What are the liver function parameters that would be affected by a Sickle Cell Crisis and why?

What is Sickle Cell crisis?

To understand what sickle cell crisis is, one needs to understand what sickle cell anaemia is. Sickle cell anaemia is an inherent form of anaemia which affects the morphology of the red blood cells. In a healthy individual, the red blood cells are disc-shaped and have maximum efficiency for transport of oxygen and passing through narrow pathways. But, in sickle cell anaemia, the red blood cells are crescent-shaped or sickle-shaped and this change in shape causes various effects in the person’s body.

The changed shape of the cells reduces the surface area making it difficult for the transport of oxygen. The cells also break down easily due to haemolysis. The crescent shape of the cells prevents them from easily moving through the blood vessels and may cause obstruction of the blood vessels.  This obstruction leads to a painful condition called sickle cell crisis.

Where is the pain usually felt?

Painful episodes due to sickle cell crisis are seen in many parts of the body. Some of the common regions are:

·         Chest·         Limbs·         Digits (toes and fingers)

Sometimes, the pain may be unbearable and last for over weeks, but sometimes, the pain is mild and disappears in a few hours. Depending on the pain levels, patient is treated.

What happens in Sickle Cell Crisis?

In sickle cell crisis, the sickle celled red blood cells block the narrow blood vessels. The exact mechanism of this procedure is unknown but researchers say that the “sickling” process occurs due to certain triggers. Some of these triggers are reduced oxygen content, sudden strenuous exercise, the sudden change in temperature, dehydration, infections and even stressful conditions. When the blood cells are stuck, they obstruct the flow of blood and this leads to pain.

How is Sickle Cell crisis managed?

The management of sickle cell crisis is dependent on the intensity of pain. If the pain levels are mild to moderate, the patient has advised the use of over-the-counter pain medications. Warm baths, massages and hot packs also provide relief. One must remember to keep hydrated throughout the day.

In case of severe pain, sickle cell crisis can be managed by pain medications prescribed by the doctor. This can be simple non-steroidal anti-inflammatory drugs or stronger steroidal drugs and opioids.

What are the liver function test parameters that are affected in sickle cell crisis?

Liver function test is a test which measures the values of substances commonly found in the liver. An increase or decrease in these levels denotes problems in liver functioning. The functions of the liver are affected in sickle cell crisis because of the condition itself and also the treatment. Sickling within the liver, gallstones and frequent transfusions are some of the main causes of hepatic malfunction.

Sickled cells which lie trapped in the sinusoids of the liver are engulfed by the white blood cells, leading to hepatomegaly, a condition where the size of the liver is increased.

It has been observed that patients with sickle cell anaemia show increased levels of ferritin due to frequent blood transfusions. Many showed elevated levels of alanine aminotransferase (ALT).  Alkaline phosphatase levels were also seen to be increased in patients with sickle cell crisis. The bilirubin content was seen to be more than 2mg/dl which is more than the normal levels. Bilirubin is the yellowish pigment seen after a breakdown of red blood cells. All these features were seen to be a result of either sickle cell crisis directly or due to the treatment for sickle cell crisis.

These elevated values of certain substances in the liver, as seen on the liver function test confirm the various complications of sickle cell crisis. One must be aware of these complications so that the serious consequences can be avoided at the earliest.

Also Read: Is there a cure for Sickle Cell Disease?

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