Portal de Periódicos da CAPES

Platelets decline during V aso‐occlusive crisis as a predictor of acute chest syndrome in sickle cell disease

2015; Wiley; Volume: 90; Issue: 12 Linguagem: Inglês

10.1002/ajh.24214

1096-8652

Chaher Alhandalous, Jin Han, Lewis L. Hsu, Michel Gowhari, Johara Hassan, Robert E. Molokie, Taimur Abbasi, Victor R. Gordeuk,

Autopsy Techniques and Outcomes

American Journal of HematologyVolume 90, Issue 12 p. E228-E229 CorrespondenceFree Access Platelets decline during Vaso-occlusive crisis as a predictor of acute chest syndrome in sickle cell disease Chaher H. Alhandalous, Corresponding Author Chaher H. Alhandalous Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorJin Han, Corresponding Author Jin Han Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorLewis Hsu, Corresponding Author Lewis Hsu Department of Pediatrics, University of Illinois at Chicago, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorMichel Gowhari, Corresponding Author Michel Gowhari Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorJohara Hassan, Corresponding Author Johara Hassan Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorRobert Molokie, Corresponding Author Robert Molokie Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois Jesse Brown VA Medical Center, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorTaimur A. Abbasi, Corresponding Author Taimur A. AbbasiCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorVictor R. Gordeuk, Corresponding Author Victor R. Gordeuk Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this author Chaher H. Alhandalous, Corresponding Author Chaher H. Alhandalous Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorJin Han, Corresponding Author Jin Han Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorLewis Hsu, Corresponding Author Lewis Hsu Department of Pediatrics, University of Illinois at Chicago, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorMichel Gowhari, Corresponding Author Michel Gowhari Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorJohara Hassan, Corresponding Author Johara Hassan Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorRobert Molokie, Corresponding Author Robert Molokie Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois Jesse Brown VA Medical Center, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorTaimur A. Abbasi, Corresponding Author Taimur A. AbbasiCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this authorVictor R. Gordeuk, Corresponding Author Victor R. Gordeuk Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IllinoisCorrespondence to: Chaher H. Alhandalous, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Jin Han, Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Michel Gowhari, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Johara Hassan, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Lewis Hsu, Department of Pediatrics, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Robert Molokie, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected] (or) Taimur A. Abbasi, E-mail: [email protected] (or) Victor R. Gordeuk, Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL. E-mail: [email protected]Search for more papers by this author First published: 09 October 2015 https://doi.org/10.1002/ajh.24214Citations: 8 Conflict of interest: Nothing to report. AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL To the Editor Acute chest syndrome (ACS) is a frequent complication of sickle cell disease patients hospitalized with vaso-occlusive crisis and is leading cause of death 1. The manifestations of ACS may be gradual or rapid leading to death in a few hours. ACS may be caused by infection, fat embolism from necrotic bone marrow, pulmonary thromboembolism or pulmonary changes due to microvascular obstruction. It is defined as a new infiltrate on chest x-ray with one or more of these findings: fever, cough, shortness of breath, and hypoxia. Given the high mortality and morbidity associated with ACS, some investigators have sought to define objective biologic markers to predict its occurrence. Elevation in serum concentration of the acute phase reactant, secretory phospholipase A2 (SplA2), during hospitalization for vaso-occlusive crisis was found to correlate the development of ACS in children, but the time to perform the test made it impractical for clinical use as ELISA-based assays are not widely available in clinical laboratories 2. C-reactive protein is an acute phase reactant whose serum concentration parallels the concentration of SplA2 during the the hospital course, so it was suggested as a substitute for Spla2 to predict development of ACS 3. Pentraxin–related protein (PTX3) behaves as an acute phase protein and is a rapid marker for primary local activation of innate immunity and inflammation. PTX3 concentrations were higher in patients with sickle cell disease during vaso-oclusive crisis and higher initial concentrations correlated with the development of ACS 4. Sickle cell disease is a chronic inflammatory state characterized by increased levels of acute phase reactants and activation of platelets. Platelet activation increases during a vaso-occlusive crisis as do platelet-derived molecules that promote cellular adhesion 5, 6. Platelet-derived markers of inflammation. Patients may have high platelet counts during steady state, but platelets usually decrease during an acute vaso-occlusive crisis. A decrease in platelet count has been reported in patients with ACS. We hypothesized that the magnitude of platelet decline during a vaso-occlusive may be predictive of the development of ACS during the hospital course. We retrospectively analyzed data from adult sickle cell disease patients who were admitted to the hospital due to vaso-occlusive crisis from February to October 2014. If there were multiple admissions, the first hospitalization during the steady window was selected. We also analyzed data from the same patients when they were seen in the clinic under steady-state conditions before the hospital admission. The primary outcome was the development of ACS, defined as a new infiltrate on chest x-ray in a patient admitted for vaso-occlusive pain crisis. The lowest platelet was defined as that which occurred before a simple or exchange transfusion. We studied 71 patients with a mean (SD) age of 36 (13) years; 41 (58%) were females, 58 (82%) had hemoglobin SS or Sbeta0 thalassemia, and 32 (45%) were on hydroxyurea. ACS developed in 30 (42%) of the patients. A decline in platelet count from steady state to admission was almost twice as common in the patients who developed ACS compared to those who did not (60% vs. 32%, P = 0.018). The decline in platelet counts from steady-state to admission was greater in those who developed ACS as well (18 × 109/L vs. −27 × 109/L, P = 0.012) In this study, a logistic regression model was used, adjusting for age, gender, SCD genotypes, oral administration of hydroxyurea, and the proportional platelet drop. The platelet count drop more than 10% from steady state to admission, was an independent predictor for developing ACS (OR 6.90, 95% CI 1.82–26.3, P = 0.004). The proportional drop in platelet count from steady state to admission also correlated with the need for blood transfusion (P = 0.0331), but less significantly than the platelet drop to the nadir during the hospitalization (P < 0.001). The larger platelet proportional drop to the nadir had correlation with longer hospital length of stay (LOS (P = 0.0131).but it also correlated with lower 30-day readmission rate (P = 0.03). ACS is a frequent complication of sickle cell disease patients, and a leading cause of death. But there are few objective markers to predict its occurrence. It would be helpful to find a simple, widely available cost-effective test, which can be done on a daily basis, to anticipate the event. We found that the change in platelet count at presentation is a significant predictor of the development of ACS. In particular, patients who developed ACS tended to have a decline in platelet count from steady state at the time of presentation whereas those who did not tended to have an increase in platelet count at presentation. Both groups experienced a decline in platelet count during hospitalization, but those who developed ACS had a significantly greater decline. Putting our findings into perspective, change in platelet count will not be a single definitive test for predicting ACS. However, it has the potential to be part of a clinical panel including other tests to subdivide patients with sickle cell disease during VOC into risk-categories for developing ACS. The proportional decline in platelet count also strongly correlated with the need for blood transfusion, and this may be explained partly by giving blood as a treatment for ACS. Another association of proportional decline in platelet counts was with longer length of hospital stay, which also may be related in part to a hospitalization complicated by ACS. Interestingly, the 30-day readmission rate was lower in patients having a larger proportional decline, raising the possibility that management of ACS with antibiotics and blood transfusion has benefits extending beyond the hospitalization itself. The reason for the decline in platelet count in most patients experiencing a vaso-occlusive crisis is not clear, but there are several possibilities. Consumption of platelets in a DIC-like picture or a TTP-like picture are possible factors. Platelets decline during VOC could also be due to sepsis or to a viral syndrome. Acute splenic sequestration or hypersplensism with chronic thrombocytopenia in patients with sickle cell SC disease could be the culprit in some cases of platelet decline during VOC. Further research is needed to define the cause or causes of platelet decline during VOC and whether this process is pathophysiologically related to the development of ACS in some cases. The authors declare that they have no conflicts of interest, and no financial relationship with the organization that sponsored the research. Odds ratio 95% confidence internval P-value Platelet drop from Steady State to admission >10% 6.896552 1.82–26.3 0.004 Age 0.97371 0.93–1.02 0.227 Gender 0.866551 0.29–2.62 0.8 SCD genotype 1.392758 0.34–5.65 0.643 On hydroxyurea 0.525762 0.18–1.58 0.252 Chaher H. Alhandalous1*, Jin Han2*, Lewis Hsu3*, Michel Gowhari1*, Johara Hassan1*, Robert Molokie1,4*, Taimur A. Abbasi5* and Victor R. Gordeuk1* 1Sickle Cell Center, Division of Hematology-Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, Illinois; 2Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, Illinois; 3Department of Pediatrics, University of Illinois at Chicago, Chicago, Illinois; 4Department of Hematology/Oncology at University of Illinois at Chicago, Jesse Brown VA Medical Center, Chicago, Illinois; 5Department of pulmonary and Critical care, University of Illinois at Chicago, Chicago, Illinois; References 1Vichinsky EP, Neumayr LD, Earles AN, et al. Causes and outcomes of the acute chest syndrome in sickle cell disease. National Acute Chest Syndrome Study Group. N Engl J Med 2000; 342: 1855– 1865. 2Styles LA, Aarsman AJ, Vichinsky EP, et al. Secretory phospholipase A(2) predicts impending acute chest syndrome in sickle cell disease. Blood 2000; 96: 3276– 3278. 3Bargoma EM, Mitsuyoshi JK, Larkin SK, et al. Serum C-reactive protein parallels secretory phospholipase A2 in sickle cell disease patients with vasoocclusive crisis or acute chest syndrome. Blood 2005; 105: 3384– 3385. 4Elshazly SA, Heiba NM, Abdelmageed WM. Plasma PTX3 levels in sickle cell disease patients, during vaso occlusion and acute chest syndrome (data from Saudi population). Hematology 2014; 19: 52– 59. 5Brittain HA, Eckman JR, Swerlick RA, et al. Thrombospondin from activated platelets promotes sickle erythrocyte adherence to human microvascular endothelium under physiologic flow: A potential role for platelet activation in sickle cell vaso-occlusion. Blood 1993; 81: 2137– 2143. 6Beurling-Harbury C, Schade SG. Platelet activation during pain crisis in sickle cell anemia patients. Am J Hematol 1989; 31: 237– 241. Citing Literature Volume90, Issue12December 2015Pages E228-E229 ReferencesRelatedInformation