Management recommendations in acute sickle hepatopathy
| Clinical scenario . | Clinical/investigative data . | Management recommendations . |
|---|---|---|
| Gallstones | May be asymptomatic Right upper quadrant pain Cholangitis | Cholecystectomy for symptomatic gallstones ERCP with duct clearance for bile duct stones |
| Acute sickle hepatic crisis | Vaso-occlusive crisis RUQ pain/jaundice/leukocytosis Bilirubin <15 mg/dL ALT rarely >300 IU/L | Supportive Consider exchange blood transfusion |
| Sickle cell intrahepatic cholestasis | Vaso-occlusive crisis RUQ pain, leukocytosis, fever, striking jaundice Very high bilirubin ALT can be in 1000s Coagulopathy Renal failure | Full supportive management Exchange blood transfusion |
| Hepatic sequestration | Enlarging liver RUQ pain Anemia Reticulocytosis | Supportive Transfusion |
| Clinical scenario . | Clinical/investigative data . | Management recommendations . |
|---|---|---|
| Gallstones | May be asymptomatic Right upper quadrant pain Cholangitis | Cholecystectomy for symptomatic gallstones ERCP with duct clearance for bile duct stones |
| Acute sickle hepatic crisis | Vaso-occlusive crisis RUQ pain/jaundice/leukocytosis Bilirubin <15 mg/dL ALT rarely >300 IU/L | Supportive Consider exchange blood transfusion |
| Sickle cell intrahepatic cholestasis | Vaso-occlusive crisis RUQ pain, leukocytosis, fever, striking jaundice Very high bilirubin ALT can be in 1000s Coagulopathy Renal failure | Full supportive management Exchange blood transfusion |
| Hepatic sequestration | Enlarging liver RUQ pain Anemia Reticulocytosis | Supportive Transfusion |
Adapted from Tavabie and Suddle5 with permission.
ALT, alanine aminotransferase; RUQ, right upper quadrant.