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Reverse sequestration in a case of sickle crisis
Postgraduate Medical Journal
|August 1, 1996
Summary
A patient with homozygous sickle cell disease experienced a severe sickle crisis. Post-crisis, a rapid hemoglobin increase led to hypertension, heart failure, and stroke, likely due to sequestration reversal.
Area of Science:
- Hematology
- Cardiology
- Neurology
Background:
- Homozygous sickle cell disease (HbSS) patients can experience vaso-occlusive crises.
- Hepatic and pulmonary sequestration are serious complications of sickle cell crisis.
Observation:
- A patient with HbSS developed hepatic and pulmonary sequestration during a sickle crisis.
- Following intensive therapy and during recovery, the patient exhibited a rapid, spontaneous rise in hemoglobin concentration.
- This was followed by severe hypertension, congestive cardiac failure, and an intracerebral hemorrhage.
Findings:
- The observed hemodynamic disturbance, including hypertension, cardiac failure, and stroke, was attributed to a reversal of the sequestration process.
- This reversal led to a rapid increase in blood volume and viscosity.
Implications:
- Close monitoring of sickle cell patients post-sequestration crisis is crucial.
- Parameters like blood pressure, blood counts, hematocrit, hemoglobin S levels, and plasma viscosity require careful attention even after apparent recovery.
- This case highlights a potential, severe complication of sickle cell disease recovery, emphasizing the need for vigilant management.