102. [PMID: 16651237 DOI: 10.1080/08880010500456964] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sickle cell intrahepatic cholestasis (SCIC) is a rare complication seen in sickle cell patients who present with sudden onset of RUQ pain, progressive hepatomegaly, mild elevation of transaminases, coagulopathy, and extreme hyperbilirubinemia. Early recognition of this entity is essential to avoid life-threatening complications. Diagnosis can be challenging given the overlap in clinical presentation with other conditions affecting the hepatobiliary biliary system in sickle cell anemia such as hepatitis, cholecystitis, and hepatic crisis. Treatment is currently limited to exchange transfusion. The authors present two patients with SCIC and cholelithiasis; the clinical picture of one is complicated by choledocholithiasis.
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Affiliation(s)
- Karina Irizarry
- Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida, USA.
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11
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Qureshi A, Lang N, Bevan DH. Sickle cell 'girdle syndrome' progressing to ischaemic colitis and colonic perforation. ACTA ACUST UNITED AC 2006; 28:60-2. [PMID: 16430462 DOI: 10.1111/j.1365-2257.2006.00739.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Abdominal pain of presumed vasocclusive origin, often termed 'girdle syndrome' because of the circumferential distribution of the pain, is common in sickle cell anaemia (SCA). Evidence of progression to bowel infarction is rare. A 27-year-old man with SCA developed chest and abdominal pain unresponsive to opiate analgesia. Abdominal X-ray showed dilated bowel loops because of partial obstruction. Despite reduction of HbS to 23% by automated red cell exchange, abdominal pain worsened. A CT scan was the most informative investigation and showed free peritoneal air. He underwent emergency hemicolectomy and reversible ileostomy formation. Histology of the resected colon was consistent with acute ischaemic colitis. Early surgical intervention remains essential in SCA when abdominal pain does not respond to maximal therapy including red cell exchange: as this case illustrates, sickle girdle syndrome has the capacity to progress to irreversible ischaemic colitis and necrotic perforation of the bowel wall.
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Affiliation(s)
- A Qureshi
- St George's Hospital - Haematology, Tooting, SW17 0QT, UK.
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Fall B, Sagna A, Diop PS, Faye EAB, Diagne I, Dia A. [Laparoscopic cholecystectomy in sickle cell disease]. ACTA ACUST UNITED AC 2004; 128:702-5. [PMID: 14706881 DOI: 10.1016/j.anchir.2003.10.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
STUDY AIM Sickle cell affection is a public health problem in Africa. The aims of this prospective study were to evaluate the early results of laparoscopic cholecystectomy in sickle cell patients in Senegal. METHOD From January 1998 to June 2002 all the sickle cell patients undergoing a laparoscopic cholecystectomy were included. Intra- and post-operative protocol (blood transfusion if Hb < 9 g/dl, rehydration, oxygenotherapy) was standardized. RESULTS Forty-two patients with sickle cell of types SS-33 and AS9 were operated upon by same surgeon. One case of conversion due to an effraction of biliary junction was reported. One homozygote patient died post-operatively because of peritonitis. Two acute thoracic syndromes, three vaso-occlusive crisis, and two cases of wound infection constituted the post-operative morbidity. No case of complication was noted in those who underwent pre-operative transfusion. CONCLUSION Laparoscopic cholecystectomy can be carried out in sickle cell patients with biliary lithiasis provided that general anaesthetic rules are respected.
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Affiliation(s)
- B Fall
- Clinique chirurgicale, CHU Aristide-Le-Dantec, BP 344 Dakar-Liberté, Dakar, Sénégal
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Abstract
Sickle cell disease (SCD) is a relatively common inherited disorder of haemoglobin with significant morbidity and mortality. This review describes the epidemiology and pathophysiology of the disease, and discusses the clinical manifestations found in children with SCD. A discussion of the evidence concerning the perioperative management of such children is presented.
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Bonatsos G, Birbas K, Toutouzas K, Durakis N. Laparoscopic cholecystectomy in adults with sickle cell disease. Surg Endosc 2001; 15:816-9. [PMID: 11443426 DOI: 10.1007/s004640000383] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2000] [Accepted: 02/11/2000] [Indexed: 02/07/2023]
Abstract
BACKGROUND Chronic hemolysis predisposes adults with sickle cell disease (SCD) to the formation of bilirubinate cholelithiasis. METHODS To study the impact of laparoscopic cholecystectomy (LC) on this groups, we reviewed our records of all patients with SCD and cholelithiasis treated electively from 1991 to 1999. During that period, 13 consecutive patients with SCD underwent elective LC for symptomatic cholelithiasis. Nine patients (69.2%) were managed with a preoperative transfusion regimen to achieve a hemoglobin value of >/=10 g/dl, independent of hemoglobin S percentage. Five patients who presented with jaundice were referred for preoperative endoscopic retrograde cholangiopancreatography (ERCP), which identified choledocholithiasis in two of them. Three other patients underwent intraoperative cholangiography, which revealed common bile duct stones in one patient. RESULTS One patient developed pyrexia for 2 days. There were no vaso-occlusive crises or deaths. The mean hospital stay was 3.3 days. CONCLUSIONS LC has proven to be a safe and efficacious method for the treatment of symptomatic cholelithiasis in this high-risk population. Hematologists are now more willing to refer early, well-prepared patients with SCD and uncomplicated gallbladder disease for elective LC.
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Affiliation(s)
- G Bonatsos
- First Department of Propaedeutic Surgery, Athens University, Hippokration Hospital, 114 Vas. Sofias Avenue, Athens, Greece
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Affiliation(s)
- A D Adekile
- Department of Pediatrics, Faculty of Medicine, Kuwait University.
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16
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Abstract
The prevalence, incidence, risk factors, clinical associations, and morbidity of gallstones were studied in 311 patients with homozygous sickle cell disease and 167 patients with sickle cell-hemoglobin C disease in a cohort study from birth. Gallstones developed in 96 patients with homozygous sickle cell disease and 18 patients with sickle cell-hemoglobin C disease; specific symptoms necessitating cholecystectomy occurred in only 7 patients with homozygous sickle cell disease.
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Affiliation(s)
- T M Walker
- Medical Research Council Laboratories (Jamaica), University of the West Indies, Kingston, Jamaica
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Neumayr L, Koshy M, Haberkern C, Earles AN, Bellevue R, Hassell K, Miller S, Black D, Vichinsky E. Surgery in patients with hemoglobin SC disease. Preoperative Transfusion in Sickle Cell Disease Study Group. Am J Hematol 1998; 57:101-8. [PMID: 9462540 DOI: 10.1002/(sici)1096-8652(199802)57:2<101::aid-ajh2>3.0.co;2-#] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
While surgery is commonly required for complications related to hemoglobin SC (HbSC) disease, little is known about the perioperative complications or the indications for preoperative transfusion in this group. We describe the patient characteristics, preoperative transfusion regimens, and outcome in 92 patients with HbSC and sickle-variants undergoing elective surgery. Thirty-eight percent of the patients were transfused preoperatively. Patients transfused were more likely to have been hospitalized in the year prior to the surgery and scheduled for abdominal procedures. Abdominal and ear, nose and throat procedures were the most common surgeries in our study. The overall complication rate was 18% and sickle cell-related complications occurred in 9% of patients. In patients undergoing intra-abdominal procedures, the incidence of sickle cell-related complications was significantly higher in those patients not transfused prior to their surgery (35 vs. 0%). There were two deaths. We recommend selective use of preoperative transfusion in patients with HbSC disease undergoing surgery. Transfusion appears to be beneficial in abdominal cases but is not necessary with minor procedures such as myringtomy.
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Affiliation(s)
- L Neumayr
- Department of Hematology/Oncology, Children's Hospital Oakland, California 94609, USA
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Vichinsky EP, Haberkern CM, Neumayr L, Earles AN, Black D, Koshy M, Pegelow C, Abboud M, Ohene-Frempong K, Iyer RV. A comparison of conservative and aggressive transfusion regimens in the perioperative management of sickle cell disease. The Preoperative Transfusion in Sickle Cell Disease Study Group. N Engl J Med 1995; 333:206-13. [PMID: 7791837 DOI: 10.1056/nejm199507273330402] [Citation(s) in RCA: 389] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Preoperative transfusions are frequently given to prevent perioperative morbidity in patients with sickle cell anemia. There is no consensus, however, on the best regimen of transfusions for this purpose. METHODS We conducted a multicenter study to compare the rates of perioperative complications among patients randomly assigned to receive either an aggressive transfusion regimen designed to decrease the hemoglobin S level to less than 30 percent (group 1) or a conservative regimen designed to increase the hemoglobin level to 10 g per deciliter (group 2). RESULTS Patients undergoing a total of 604 operations were randomly assigned to group 1 or group 2. The severity of the disease, compliance with the protocol, and the types of operations were similar in the two groups. The preoperative hemoglobin level was 11 g per deciliter in group 1 and 10.6 g per deciliter in group 2. The preoperative value for hemoglobin S was 31 percent in group 1 and 59 percent in group 2. The most frequent operations were cholecystectomies (232), head and neck surgery (156), and orthopedic surgery (72). With the exception of transfusion-related complications, which occurred in 14 percent of the operations in group 1 and in 7 percent of those in group 2, the frequency of serious complications was similar in the two groups (31 percent in group 1 and 35 percent in group 2). The acute chest syndrome developed in 10 percent of both groups and resulted in two deaths in group 1. A history of pulmonary disease and a higher risk associated with surgery were significant predictors of the acute chest syndrome. CONCLUSIONS A conservative transfusion regimen was as effective as an aggressive regimen in preventing perioperative complications in patients with sickle cell anemia, and the conservative approach resulted in only half as many transfusion-associated complications.
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Affiliation(s)
- E P Vichinsky
- Department of Hematology/Oncology, Children's Hospital Oakland, CA 94609, USA
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Bhattacharyya N, Wayne AS, Kevy SV, Shamberger RC. Perioperative management for cholecystectomy in sickle cell disease. J Pediatr Surg 1993; 28:72-5. [PMID: 8429477 DOI: 10.1016/s0022-3468(05)80359-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Perioperative complications of surgical procedures are frequently encountered in patients with sickle cell disease. We have reviewed our series of patients with hemoglobinopathies who underwent cholecystectomy from 1978 to 1991 to evaluate their perioperative management and clinical outcome. Twenty-two children with major sickle hemoglobinopathy underwent cholecystectomy for symptomatic cholelithiasis. All 22 were transfused to achieve a hemoglobin (Hgb) level greater than 9 g/dL and hemoglobin S (HbS) less than 37%. Fourteen underwent immediate preoperative automated red cell exchange (ARCE). The median preexchange Hgb of these patients was 8.1 g/dL (range, 6.8 to 10.5). Their median HbS was 84% (range, 53% to 97%). These patients underwent placement of an apheresis catheter under local anesthesia followed by red cell exchange. The median volume of packed red blood cells (PRBC) exchanged was 28.1 mL/kg (range, 13.8 to 58.7). The median HbS after exchange was 21% (range, 16% to 37%) and the median Hgb was 10.6 g/dL (range, 6.5 to 16.7). Eight other patients underwent sequential transfusion (3 after an exchange for an acute pulmonary vasoocclusive crisis). These patients had been prepared over an interval of 2 to 8 weeks preoperatively and had received a median of 26.9 mL PRBC/kg (range, 12.8 to 95). Following sequential transfusion the median Hgb was 11.8 g/dL (range, 9 to 15.7) and the median HbS was 19% (range, 5% to 32%) at the time of surgery. All patients received extended antigen matched blood. Complications of preoperative transfusion were minor and included two febrile-/allergic reactions and one mild superficial catheter-induced phlebitis.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- N Bhattacharyya
- Department of Surgery, Children's Hospital, Boston, MA 02115
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Ware RE, Kinney TR, Casey JR, Pappas TN, Meyers WC. Laparoscopic cholecystectomy in young patients with sickle hemoglobinopathies. J Pediatr 1992; 120:58-61. [PMID: 1530971 DOI: 10.1016/s0022-3476(05)80598-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Nine young patients with sickle hemoglobinopathies successfully underwent laparoscopic cholecystectomy; no complications resulted from the procedure. The mean postoperative hospital stay was 1.6 days. This technique appears to be a safe and efficacious procedure in children with sickle hemoglobinopathies who require cholecystectomy for cholelithiasis.
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Affiliation(s)
- R E Ware
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710
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Pappis CH, Galanakis S, Moussatos G, Keramidas D, Kattamis C. Experience of splenectomy and cholecystectomy in children with chronic haemolytic anaemia. J Pediatr Surg 1989; 24:543-6. [PMID: 2738820 DOI: 10.1016/s0022-3468(89)80502-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Since 1973, 419 children (233 boys, 186 girls) with chronic haemolytic anaemia (mean age, 10.2 +/- 3.5 years) have been splenectomised. Fifty-three (12.6%) have also been cholecystectomised because of cholelithiasis. Between 1973 and 1982, cholecystectomy and splenectomy were performed at the same time in symptomatic patients. Later, between 1983 and 1987, cholecystectomy was also performed in clinically asymptomatic patients with positive sonographic findings. In the first period, 11 thalassaemic patients (45.8%) were cholecystectomised a short period after splenectomy (in two cases, only 2 and 3 weeks later). Between 1983 and 1987, when asymptomatic patients with cholelithiasis were screened by sonography, simultaneous cholecystectomy and splenectomy were performed in 13.6% of the patients with thalassaemia, in 41% of the patients with sickle cell or microdrepanocytic disease, and in 22.2% of the patients with spherocytosis. As there is a high incidence of asymptomatic cholelithiasis and hypersplenism in patients with chronic haemolytic anaemia, screening for gallstones should precede splenectomy. Simultaneous cholecystectomy should be performed in patients with cholelithiasis.
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Affiliation(s)
- C H Pappis
- First Paediatric Surgery Department, Aghia Sophia Children's Hospital, Athens, Greece
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Ware R, Filston HC, Schultz WH, Kinney TR. Elective cholecystectomy in children with sickle hemoglobinopathies. Successful outcome using a preoperative transfusion regimen. Ann Surg 1988; 208:17-22. [PMID: 3389943 PMCID: PMC1493571 DOI: 10.1097/00000658-198807000-00003] [Citation(s) in RCA: 72] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Twenty-seven children with major sickle hemoglobinopathies underwent elective cholecystectomy for cholelithiasis. All were managed with a preoperative transfusion regimen to achieve a hemoglobin concentration of 11-14 g/dl with greater than 65% hemoglobin A. Intraoperative cholangiography revealed common bile duct stones in five patients, although only one case was diagnosed by preoperative ultrasonographic examination. Twenty-four children underwent incidental appendectomy by total intussusception. There were no vaso-occlusive events nor any other perioperative morbidity or mortality. Four months after cholecystectomy, one boy had a small bowel obstruction requiring surgical re-exploration. No patients had transfusion-acquired infection, although one boy had erythrocyte allosensitization to Lewis A antigen. This preoperative transfusion regimen and careful perioperative management permits safe elective cholecystectomy in children with sickle cell disease.
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Affiliation(s)
- R Ware
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina 27710
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Taylor EL, Harrington TM. Cholecystitis and Cholelithiasis. Prim Care 1988. [DOI: 10.1016/s0095-4543(21)01064-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Bond LR, Hatty SR, Horn ME, Dick M, Meire HB, Bellingham AJ. Gall stones in sickle cell disease in the United Kingdom. BRITISH MEDICAL JOURNAL 1987; 295:234-6. [PMID: 3115390 PMCID: PMC1247079 DOI: 10.1136/bmj.295.6592.234] [Citation(s) in RCA: 69] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The prevalence of gall stones was studied prospectively by abdominal ultrasound examination in 131 patients with sickle cell disease aged 10-65 years. Of 95 patients with homozygous sickle cell disease, 55 (58%) had gall stones or had had a cholecystectomy. Gall stones were present in four out of 24 (17%) patients with haemoglobin S + C disease and two out of 12 (17%) with haemoglobin S beta thalassaemia. The presence of gall stones was not related to sex, geographical origin, or haematological variables and was not associated with abnormal results of liver function tests. Symptoms typical of biliary colic were reported by 32 out of 47 adult patients with gall stones, and cholecystitis or cholestasis was diagnosed in 18. Cholecystectomy was performed in 29 patients with good relief of symptoms in most cases. Postoperative complications were common, occurring in 10 of the 28 patients who could be evaluated, but not generally serious; they were considerably lessened by a preoperative exchange transfusion that reduced the haemoglobin S concentration to below 40%. It is suggested that all patients with sickle cell disease should be screened for gall stones and that elective cholecystectomy should be performed in those with symptoms or complications.
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