Bone marrow infarction in sickle cell anemia: correlation with hematologic profiles

Area of Science:

• Nuclear Medicine
• Hematology
• Radiology

Background:

• Sickle cell anemia (SS) is a genetic blood disorder characterized by abnormal hemoglobin.
• Bone marrow infarction is a known complication, but its detection and management can be challenging.

Purpose of the Study:

• To evaluate the utility of 99mTc-sulfur colloid imaging in identifying bone marrow infarction in sickle cell anemia patients.
• To compare the effectiveness of this imaging technique with conventional radiography and bone scans for managing sickle cell crisis.

Main Methods:

• 42 patients with sickle cell anemia underwent 99mTc-sulfur colloid imaging over two years.
• Findings were correlated with roentgenographic evidence, clinical presentation (crisis vs. asymptomatic), and hematologic variables.
• Follow-up imaging was performed to assess defect changes over time.

Main Results:

• Bone marrow defects were identified in 66.6% of patients.
• Defects correlated with roentgenographic evidence of infarction in 15 patients, showing no change on repeat imaging.
• In patients experiencing crisis, defects often resolved or decreased in size within 3-6 months, irrespective of initial size or limb swelling.
• Asymptomatic patients showed no defects.
• Higher hemoglobin and hematocrit levels were associated with marrow infarcts (p < 0.0001).
• HbF or alpha-thalassemia did not confer protection against infarction.

Conclusions:

• 99mTc-sulfur colloid imaging is a valuable tool for diagnosing bone marrow infarction in sickle cell anemia.
• It provides more useful information for the initial management of bone pain and swelling during sickle cell crisis than radiography or 99mTc-methyldiphosphate bone imaging.