Hepatobiliary Findings in Nigerian Children with Sickle Cell Anaemia

Hepatobiliary abnormalities occur commonly in sickle cell anaemia and these have been extensively reported in the adult patients. However, complications have been sparsely reported in children especially in the sub-Saharan African continent. This study aimed to highlight the hepatobiliary complications in this group of children using clinical examination, laboratory testing and abdominal ultrasonography. The challenges in a resource limited country are also highlighted.

One hundred and thirty- four (134) children aged 1-18years with sickle cell anaemia in steady state were recruited into this crossectional study. Clinical history and physical examination obtained were documented. Relevant basic haematologic and biochemical indices (Full blood count, liver enzymes and viral markers for hepatitis B and C) and abdominal ultrasonographic parameters were documented for all the children. The relationship between the complications and possible risk factors (age, frequency of crisis and blood transfusions) were also documented.

Fifty-three (39.6%) of the children had hepatobiliary abnormalities. Chronic hepatitis B infection was the most prevalent complication (14.9%) seen followed by cholelithiasis (12.7%) and Hepatitis C infection (4.5%). Other complications identified were cholecystitis (3.0%), biliary sludge (1.5%), liver cirrhosis (0.7%). Age was significantly associated with viral hepatitis (p=0.003) and cholelithiasis (p=0.0007) and the conditions were more prevalent in the older age group. The hepatobilary complications were also more prevalent in the males. Frequent blood transfusions was significantly related to viral hepatitis (p=0.03). The use of hydroxyurea was not significantly related to any of the complications.

Hepatobiliary abnormalities are prevalent in children with sickle cell anaemia. Clinical screening and the use of ultrasonography would aid early diagnosis and appropriate therapeutic intervention in this group of children.