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Intrahepatic cholestasis in sickle cell disease: a case report. 2011
Denise Menezes Brunetta, and
Ana Cristina Silva-Pinto, and
Maria do Carmo Favarin de Macedo, and
Sarah Cristina Bassi, and
Joao Victor Piccolo Feliciano, and
Fernanda Borges Ribeiro, and
Benedito de Pina Almeida Prado, and
Gil Cunha De Santis, and
Ivan de Lucena Angulo, and
Dimas Tadeu Covas
Hematology Division and Center for Cell Based Therapy, Department of Internal Medicine, Medical School of Ribeirao Preto, University of Sao Paulo, 14051-140 Ribeirao Preto, SP, Brazil.
Intrahepatic cholestasis (SCIC) is an uncommon but potentially fatal complication of sickle cell disease (SCD), with a high death rate, observed mainly in patients with homozygous sickle cell anemia. Herein, we describe a case of severe SCIC treated successfully with aggressive manual exchange transfusion (ET). The patient was admitted with enlarged liver and signs of hepatic failure, such as hyperbilirubinemia and coagulopathy. There was no evidence of viral hepatitis or biliary obstruction. We performed several sessions of ET in order to reduce the percentage of HbS to levels inferior to 30%, which was successfully accomplished. The patient had a complete recovery of hepatic function. This case has shown that ET is an effective treatment of SCIC and should be introduced early on the onset of this severe complication.
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