Document Detail


Pulmonary artery thrombosis during acute chest syndrome in sickle cell disease.
MedLine Citation:
PMID:  21836136     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
RATIONALE: 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.
OBJECTIVES: 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.
MEASUREMENTS AND MAIN 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:
Armand Mekontso Dessap; Jean-François Deux; Nour Abidi; Cécile Lavenu-Bombled; Giovanna Melica; Bertrand Renaud; Bertrand Godeau; Serge Adnot; Laurent Brochard; Christian Brun-Buisson; Frederic Galacteros; Alain Rahmouni; Anoosha Habibi; Bernard Maitre
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Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American journal of respiratory and critical care medicine     Volume:  184     ISSN:  1535-4970     ISO Abbreviation:  Am. J. Respir. Crit. Care Med.     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-12-08     Completed Date:  2012-01-27     Revised Date:  2012-03-16    
Medline Journal Info:
Nlm Unique ID:  9421642     Medline TA:  Am J Respir Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1022-9     Citation Subset:  AIM; IM    
Affiliation:
Service de Réanimation Médicale, Assistance Publique - Hôpitaux de Paris, Groupe Henri-Mondor Albert-Chenevier, Créteil, France. armand.dessap@hmn.aphp.fr
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MeSH Terms
Descriptor/Qualifier:
Acute Chest Syndrome / complications*,  etiology,  physiopathology
Adult
Algorithms
Anemia, Sickle Cell / complications*
Anticoagulants / therapeutic use
Antifibrinolytic Agents / blood
Biological Markers / blood
Female
Fibrin Fibrinogen Degradation Products / metabolism
Follow-Up Studies
Hospitals, University
Humans
Male
Multidetector Computed Tomography*
Pennsylvania / epidemiology
Prevalence
Prospective Studies
Pulmonary Artery*
Thrombosis / complications,  drug therapy,  epidemiology*,  etiology,  radiography*
Chemical
Reg. No./Substance:
0/Anticoagulants; 0/Antifibrinolytic Agents; 0/Biological Markers; 0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D
Comments/Corrections
Comment In:
Am J Respir Crit Care Med. 2011 Nov 1;184(9):990-1   [PMID:  22045743 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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