Sonographic Screening for Abdominal Organ Involvement in Sickle Cell AnemiaA Step towards Better Patient Care

Background: Sickle cell disease is characterized by repeated crisis and need for frequent transfusions. Abdominal crisis are common and potentially can damage any abdominal organ. Screening for organ involvement will lead to early detection and better patient care. Aim and Objectives: To see whether ultrasound can be a better noninvasive technique for early detection of organ involvement. Material and Methods: Prospective cross sectional observational study done on patients admitted in pediatric ward of a medical college. Total of 150 patients, already diagnosed to have sickle cell anemia (homozygous 110 and heterozygous 40) was included in the study. All the patients were in steady state. Demographic, clinical biochemical details were noted and were subjected to ultrasonography. Renal artery, Being end artery, Doppler study was also done. All the modalities were compared for early detection. Results: Majority of patients (77%) were between 1 to 30 years with male female ratio of 2:1. Recurrent fever (64%) and recurrent abdominal pain (47%) were most common symptoms and anemia (66%), hepatomegaly (62%), splenomegaly (21%) were most common signs. When clinical examination, biochemical tests and ultrasonography were compared for organ detection, ultrasound significantly detected more patients (p=<0.05). Ultrasonography of kidney included renal doppler also. Renal involvement by microalbuminuria measurement was of same as ultrasonography. Organ involvement increased with age. Conclusion: Ultrasonography was good noninvasive technique for organ detection but kidneysyield was better with Doppler study. Most common organ found to be affected was liver. Involvement increased with age. Early detection helps clinicians to avoid drugs toxic to involved organs

Acoustic radiation force impulse elastography of liver as a screening tool for liver fibrosis in alcoholic liver disease

Context: Acoustic radiation force impulse (ARFI) elastography is a noninvasive and quantitative technique for diagnosis of liver fibrosis. To the best of our knowledge, there are only two studies reported in literature for evaluation of alcoholic liver disease using ARFI. Aims: The aim of this study was to evaluate the diagnostic performance of ARFI elastography for assessing liver fibrosis in alcoholic liver disease and compare it with biochemical indices aspartate transaminase-to-platelet ratio index (APRI) and fibrosis-4 Index (FIB-4) using histopathology as the reference standard. Settings and Design: Institutional cross-sectional study. Methods and Materials: The patients visiting our hospital over a period of 2 years with a high-risk consumption of alcohol (>40 g/day for men and >20 g/day for women for a cumulative period of more than 5 years) were subjected to ARFI elastography of liver, Liver Function Tests (to calculate APRI and FIB-4 indices), and liver biopsy. Statistical Analysis Used: Area under the receiver operating characteristic (AUROC) curve analysis, Kruskal--Wallis test for ANOVA. Results: A total of 50 patients of chronic alcoholic liver disease were evaluated with ARFI elastography, which performed better than the biochemical indices in distinguishing cirrhosis of the liver (F = 4) from the severe fibrosis (F ≥ 3) with area under the receiver operating characteristic of 0.97, whereas for significant fibrosis (F ≥ 2) and severe fibrosis (F ≥ 3), it was comparable to the biochemical indices with AUROC of 0.65 and 0.70. In our study, the median shear wave velocity cutoff values were 1.37 m/s, 1.51 m/s, and 1.87 m/s for F ≥ 2, F ≥ 3, and F = 4 fibrosis stages, respectively. Conclusions: ARFI elastography is a noninvasive, reliable, and repeatable diagnostic test for grading of liver fibrosis. It performs better than the biochemical indices to differentiate severe fibrosis and cirrhosis of liver