Priapism in a 6½-Year-Old Boy with Sickle Cell Disease

Myth: Blood transfusion is effective for sickle cell anemia—associated priapism

Objective:

Priapism is a recognized complication of sickle cell anemia (SCA). When initial conventional treatments fail, simple or exchange blood transfusion has been advocated as a secondary intervention. However, recent literature suggests this may not be an effective therapy and may have significant neurologic sequelae. This paper reviews and summarizes the effectiveness and risks of blood transfusion compared with conventional priapism therapy.

Methods:

All relevant papers identified from a MEDLINE search were systematically examined for data related to the use of blood transfusion in the setting of priapism due to SCA. The effectiveness of conventional therapy was compared with transfusion therapy using the outcome of “time to detumescence” (TTD). In addition, papers documenting adverse neurologic sequela were reviewed and summarized.

Results:

Forty-two case reports were identified containing complete information with regard to patient age and TTD. The mean TTD was 8.0 days with conventional therapy (n= 16) and 10.8 days with blood transfusion therapy (n= 26). Adverse neurologic sequelae from blood transfusion therapy was described in 9 cases, with long term outcomes ranging from complete resolution to severe residual deficits.

Conclusion:

The current literature does not support the contention that blood transfusion is an effective therapy in the treatment of priapism due to SCA, as defined by an acceleration of TTD. In fact, numerous reports suggest that serious neurologic sequelae may result from this treatment. We feel the routine use of this therapy cannot be recommended.

Impotence following childhood priapism

Priapism in childhood, although an uncommon event, generally is believed to be associated rarely with future impotence in adulthood. These beliefs may be a reflection of under-reporting or a lack of long-term followup. We present a case of a 23-year-old impotent man who had a history of priapism as an 8-year-old child. Even though a review of the literature reveals that impotence following childhood priapism is an infrequently reported phenomenon we believe its incidence to be significant and since it can occur aggressive treatment is essential.