title: Acute chest syndrome in sickle-cell disease.
abstract: 25 consecutive episodes of acute chest syndrome in 13 adult patients with sickle-cell disease were studied retrospectively. Chest symptoms were present on admission in 23 of 25 episodes. Abnormal chest signs and an abnormal chest X-ray were present on admission in only 11 and 9 episodes, respectively, but developed later in the remainder. The 9 episodes with bilateral radiological changes were associated with higher pulse rates, longer-lasting fever, more profound arterial hypoxaemia, and greater falls in haemoglobin than the 16 unilateral episodes. 2 patients with bilateral disease died; both had platelet counts less than 100 X 10(9)/litre. In 12 episodes (6 bilateral, 6 unilateral) exchange transfusion was required and produced striking improvement in 11. Despite intensive microbiological investigation, infection was found in only 2 episodes--1 mycoplasma and 1 evidence of Escherichia coli. Pulmonary intravascular sickling may account for much of the clinical picture.
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D005078:Exchange Transfusion, Whole Blood; D005260:Female; D006451:Hemoglobin, Sickle / Q000032:analysis; D006801:Humans; D007964:Leukocytosis / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000150:complications* / Q000503:physiopathology; D011674:Pulse; D013902:Radiography, Thoracic; D012189:Retrospective Studies; D013577:Syndrome; D013909:Thorax
chemical_list: D006451:Hemoglobin, Sickle