Abdominal ultrasonographic abnormalities in patients with sickle cell anaemia at muhimbili national hospital

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