Deep venous thrombosis and pulmonary embolism in hospitalized patients with sickle cell disease

Abstract

Background: As would be expected with a hypercoagulable state, pulmonary embolism (PE) occurs in sickle cell disease (SCD). Its frequency, however, is undetermined, largely because of difficulties in distinguishing it from thrombosis in situ. The prevalence of deep venous thrombosis (DVT) is also undetermined in patients with SCD. Knowing the prevalence of DVT would be an important step in the overall assessment of the risk of PE in these patients.

Methods: Data from the National Hospital Discharge Survey were assessed.

Results: In patients <age 40 years, 7000 of 1,581,000 (0.44%) with SCD had a discharge diagnosis of PE compared with 59,000 of 48,611,000 (0.12%) of African Americans without SCD. The prevalence of DVT was similar in patients < age 40 with SCD, 7000 of 1,581,000 (0.44%) and in African Americans who did not have SCD, 193,000 of 48,611,000 (0.40%).

Conclusion: The high prevalence of apparent PE in patients with SCD, compared with non-SCD African-American patients of the same age and the comparable prevalence of DVT in both groups are compatible with the concept that thrombosis in situ might be present in many. On the other hand, the data suggest that PE is not rare in patients with SCD. This suggests that PE might be an etiologic factor in patients with SCD who develop respiratory symptoms. In such patients, an imaging procedure might be appropriate.