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Two biomarkers of splenic function in sickle cell anemia may correlate with liver-spleen scan
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Pitted cell counts and Howell-Jolly bodies may be effective biomarkers for splenic function in children with sickle cell anemia, according to study results.
Researchers from several sites in the United States used sulfur colloid liver-spleen scans to evaluate spleen function in 193 children with sickle cell anemia. Eligible children were aged 8 to 18 months. Results were correlated with clinical and laboratory parameters that included two splenic biomarkers: pitted cell counts and quantitative Howell-Jolly bodies enumerated by flow cytometry.
Eighty-six percent of children younger than 12 months experienced loss of splenic function that was linked to lower total or fetal hemoglobin and higher white blood cell or reticulocyte counts. These results reinforce the need for increased preventive care and more effective early diagnosis strategies, according to the researchers.
The two splenic biomarkers correlated with each other and with scan results. Children with normal splenic uptake had lower values for the two biomarkers, and children with absent splenic function had higher values (P<.001).
Biomarker threshold values that were described in previous research effectively defined children with abnormal splenic function. However, the current findings indicate that normal spleen function is more effectively predicted by pitted cell counts of less than 1.2% or Howell-Jolly bodies of less than 55/106red blood cells. Absent spleen function was measured best in the current study by pitted cell counts of more than 4.5% or Howell-Jolly bodies of more than 665/106.
Howell-Jolly bodies may be a more methodologically advantageous biomarker than pitted cell counts; however, “both are valid biomarkers of splenic function,” the researchers wrote. “We conclude that the high rate of splenic dysfunction documented by 1 year of age mandated that preventive strategies be adhered to assiduously.”
For more information:
- Rogers ZR. Blood. 2011;doi:10.1182/blood-2010-04-278747.
How astonishing that virtually all sickle babies have lost splenic function by 18 months. The need for pneumococcal vaccination very early in these children is validated.
– Harry S. Jacob, MD, FRCPath (Hon)
HemOnc Today Chief Medical Editor