Abstract
Sickle cell disease (SCD) is an autosomal genetic blood disorder resulting in multiple end-organ complications. Malnutrition is a stress factor that can cause a SCD crisis. Bariatric surgery is a weight reduction surgery that involves the binding or removing a part of the stomach or resecting and re-routing the small intestine to a small stomach pouch. It is known to cause malnutrition and stress. Malnutrition affects more than two billion people of all ages worldwide due to different causes. Long-term deficiency of micronutrients leads to reduced immunity, leukopenia, and diseases affecting the psychological, skeletal, and central nervous system. We here present the case of a 20-year-old woman with SCD and class III obesity. She underwent sleeve gastrectomy in 2018 following psychological distress caused by being severely overweight. She had mild SCD pain, but after the bariatric surgery, it became severe, requiring morphine treatment and monthly exchange transfusion beside the NSAID which become not much effective as before bariatric surgery. Our findings show that bariatric surgery, which leads to a stressful condition, can aggravate the SCD pain crisis, thereby highlighting the need for alternative methods of weight reduction in these patients. Controlled studies are required for the proper assessment of bariatric surgery in SCD.
Highlights
IntroductionSickle cell disease (SCD) is an autosomal genetic blood disorder leading to severe anemia and impaired tissue perfusion, resulting in multiple end-organ compli-
Our findings show that bariatric surgery, which leads to a stressful condition, can aggravate the Sickle cell disease (SCD) pain crisis, thereby highlighting the need for alternative methods of weight reduction in these patients
Those with SCD have a much lower tolerance for stress. Bariatric surgery puts these patients in a severely stressful condition. This case is significant for both areas of hematology and bariatric surgery
Summary
Sickle cell disease (SCD) is an autosomal genetic blood disorder leading to severe anemia and impaired tissue perfusion, resulting in multiple end-organ compli-. Pain is the most common complication of SCD. Some SCD patients have mild to moderate pain, while others have severe vaso-occlusive complications, which lead to a pain crisis. Even mild dehydration can have a significant impact on hemoglobin concentration [1]. Stress factors that affect the SCD pain crisis are fever, loss of fluids due to excessive sweating, vomiting, diarrhea, malnutrition, high temperature, and humidity. The renal complications in SCD can impact the urine concentration resulting in higher urine loss and dehydration due to tubular damage [2]
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