title: Safety of iodinated intravenous contrast medium administration in sickle cell disease.
abstract: BACKGROUND
  Increased sickling of erythrocytes following intravenous iodinated contrast has been described in patients with sickle cell disease. In vitro, the effect is correlated with the tonicity, viscosity, acidity, and ionic nature of contrast media. Less erythrocyte sickling is observed in vitro with second-generation low- and iso-osmolar contrast agents. Clinical impact of these newer intravenous contrast agents has not been investigated.
  
  
  OBJECTIVE
  To review adverse outcomes following contrast administration in a cohort of patients with sickle cell disease.
  
  
  METHODS
  Inpatients with sickle cell disease who received iodinated intravenous were identified. Medical records were reviewed for evidence of worsening crisis and occurrence of adverse events within 48 hours of contrast administration. Data points were further analyzed with the goal of identifying predictors of adverse outcome.
  
  
  RESULTS
  There were 132 imaging studies that met inclusion criteria in 79 patients, mostly with homozygous hemoglobin S. The low-osmolar contrast Optiray (Coviden Imaging Inc., Hazelwood, Mo) was used in 45%. Administration of fluids, Mucomyst (Bristol-Myers Squibb, New York, NY), oxygen, or blood transfusion preceded 58% of studies. Minor adverse events followed 16% of studies, with new or worsening pain being most common (12%). Contrast-induced nephropathy occurred in 1.5%, resolving in all cases. Prehydration was associated with a decreased incidence of adverse events (P=.02).
  
  
  CONCLUSIONS
  Adverse events related to intravenous contrast occur in sickle cell disease patients at a rate similar to the general population, without an increase in contrast-induced nephropathy. Subjective reports of new or worsening pain crisis do not translate to objective findings. Beneficial diagnostic imaging can be performed without increased risk of serious complication in this population.
authors.affiliation: Division of Cardiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
authors.forename: Kimberly L
authors.initials: KL
authors.lastname: Campbell
authors.forename: Laryssa M
authors.initials: LM
authors.lastname: Hud
authors.forename: Suzanne
authors.initials: S
authors.lastname: Adams
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Andrel
authors.forename: Samir K
authors.initials: SK
authors.lastname: Ballas
authors.forename: Arthur M
authors.initials: AM
authors.lastname: Feldman
authors.forename: David
authors.initials: D
authors.lastname: Axelrod
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014283:Triiodobenzoic Acids / Q000008:administration & dosage / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D003287:Contrast Media; D014283:Triiodobenzoic Acids; C054871:ioversol