Can Infant US Predict Clinical Function in Sickle Cell Anemia?

Abstract

Research Article| November 01 2011 Can Infant US Predict Clinical Function in Sickle Cell Anemia? AAP Grand Rounds (2011) 26 (5): 57. https://doi.org/10.1542/gr.26-5-57 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Can Infant US Predict Clinical Function in Sickle Cell Anemia?. AAP Grand Rounds November 2011; 26 (5): 57. https://doi.org/10.1542/gr.26-5-57 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: sickle cell anemia, spleen, kidney, gallbladder Source: McCarville MB, Luo Z, Huang X, et al. Abdominal ultrasound with scintigraphic and clinical correlates in infants with sickle cell anemia: baseline data from the BABY HUG trial. AJR. 2011; 196(6): 1399– 1404; doi: https://doi.org/10.2214/AJR.10.4664Google Scholar Investigators from multiple United States centers sought to determine if ultrasound (US) findings in/of the spleen, kidneys, and gallbladder/biliary tree among infants with sickle cell anemia (SCA) correlate with clinical, nuclear medicine (NM), and/or laboratory findings. Infants in this study were participating in the multi-institutional BABY HUG study, a randomized placebo-controlled phase 3 trial of hydroxyurea among infants with SCA. (See AAP Grand Rounds, August 2011;26:16.) US studies of 203 infants (116 females) between ages 7.5 and 18 months (mean 12.9 months) from 14 institutions were reviewed by one experienced pediatric radiologist. The following were considered abnormal: indistinct renal corticomedullary differentiation; gallbladder thickness greater than 3 mm after 6 hours NPO; and common bile duct greater than 2 mm. Splenic function was assessed by Technetium 99m sulfur colloid liver spleen scans, pitted RBC count, and flow cytometry for Howell-Jolly bodies. Spleen scans were reported as radiotracer uptake equal to the liver, less than that of the liver, or no splenic uptake. Renal glomerular filtration rates (GFR) were evaluated by DTPA (Technetium 99m diethylenetriaminepentaacetic acid). Liver function was assessed by serum alanine aminotransferase (ALT) levels. SCA patients had greater spleen volumes than hematologically normal children. However, spleen volume did not predict NM function. Lesser uptake was associated with some increase in spleen volume, perhaps due to increased congestion causing decreased function prior to inevitable splenic autoinfarction. There was no correlation between volumes and percentages of pitted RBCs or Howell-Jolly bodies. As expected, sonographic spleen volumes correlated with spleen palpation. Two hundred and one patients had adequate renal US images; 4% had renal abnormalities. Three percent had increased renal echogenicity or absent corticomedullary differentiation. Both kidneys were significantly larger in the studied cohort compared with charts for normal children. Kidney sizes correlated positively with GFR, and the cohorts’ GFRs were statistically greater than published values for normal children. Two hundred patients had adequate biliary tree imaging. Abnormalities included multiple gallstones (1 child), sludge (6), thickened gallbladder wall (1), and dilated common duct (2). Only two patients had abnormal ALT levels: a child with a dilated duct and a child with sludge. There was no overall correlation between serum chemistries (ALT or bilirubin) and gallbladder findings, although the patient with gallstones had a markedly elevated total bilirubin. The authors conclude that among infants with SCA, sonographic spleen volume does not reflect function, although increased kidney volume correlates with increased GFR, consistent with hyperfiltration. They also note that clinically silent gallbladder disease in SCA begins in infancy. Dr Cohen has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Transcranial Doppler US1 has been used... You do not currently have access to this content.