Chest
Clinical InvestigationsDIFFUSE LUNG DISEASEAcute Chest Syndrome in Adults With Sickle Cell Disease
Section snippets
Patients
All patients were recruited from the Sickle Cell Disease Center at the Henri Mondor University Hospital, Créteil, France, which follows a cohort of 800 adult patients. All consecutive ACS episodes in this cohort were recorded from 1991 to 1997. Hemoglobin (Hb) phenotype was determined by standard procedure to be homozygous Hb SS, Hb SC, or Hb Sβ-thalassemia. β-globin cluster haplotypes were determined as previously described.20 The diagnosis of ACS was based on the presence of fever or chest
Results
One hundred seven consecutive episodes of ACS were considered in 77 patients. Of these patients, 52 had one ACS episode, 17 had two episodes, and 7 had three episodes. For 14 patients (20%), ACS was the first severe acute event related to SCD. Table 1 shows the baseline characteristics of the 77 patients before the first episode. The haplotype distribution of patients presenting ACS was similar to that of the total patient population followed at our center. Only three patients received chronic
Discussion
The aim of this study was to determine the characteristics and outcome of ACS in adult patients. Recent studies, particularly the report of the Cooperative Study of Sickle Cell Disease (CSSCD), have described ACS clinical features in large numbers of patients.5, 1415, 1617, 1819 However, most of these studies have focused on patients < 16 years old. In contrast, our monocentric study included only adult patients treated according to an uniform protocol in which transfusion was used only for the
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Acute chest syndrome in adult sickle cell patients
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2020, Medecine et Maladies InfectieusesCitation Excerpt :An empirical antibiotic course was introduced in 52 patients (85.2%) and was later adapted according to the bacterial detection results in nine patients. The mean time from initial empirical therapy to adapted specific therapy was 3.1 [2–7] days. Overall, prescribed antibiotics were amoxicillin (n = 30), amoxicillin-clavulanic acid (n = 9), cefotaxime (n = 18), spiramycin (n = 22), telithromycin (n = 8), levofloxacin (n = 1), piperacillin-tazobactam (n = 1), oxacillin (n = 1), and linezolid (n = 1).
Recommendations for the use of red blood cell exchange in sickle cell disease
2019, Transfusion and Apheresis ScienceManifestations of sickle cell disease on thoracic imaging
2018, Clinical ImagingCitation Excerpt :Bone infarction usually occurs in the medullary cavity and epiphysis in marrow-containing bones, resulting in painful bone crises and the potential for fat emboli and ACS [28]. Bone infarction initially presents as an ill-defined radiolucent lesion and progresses to patchy areas of lucency [28,29]. Epiphyseal sclerosis, eventual collapse, and fragmentation identifies a chronic infarct.