Acute splenic sequestration crisis in sickle cell disease: cohort study of 190 paediatric patients.
Acute splenic sequestration crisis (ASSC) is an unpredictable life-threatening complication of sickle cell disease (SCD) in infants. Here, our objective was to update available clinical information on ASSC. We retrospectively studied the 190 patients who were diagnosed at birth with SS or Sbeta(0) in the Paris conurbation between 2000 and 2009 and who experienced ASSC. They had 437 ASSC episodes (0.06/patient-year). Median age at the first episode was 1.4 years (0.1-7) and 67% of patients had more than one episode. Age was the only factor predicting recurrence: the risk was lower when the first episode occurred after 2 years versus before 1 year of age (hazard ratio, 0.60; 95% confidence interval, 0.41-0.88; P=0.025). A concomitant clinical event was found in 57% of episodes. The mortality rate was 0.53%. The treatment consisted in watchful waiting without prophylactic blood transfusions or splenectomy in 103 (54%) patients and in a blood transfusion programme in 55 (29%) patients. Overall, splenectomy was performed in 71 (37%) patients, at a median age of 4.5 years (range, 1.9-9.4). In conclusion, aggressive treatment may be warranted in patients experiencing ASSC before 2 years of age. Randomized controlled trials are needed to define the best treatment modalities.
Department of Paediatrics, Reference Centre for Sickle Cell Disease, Hôpital Necker, APHP, Paris, France. valentine.brousse@nck.aphp.fr
Valentine
V
Brousse
Caroline
C
Elie
Malika
M
Benkerrou
Marie-Hélène
MH
Odièvre
Emmanuelle
E
Lesprit
Francoise
F
Bernaudin
Marion
M
Grimaud
Corinne
C
Guitton
Béatrice
B
Quinet
Silvana
S
Dangiolo
Mariane
M
de Montalembert
D000208:Acute Disease; D017677:Age Distribution; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010297:Paris / Q000453:epidemiology; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D013158:Splenic Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome