[Gallstone complications in sickle cell patients].

Abstract

Chronic haemolysis exposes patients with sickle cell disease (SCD) to the development of black pigment gallstones, which can trigger biliary complications. In order to avoid these complications, elective cholecystectomy is recommended in France for all SCD patients with detected gallstones. However, all surgeries, and especially abdominal surgeries, entail an increased risk of vaso-occlusive complications in the peri- and post-operative periods, the most dreadful one being the acute chest syndrome. Preoperative transfusion has been shown in several studies to reduce acute postoperative complications, but exposes the patient to definitive alloimmunization, or even delayed post- transfusion haemolysis, justifying a recent trend towards transfusion sparing. The conditions for avoiding transfusion for a simple and frequent surgery such as cholecystectomy are based on a benefit- risk balance, and must be discussed on a case-by-case basis by the SCD specialist. In particular, it seems fully justified to perform prophylactic preoperative transfusion in patients with a history of recent vaso-occlusive crisis or acute chest syndrome (within 6 months preoperatively), and those operated on in an emergency setting, who are particularly at risk of postoperative events.

• Authors: E Rambaud, B Ranque, J Pouchot, J-B Arlet
• Journal: La Revue de medecine interne (Rev Med Interne) Vol. 43 Issue 8 Pg. 479-486 (Aug 2022) ISSN: 1768-3122 [Electronic] France
• Vernacular Title: Complications lithiasiques chez les patients drépanocytaires.
• PMID: 35688668 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.

Topics

• Acute Chest Syndrome (complications)
• Anemia, Sickle Cell (complications, therapy)
• Gallstones (complications, epidemiology, surgery)
• Hemolysis
• Humans
• Transfusion Reaction (complications)