Approach to Abdominal Pain in Sickle Cell Anaemic Patients

  • Basim AA. Al Hijjaj (F.I.C.M.S) consultant pediatrician , Basra center For hereditary Blood diseases, Member of Iraqi Association for Medical Research and Studies (IAMRS)
  • Sadik Hassan (FICMS, pediatric surgery) Assistant Professor, Consultant Pediatric Surgeon, Al-Zahraa Medical College, University of Basrah
Keywords: sickle, abdominal pain, anemia

Abstract

Sickle cell disease is the term that involve both homozygous sickle cell anemia and the heterozygous sickle cell thalassemia disease. (1)

As a result of a single amino acid substitution (valine for glutamic acid at the β6 position), sickle hemoglobin crystallizes and forms a gel in the deoxygenated state. When reoxygenated, the sickle hemoglobin is normally soluble. The so-called reversible sickle cell can enter the microcirculation. As the oxygen is extracted and saturation declines, sickling may occur, occluding the microvasculature. The surrounding tissue undergoes infarction, inducing pain and chronic organ dysfunction. This sickling phenomenon is exacerbated by hypoxia, acidosis, fever, hypothermia, and dehydration. (2)

Musculoskeletal, chest, and abdominal pain are remarkable manifestations of the sickling.

Sickle cell patient with abdominal pain is one of the common presentations of the disease and one of its clinical dilemmas that impose itself to be discussed and clarified.

References

1. Ohene-Frempong K. Sickle cell disease in the United States of America and Africa. Hematology (Am Soc Hematol Educ Program) 1999: 64 –72.
2. Karen J. Marcdante, Robert M. Kliegman, Wisconsin Abigail M. Schuh, Md, Nelson Essentials Of Pediatrics,Sickle Cell Disease,P 594-612.
3. Robert M Penner, Sumit R Majumdar.Diagnostic approach to abdominal pain in adults.UpToDate13.1 available from https://sites.ualberta.ca/~loewen/Medicine/GIM%20Residents%20Core%20Reading/ACUTE%20&%20CHRONIC%20ABDO%20PAIN/Diagnosic%20approach%20to%20abdo%20pain.htm
4. EVIDENCE-BASED MANAGEMENT OF SICKLE CELL DISEASE: EXPERT PANEL REPORT, 2014،Vaso-Occlusive Crisis,p.32
5. Ballas SK. Pain management of sickle cell disease. Hematol Oncol Clin North Am. 2005;19(5):785-802.
6. Ballas SK. The sickle cell painful crisis in adults: phases and objective signs. Hemoglobin. 1995;19(6):323-33.
7. Nath, Karl A, and Robert P Hebbel. “Sickle cell disease: renal manifestations and mechanisms.” Nature reviews. Nephrology vol. 11,3 (2015): 161-71. doi:10.1038/nrneph.2015.8
8. Abadin SS, Salazar MR, Zhu RY, Connolly MM, Podbielski FJ (2009) Small Bowel Ischemia in a Sickle Cell Patient. Case Rep Gastroenterol 3: 26-29. [Crossref]
9. van der Neut FW, Statius van Eps LW, van Enk A, van de Sandt MM (1993) Maternal death due to acute necrotizing colitis in homozygous sickle cell disease. Neth J Med 42: 132-1323.
10. Kane I, Kumar A, Atalla E, et al. Splenic Sequestration Crisis. [Updated 2022 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553164/
11. Bates I, de Caestecker J. Sickle cell disease and risk of peptic ulceration. Trans R Soc Trop Med Hyg. 1996 May-Jun;90(3):292–292.
12. Woods KF, Onuoha A, Schade RR, Kutlar A. Helicobacter pylori infection in sickle cell disease. J Natl Med Assoc. 2000 Jul;92(7):361-5. Erratum in: J Natl Med Assoc 2000 Dec;92(12):A22. PMID: 10946532; PMCID: PMC2608584.
Published
2023-05-31
How to Cite
Al Hijjaj, B. A., & Hassan, S. (2023). Approach to Abdominal Pain in Sickle Cell Anaemic Patients. Central Asian Journal of Medical and Natural Science, 4(3), 431-436. https://doi.org/10.17605/cajmns.v4i3.1542
Section
Articles