Cholelithiasis in Children with Sickle Cell Anaemia in Rural and Tribal Central India

Abstract

Background: Sickle cell anaemia (SCA) is prevalent in central India. Gall stones are known to be present in SCA but its prevalence in the paediatric population is variably reported.

Objective: To study the prevalence of gall stones in children with sickle cell anaemia and its correlation with various crises and serum bilirubin levels. Setting: Department of Pediatrics, Shri VN.Government Medical College, Yavatmal, Maharashtra, India.

Design: Prospective hospital-based study. Methods: All patients with SCA aged 12 years and below, admitted to the pediatric ward of the hospital between June 2006 and May 2007 formed the study material. Detailed history of blood transfusion, jaundice, cholelithiasis, haemolytic crises, and vaso-occlusive crises (VOC) was obtained in respect of each patient. Investigations, including serum bilirubin (total and direct) and cholecystosonogram, were carried out in all cases.

Results: The incidence of SCA was 5.2 percent among the 103 patients studied. Gallstones were detected in eight patients, a prevalence of 7.7 percent; the M: F ratio of the eight was 1:1.66. Significant correlation was found between gallstones and recurrent abdominal VOC, frequency of blood transfusion, as well as total bilirubin and indirect bilirubin levels. However, there was no significant correlation with haemoglobin level, direct bilirubin level and age at first transfusion.

Conclusion: SCA is prevalent in central India. Cholecystosonogram is a non-invasive tool that can be used to diagnose gall stones in these children; hence, all SCA patients aged above five years with total serum bilirubin of more than 3mg/dl and recurrent blood transfusions should be screened for gall stones.