Acute sickle cell hepatopathy represents a potential contraindication for percutaneous liver biopsy.
After several complications following percutaneous liver biopsy in patients with sickle cell disease, we reviewed our experience. We examined 14 patients with sickle cell disease who underwent a percutaneous liver biopsy. Clinicopathologic findings were correlated with outcome. Of 14 patients, 5 (36%) suffered serious hemorrhage; 4 died (80%; 28% of all patients). None of the 9 patients without biopsy complications was in an acute sickling crisis at the time of biopsy; 4 of 5 patients with complications were in acute sickling crisis. Of the 5 patients with complications, 4 underwent biopsy for an emergency indication. Chronic venous outflow obstruction, marked hepatic sequestration of erythrocytes, and sinusoidal dilatation were strongly associated with complications. Data obtained by biopsy in group 1 were not of substantial value in clinical management, in contrast to group 2 (8/9; 89%). Acute hepatic disease complicating sickle cell anemia represents a newly identified contraindication to percutaneous liver biopsy.
Zakaria
Nada
N
Institute of Liver Studies and the Department of Haematological Medicine, King's College Hospital, London, United Kingdom. nadawho@hotmail.com
Knisely
Alex
A
Portmann
Bernard
B
Mieli-Vergani
Giorgina
G
Wendon
Julia
J
Arya
Roopen
R
Devlin
John
J
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000473:pathology; D001706:Biopsy / Q000009:adverse effects / Q000401:mortality; D002648:Child; D000075202:Contraindications; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D008099:Liver / Q000473:pathology*; D008107:Liver Diseases / Q000209:etiology / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment