Abstract:
Sickle cell disease, particularly in homogeneous state, has significant contribution to
the morbidity and mortality of this disorder during crisis. The various types of crises
cause changes in different organs of the body, some of which may have long term
complications to the sickle cell patient. Most of these changes occur in the abdominal
organs, that is the liver, kidneys, spleen, gall bladder as well as the pancreas. Early
detection of these changes which are mostly due to vaso-occlusion enables those
involved in the care of sicklers to take preventive measures which may help reduce
the degree of morbidity and mortality due to sickle cell anaemia. Ultrasound being
the most simple, cheap and easily accessible imaging investigation modality, may
play an important role in early detection of these changes so that appropriate
intervention measures can be carried out. Determination of the pattern and
prevalence of abnormal ultrasonographic findings in sickle cell patients in our set up
was an important step to enable us decide whether or not there is importance of early
ultrasonographic screening for all .sickle cell patients.
Objective
The aim of this study was to evaluate the types and prevalence of abdominal
ultrasonographic abnormalities in patients with sickle cell disease, attending sickle
cell clinics of MNH.
Materials and Methods
A total of 152 patients with sickle cell anaemia at Muhimbili National Hospital were
screened for intra-abdominal abnormalities in the liver, gall bladder, spleen and
kidneys from October 2009 to January 2010. Their ages ranged from 3 to 46 years.
32% were below the age of 10 years and 79% below 20 years. 41.4% were males and
58.6 % were females. All patients were homozygous for HbSS. None of the patients
had any clinical evidence of acute sickle cell crisis at the time of ultras ono graphic
examination. At the time of examination, 4 (2.6%) patients had undergone
splenectomy and 2 (1.3%) patients had undergone cholecystectomy.
VIII
Results
The most frequent US findings were hepatomegaly (28.3%), splenomegally(22.4%)
and cholelithiasis (17%). Bright liver was identified in 19(12.5%) patients, increased
renal echogenicity in 15(10%) patients, shrunken spleen in 14(9%) patients, and
renal enlargement in 6 (4%) patients. Biliary sludge was identified in 4(3%) patients,
autosplenectomy in 10(6.6%) patients and renal cysts in 5(3%) patients.
Conclusion
In conclusion, abdominal US imaging of patients with sickle cell anaemia revealed a
significant prevalence of abdominal abnormalities, in the liver, gall bladder, kidneys,
and spleen.
Recommendations
There is a need to conduct further similar studies in order to establish the average
prevalent rates for each of the abdominal pathologies in sickle cell patients
Also there is a need for correlation studies, to establish whether or not there is any
association between US findings and biochemistry changes in these patients
