Bariatric Surgery Impact on Sickle Cell Disease Pain Crisis: A Case Report

Sickle cell disease (SCD) is an autosomal genetic blood disorder resulting in multiple end-organ complications. Malnutrition is a stress factor that can cause a SCD crisis. Bariatric surgery is a weight reduction surgery that involves the binding or removing a part of the stomach or resecting and re-routing the small intestine to a small stomach pouch. It is known to cause malnutrition and stress. Malnutrition affects more than two billion people of all ages worldwide due to different causes. Long-term deficiency of micronutrients leads to reduced immunity, leukopenia, and diseases affecting the psychological, skeletal, and central nervous system. We here present the case of a 20-year-old woman with SCD and class III obesity. She underwent sleeve gastrectomy in 2018 following psychological distress caused by being severely overweight. She had mild SCD pain, but after the bariatric surgery, it became severe, requiring morphine treatment and monthly exchange transfusion beside the NSAID which become not much effective as before bariatric surgery. Our findings show that bariatric surgery, which leads to a stressful condition, can aggravate the SCD pain crisis, thereby highlighting the need for alternative methods of weight reduction in these patients. Controlled studies are required for the proper assessment of bariatric surgery in SCD.

The Prevalence and Severity of Gallstones in Sickle Cell Disease in Kuwait

Introduction: Sickle cell disease (SCD) is a genetic disease affecting hemoglobin development. Complications may occur in all organs due to sickle cell hemoglobin. Gallstones may develop as the complication of the biliary system in SCD. Aim: To calculate the prevalence and severity of the biliary system complications in SCD. Method: A total of 220 patients with homozygous SCD were recruited. The prevalence of gallstones was estimated, and the severity of the biliary system complications was classified according to the condition of the gallstones;it was classified as grade 0 when no gallstones were detected, grade 1 when gallstones were present only in the gallbladder, grade 2 when gallstones were present in both the gallbladder and the common bile duct, and grade 3 when the patient had cholecystectomy due to gallstones. Results: The overall prevalence of gallstones and cholecystectomy was 51%;it was 22% in females and 29% in males. The prevalence of the severity of grade 0 was 49%, grade 1 was 14%, and grade 3 was 37%. Grade 2 prevalence was not calculated because this study was based on abdominal ultrasound only. Conclusion: The prevalence of gallstones in SCD is much higher than in the normal population, and more in males than in females. It begins at an early age during childhood due to several underlying etiological factors related to SCD. This study provided a simple grading of severity for the biliary system based on the gallbladder stone complication. The severity calculation in the biliary system is a part of the assessment of the severity in other systems in this multisystem chronic disorder.