Abstract
Background: Although pulmonary infarction and pulmonary embolism (PE) have been reported in sickle cell disease patients during acute chest syndrome (ACS), there is no comprehensive study evaluating the prevalence of PE during ACS.
Methods: We screened 125 consecutive patients during 144 ACS episodes to perform a multidetector computed tomography (MDCT). 121 MDCTs (in 103 consecutive patients) were included in the study.
Findings: 20 MDCTs were positive for PE, determining a prevalence of 17% (95% confidence interval from 10% to 23%). Revised Geneva clinical probability score was similar between patients with PE and those without. D-dimers testing was very often positive (95%) during ACS. A precipitating factor for ACS was less frequently found in patients with PE as compared to those without. Patients with PE exhibited significantly increased platelet counts (517 [273-729] vs. 307 [228-412] 109/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 to others. In addition, patients with PE had a higher platelet count peak (537 [345-785] vs. 417 [330-555] 109/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 to others.
Interpretation: PE is not a rare event in the context of ACS and seems more likely in patients with higher platelets counts and lower haemolytic rate during ACS. SCD patients presenting with respiratory symptoms suggestive of ACS may benefit from evaluation for PE.
- © 2011 ERS
