TITLE:
Acute Chest Syndrome in Children with Sickle Cell Anaemia: An Audit in Port Harcourt, Nigeria
AUTHORS:
Innocent O. George, Chika N. Aiyedun
KEYWORDS:
Acute Chest Syndrome, Clinical Features, Treatment, Outcome, Port Harcourt
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.5 No.4,
December
17,
2015
ABSTRACT: Acute chest syndrome
(ACS) is a leading cause of death from sickle cell disease worldwide accounting
for about 25% of all deaths. The aim of this study was to determine the
prevalence, clinical features and outcome in Port Harcourt, Nigeria. Materials
and Methods: A retrospective cohort study during a five year period. Records of all
patients with sickle cell anaemia (SCA) admitted into the Wards were examined.
Those enrolled for the study satisfied two criteria: 1) lower respiratory tract
symptoms and 2) new pulmonary infiltrates on the chest radiograph.
Sociodemographics, genotype, clinical and laboratory features, treatment given
and outcome were obtained. Data were analysed by descriptive statistics.
Variables were compared by students’ t-test. P value ≤ 0.05 was regarded as
significant. Results: A total of 345 children with sickle cell
anaemia were admitted during the 5 year period. Twelve of them had acute chest
syndrome (3.5%). Majority 7 (58.3%) of them were under 5 years. There were more
males 8 (66.7%) than female 4 (33.3%). The most common clinical features were
fever 12 (100%), cough 10 (83.3%), chest pain 5 (41.7%), pulmonary consolidation 12 (100%), and respiratory
distress 12 (100%). The admitting diagnosis were bronchopneumonia 6 (50%),
severe malaria 3 (25%) and vaso-occlusive crises
3 (25%). There were very high levels of leukocyte. Received ceftriaxone or ampicillin + gentamicin ± oral erythromycin), paracetamol 12 (100%), ibuprofen 8 (66.7%),
tramadol 3 (25.0%), pentazocine 8 (66.7%)
and blood transfusion 9 (75%). The average length of stay was 7 days (range 4
- 14 days). One patient died (8.3%). Conclusion:
ACS is not uncommon in children with SCA in Port Harcourt. Education of parents
on the need to recognize early symptoms of the disease is essential. Clinicians
must be trained to correctly diagnose and manage it promptly and efficiently to
avoid its related disastrous consequences.