title: Intrahepatic cholestasis in sickle cell disease: a case report.
abstract: Intrahepatic cholestasis (SCIC) is an uncommon but potentially fatal complication of sickle cell disease (SCD), with a high death rate, observed mainly in patients with homozygous sickle cell anemia. Herein, we describe a case of severe SCIC treated successfully with aggressive manual exchange transfusion (ET). The patient was admitted with enlarged liver and signs of hepatic failure, such as hyperbilirubinemia and coagulopathy. There was no evidence of viral hepatitis or biliary obstruction. We performed several sessions of ET in order to reduce the percentage of HbS to levels inferior to 30%, which was successfully accomplished. The patient had a complete recovery of hepatic function. This case has shown that ET is an effective treatment of SCIC and should be introduced early on the onset of this severe complication.
authors.affiliation: Hematology Division and Center for Cell Based Therapy, Department of Internal Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, 14051-140 Ribeirao Preto, SP, Brazil.
authors.forename: Denise Menezes
authors.initials: DM
authors.lastname: Brunetta
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Silva-Pinto
authors.forename: Maria
authors.initials: M
authors.lastname: do Carmo Favarin de Macedo
authors.forename: Sarah Cristina
authors.initials: SC
authors.lastname: Bassi
authors.forename: Joao Victor
authors.initials: JV
authors.lastname: Piccolo Feliciano
authors.forename: Fernanda Borges
authors.initials: FB
authors.lastname: Ribeiro
authors.forename: Benedito de Pina Almeida
authors.initials: Bde P
authors.lastname: Prado
authors.forename: Gil Cunha
authors.initials: GC
authors.lastname: De Santis
authors.forename: Ivan
authors.initials: I
authors.lastname: de Lucena Angulo
authors.forename: Dimas Tadeu
authors.initials: DT
authors.lastname: Covas