title: Pulmonary artery thrombosis during acute chest syndrome in sickle cell disease.
abstract: BACKGROUND
  The pathophysiology of acute chest syndrome (ACS) in patients with sickle cell disease is complex, and pulmonary artery thrombosis (PT) may contribute to this complication.
  
  
  OBJECTIVE
  To evaluate the prevalence of PT during ACS using multidetector computed tomography (MDCT).
  
  
  METHODS
  We screened 125 consecutive patients during 144 ACS episodes. One hundred twenty-one MDCTs (in 103 consecutive patients) were included in the study.
  
  
  RESULTS
  Twenty MDCTs were positive for PT, determining a prevalence of 17% (95% confidence interval, 10-23%). Revised Geneva clinical probability score was similar between patients with PT and those without. D-dimer testing was very often positive (95%) during ACS. A precipitating factor for ACS was less frequently found in patients with PT as compared with those without. Patients with PT exhibited significantly higher platelet counts (517 [273-729] vs. 307 [228-412] 10(9)/L, P < 0.01) and lower bilirubin (28 [19-43] vs. 44 [31-71] μmol/L, P < 0.01) levels at the onset of ACS as compared with others. In addition, patients with PT had a higher platelet count peak (537 [345-785] vs. 417 [330-555] 10(9)/L, P = 0.048) and smaller bilirubin peak (36 [18-51] vs. 46 [32-83] μmol/L, P = 0.048)and lactate dehydrogenase peak (357 [320-704] vs. 604 [442-788] IU/L, P = 0.01) during hospital stay as compared with others.
  
  
  CONCLUSIONS
  PT is not a rare event in the context of ACS and seems more likely in patients with higher platelet counts and lower hemolytic rate during ACS. Patients with sickle cell disease presenting with respiratory symptoms suggestive of ACS may benefit from evaluation for PT.
authors.affiliation: Service de Réanimation Médicale, Assistance Publique - Hôpitaux de Paris, Groupe Henri-Mondor Albert-Chenevier, Créteil, France. armand.dessap@hmn.aphp.fr
authors.forename: Armand
authors.initials: A
authors.lastname: Mekontso Dessap
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Deux
authors.forename: Nour
authors.initials: N
authors.lastname: Abidi
authors.forename: Cécile
authors.initials: C
authors.lastname: Lavenu-Bombled
authors.forename: Giovanna
authors.initials: G
authors.lastname: Melica
authors.forename: Bertrand
authors.initials: B
authors.lastname: Renaud
authors.forename: Bertrand
authors.initials: B
authors.lastname: Godeau
authors.forename: Serge
authors.initials: S
authors.lastname: Adnot
authors.forename: Laurent
authors.initials: L
authors.lastname: Brochard
authors.forename: Christian
authors.initials: C
authors.lastname: Brun-Buisson
authors.forename: Frederic
authors.initials: F
authors.lastname: Galacteros
authors.forename: Alain
authors.initials: A
authors.lastname: Rahmouni
authors.forename: Anoosha
authors.initials: A
authors.lastname: Habibi
authors.forename: Bernard
authors.initials: B
authors.lastname: Maitre
mesh_terms: D056586:Acute Chest Syndrome / Q000150:complications* / Q000209:etiology / Q000503:physiopathology; D000328:Adult; D000465:Algorithms; D000755:Anemia, Sickle Cell / Q000150:complications*; D000925:Anticoagulants / Q000627:therapeutic use; D000933:Antifibrinolytic Agents / Q000097:blood; D015415:Biomarkers / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D008297:Male; D061330:Multidetector Computed Tomography; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D011651:Pulmonary Artery; D013927:Thrombosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D