Sickle cell anemia connected with chronic intrahepatic cholestasis: a case report

Sickle cell anemia is a disease caused by production of abnormal hemoglobin, which binds with other abnormal hemoglobin molecules within the red blood cell to cause rigid deformation of the cell. This deformation impairs the ability of the cell to pass through small vascular channels. Sludging and congestion of vascular beds may result, followed by tissue ischemia and infarction. Liver injury can be caused by the adherence of deformed or hemolyzed erythrocytes to hepatic vascular endothelium. Adhesion of large numbers of hemolyzed red blood cells to hepatic macrophages, or occlusion of hepatic sinusoids by fragmented red cells, can also result in injury of the liver. Chronic intrahepatic cholestasis is an uncommon complication in patients with sickle cell disease. The findings in this case suggest that therapeutic erythrocyte apheresis may benefit patients who have unusual complications of sickle cell disease, such as chronic intrahepatic cholestasis in the liver.