Acute Chest Syndrome, Asthma, and Lung Function in Sickle Cell Disease. Which Is the Chicken, and Which Is the Egg?

Abstract Introduction: Chronic lung disease is a fatal complication in sickle cell disease (SCD) often undiagnosed until late stages. Early detection and treatment of risk factors may improve survival. Since asthma, pulmonary hypertension (PHT), and acute chest syndrome (ACS) are potential risk factors, in 1998, we began screening patients with history of ACS or wheezing with pulmonary function tests (PFT) and echocardiogram (echo). Methods: A chart review was completed on the 362 adults and children evaluating history of asthma, lung function (PFT) and PHT (echo, tricuspid regurgitant jet velocity ≥ 2.5). Results: PFT Findings All Ages Adults Children PHT (All Ages) Study performed 34% (124/362) 41% (95/232) 22% (29/130) Echo: 90% (111/124) Abnormal 85% (106/124) 87% (83/95) 79% (23/29) 51% (54/106) Obstructive (OBS) only 31% (33/106) 31% (26/83) 30% (7/23) 42% (14/33) Restrictive (REST) only 30% (32/106) 28% (23/83) 39%(9/23) 38% (12/32) Both OBS + REST pattern 27% (29/106) 29% (24/83) 22% (5/23) 69% (20/29) “Abnormal,” not specified 11% (12/106) 12% (10/83) 9% (2/23) 67% (8/12) DLCO < 65% predicted 48% (45/94) 53% (42/80) 21% (3/14) 54% (26/48) Diagnosis & Treatment Clinical asthma diagnosis 13% (47/362) 14% (33/232) 11% (14/130) 43% (20/47) Receiving asthma treatment 51% (24/47) 45% (15/33) 64% (9/14) 50% (12/24) Bronchodilator only 23% (11/47) 24% (8/33) 21% (3/14) 45% (5/11) Inhaled steroid 23% (11/47) 18% (6/33) 36% (5/14) 55% (6/11) Singulair 4% (2/47) 3% (1/33) 7% (1/14) 50% (1/2) PFT suggests asthma 50% (62/124) 53% (50/95) 41% (12/29) 53% (33/62) +PFT, + asthma treatment 16% (10/62) 14% (7/50) 25% (3/12) 80% (8/10) One hundred twenty-four patients underwent PFTs, of which 111 (85%) were abnormal. Obstructive and/or restrictive disease with abnormal diffusion capacity were widespread. Of patients with an obstructive pattern, only 16% were receiving any asthma treatment. Forty-seven patients (33 adults and 14 children) were diagnosed with asthma. However, only half were receiving any treatment: 23% bronchodilators, and 23% inhaled steroids. Echo was performed on 90% of patients with PFT data. Half of all patients with abnormal PFTs, and 69% of those with obstructive/restrictive patterns, had PHT. Conclusion: While a more severe population may have been tested, this data suggests abnormal lung function is prevalent in SCD and is associated with PHT. Recent data suggests abnormal NO metabolism may link asthma and PHT in SCD. In conclusion, our data suggests patient morbidity will be decreased by regular screening with PFT and echo followed by early treatment for asthma and PHT.

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ECMO Therapy in Acute Chest Syndrome for Patients with Sickle Cell Disease: a Case Report and Literature Review

SN Comprehensive Clinical Medicine ◽

10.1007/s42399-021-00987-0 ◽

2021 ◽

Author(s):

Soi Avgeridou ◽

Ilija Djordjevic ◽

Anton Sabashnikov ◽

Kaveh Eghbalzadeh ◽

Laura Suhr ◽

...

Keyword(s):

Sickle Cell Disease ◽

Sickle Cell ◽

Scientific Data ◽

Acute Chest Syndrome ◽

Data Sets ◽

Limited Data ◽

Cell Disease ◽

Life Saving ◽

Institutional Experience ◽

Ecmo Therapy

AbstractExtracorporeal membrane oxygenation (ECMO) plays an important role as a life-saving tool for patients with therapy-refractory cardio-respiratory failure. Especially, for rare and infrequent indications, scientific data is scarce. The conducted paper focuses primarily on our institutional experience with a 19-year-old patient suffering an acute chest syndrome, a pathognomonic pulmonary condition presented by patients with sickle cell disease. After implementation of awake ECMO therapy, the patient was successfully weaned off support and discharged home 22 days after initiation of the extracorporeal circulation. In addition to limited data and current literature, further and larger data sets are necessary to determine the outcome after ECMO therapy for this rare indication.

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Streptococcus pneumoniae and Its Virulence Factors H2O2 and Pneumolysin Are Potent Mediators of the Acute Chest Syndrome in Sickle Cell Disease

Toxins ◽

10.3390/toxins13020157 ◽

2021 ◽

Vol 13 (2) ◽

pp. 157

Author(s):

Joyce Gonzales ◽

Trinad Chakraborty ◽

Maritza Romero ◽

Mobarak Abu Mraheil ◽

Abdullah Kutlar ◽

...

Keyword(s):

Streptococcus Pneumoniae ◽

Sickle Cell Disease ◽

Virulence Factors ◽

Sickle Cell ◽

Biological Activities ◽

Acute Chest Syndrome ◽

Antibiotics Resistance ◽

Cell Disease ◽

Antibiotic Drug ◽

Tract Infections

Sickle cell disease (SCD) is one of the most common autosomal recessive disorders in the world. Due to functional asplenia, a dysfunctional antibody response, antibiotic drug resistance and poor response to immunization, SCD patients have impaired immunity. A leading cause of hospitalization and death in SCD patients is the acute chest syndrome (ACS). This complication is especially manifested upon infection of SCD patients with Streptococcus pneumoniae (Spn)—a facultative anaerobic Gram-positive bacterium that causes lower respiratory tract infections. Spn has developed increased rates of antibiotics resistance and is particularly virulent in SCD patients. The primary defense against Spn is the generation of reactive oxygen species (ROS) during the oxidative burst of neutrophils and macrophages. Paradoxically, Spn itself produces high levels of the ROS hydrogen peroxide (H2O2) as a virulence strategy. Apart from H2O2, Spn also secretes another virulence factor, i.e., the pore-forming exotoxin pneumolysin (PLY), a potent mediator of lung injury in patients with pneumonia in general and particularly in those with SCD. PLY is released early on in infection either by autolysis or bacterial lysis following the treatment with antibiotics and has a broad range of biological activities. This review will discuss recent findings on the role of pneumococci in ACS pathogenesis and on strategies to counteract the devastating effects of its virulence factors on the lungs in SCD patients.

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To Give or Not to Give: RhD Immunoglobulin for an RHD*39 Pregnant Woman with Sickle Cell Disease

Transfusion Medicine and Hemotherapy ◽

10.1159/000512644 ◽

2021 ◽

pp. 1-5

Author(s):

Justin E. Juskewitch ◽

Craig D. Tauscher ◽

Sheila K. Moldenhauer ◽

Jennifer E. Schieber ◽

Eapen K. Jacob ◽

...

Keyword(s):

Pregnant Woman ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Pregnancy Termination ◽

Acute Chest Syndrome ◽

Cell Disease ◽

Childbearing Age ◽

Procedural Complications ◽

History Of ◽

Chronic Hemolysis

Introduction: Patients with sickle cell disease (SCD) have repeated episodes of red blood cell (RBC) sickling and microvascular occlusion that manifest as pain crises, acute chest syndrome, and chronic hemolysis. These clinical sequelae usually increase during pregnancy. Given the racial distribution of SCD, patients with SCD are also more likely to have rarer RBC antigen genotypes than RBC donor populations. We present the management and clinical outcome of a 21-year-old pregnant woman with SCD and an RHD*39 (RhD[S103P], G-negative) variant. Case Presentation: Ms. S is B positive with a reported history of anti-D, anti-C, and anti-E alloantibodies (anti-G testing unknown). Genetic testing revealed both an RHD*39 and homozygous partial RHCE*ceVS.02 genotype. Absorption/elution testing confirmed the presence of anti-G, anti-C, and anti-E alloantibodies but could not definitively determine the presence/absence of an anti-D alloantibody. Ms. S desired to undergo elective pregnancy termination and the need for postprocedural RhD immunoglobulin (RhIG) was posed. Given that only the G antigen site is changed in an RHD*39 genotype and the potential risk of RhIG triggering a hyperhemolytic episode in an SCD patient, RhIG was not administered. There were no procedural complications. Follow-up testing at 10 weeks showed no increase in RBC alloantibody strength. Discussion/Conclusion: Ms. S represents a rare RHD*39 and partial RHCE*ceVS.02 genotype which did not further alloimmunize in the absence of RhIG administration. Her case also highlights the importance of routine anti-G alloantibody testing in women of childbearing age with apparent anti-D and anti-C alloantibodies.

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