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Updated: Jun 14, 2025
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Indicators for Osteomyelitis in Children With Sickle Cell Disease Admitted With Vaso-Occlusive Crises
Duaa A Tashkandi1, Ehab Hanafy2, Norah Alotaibi1
1Pediatrics, King Salman Armed Forces Hospital, Tabuk, SAU.
Insights
This study identified key indicators for diagnosing osteomyelitis in children with sickle cell disease (SCD). Early multidisciplinary evaluation is recommended for suspected cases, integrating clinical, lab, and MRI findings.
Area of Science:
- Pediatric Hematology
- Infectious Diseases
- Musculoskeletal Infections
Background:
- Sickle cell disease (SCD) predisposes patients to osteoarticular complications, including osteomyelitis.
- Osteomyelitis commonly affects long bones and vertebrae in individuals with SCD.
Purpose of the Study:
- To define diagnostic indicators for osteomyelitis in pediatric patients with SCD.
- To improve early and accurate diagnosis of bone infections in this vulnerable population.
Main Methods:
- A prospective, descriptive, and analytical study of pediatric patients with SCD.
- Inclusion of retrospective data for eligible patients.
- Evaluation of laboratory and radiological features for diagnosis of vaso-occlusive crisis (VOC) and osteomyelitis.
Main Results:
- Leukocytosis (75%) and elevated CRP (50%) were common in osteomyelitis cases.
- High ferritin levels (>5000 ng/mL) were observed in patients with osteomyelitis or concurrent VOC.
- MRI revealed marrow edema and bone enhancement in three cases, with two complicated by osteomyelitis.
Conclusions:
- An individualized, multidisciplinary approach is recommended for suspected osteomyelitis in SCD patients presenting with VOC.
- Integrating clinical history, laboratory results, and MRI findings is crucial for diagnosis.
- Collaboration between hematology, infectious disease, orthopedic surgery, and interventional radiology ensures comprehensive patient care.
Introduction:
Sickle cell disease (SCD) is an autosomal recessive genetic disorder characterized by the presence of a mutated form of hemoglobin (Hb) known as sickle hemoglobin (HbS). Individuals with SCD are susceptible to a variety of osteoarticular complications. Osteomyelitis is a commonly seen infection affecting the tibia, diaphysis of the femur and humerus, and vertebras.
Aim:
The aim of this study was to define the indicators suggesting the diagnosis of osteomyelitis in patients with SCD.
Methods:
This study is a descriptive, analytical, non-interventional, prospective study of pediatric patients with SCD admitted with vaso-occlusive crisis (VOC) and/or osteomyelitis, which were identified by laboratory and radiological features. Retrospective data was included for patients who met the inclusion criteria. The statistical analysis included a description of the primary and secondary outcomes in the cohort.
Results:
A total of 28 children were included in this study. Participants' ages ranged from 11 months to 13 years. Males represented the majority (64.3%) of the participants. The blood culture of most of the participants (89.3%) showed no growth; however, 7.1% had salmonella, and only 3.6% had Gram-positive cocci. Most cases (75%) had leukocytosis. Thrombocytosis was present mainly in patients with VOC (40%). CRP was 1-4.9 mg/dL, mainly in patients with osteomyelitis (50%). The ferritin level exceeded 5000 ng/mL in patients with osteomyelitis or both osteomyelitis and VOC (50%). Ultrasound examinations revealed no hip effusion in 24 of the 28 examined patients. A plain X-ray examination showed no abnormality in 24 out of the 28 examined cases; with MRI, three cases exhibited marrow edema with bone enhancement, two (66.7%) were complicated by osteomyelitis, and the last (33.3%) had osteomyelitis and VOC. Aspiration was performed only in seven of the 28 examined, of which six (85.7%) were complicated by osteomyelitis, while the last one (14.3%) had acute chest syndrome.
Conclusion:
Based on the outcomes of this study, we recommend an individualized multidisciplinary examination (hematology, infectious disease, orthopedic surgery, and interventional radiology) for SCD patients with suspected osteomyelitis admitted with VOC, considering the entire clinical history and laboratory and MRI results.
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