Mixed Anaemic Crisis in Patients with Sickle-cell Anaemia.

Abstract

Summary: The three types of severe anaemic crises recognised in sickle-cell anaemia (SCA) are aplastic, acute splenic sequestration and hyperhaemolytic. However, among 104 consecutive SCA cases admitted to the Children Emergency Ward of the University College Hospital, Ibadan with severe anaemic crises recently, were ten (9.6 percent) children who had mixed features and did not fall neatly into any of the three recognised categories. The distributions of the sex and admission haematocrits in these ten children with mixed' anaemic crises were similar to those of the 94 others with easily classified (pure) anaemic crises. However, using statistical test appropriate for the small numbers involved, Salmonella bacteraemia was significantly more common (5/10) among the patients with ‘mixed' anaemic crises than in those (5/94) with pure crises (P=0.0006). The relative risk of Salmonella bacteraemia in ‘mixed' crises was 9.4 times that among those with pure crises (95%CI=3.28-26.98). Although none of the “mixed cases died, compared with a mortality of 9.6 percent among the 'pure cases, the difference was not significant (P=0.42). Bacteraemia appears to be associated with mixed' indeterminate) anaemic crises in SCA. This finding suggests that such patients would benefit from appropriate antibiotic therapy.