Urinary Sickle Cells in a Patient with Vaso-Occlusive Crisis: A Case Report

Case Report

J Blood Disord. 2022; 9(1): 1068.

Urinary Sickle Cells in a Patient with Vaso-Occlusive Crisis: A Case Report

Panjikaran RJ¹*, Prabhalakshmy K¹, Subitha K¹ and Kottoor SJ²

¹Department of Pathology, Government Medical College, India

²Department of General Medicine, Jeevodaya Mission Hospital, India

*Corresponding author: Rosmi Joji Panjikaran, Department of Pathology, Government Medical College, Thrissur, Kerala, India

Received: May 03, 2022; Accepted: June 07, 2022; Published: June 14, 2022


Vaso-occlusive crisis is the most common complication in sickle cell disease and can cause multi organ damage. Here we present a case of sickle cell anemia with vaso- occlusive crisis. The patient is a 39-year-old tribal male, a known case of homozygous sickle cell disease who presented with acute respiratory infection, bilateral lower limb pain and decreased urine output. Peripheral blood smear showed sickled red cells with features of hemolysis and reticulocytosis. Hemoglobin electrophoresis showed prominent HbS band. His symptoms progressed rapidly and he developed hematuria. Urine examination showed sickled erythrocytes. Later the patient went into cardiac arrest and succumbed to the disease. While hematuria is a common symptom in sickle cell disease, sickled RBCs in urine microscopy should be considered a bad prognostic indicator.

Keywords: Sickle Cell Anemia; Hematuria; Urine Microscopy; Sickled Erythrocytes


SCA: Sickle Cell Anemia; SCD: Sickle Cell Disease; HPLC: High Performance Liquid Chromatography; IV: Intravenous

Case Presentation

A 39-year-old tribal male patient was admitted in a tertiary care center in Kerala with complaints of fever, cough, dyspnea, abdominal pain and bilateral lower limb pain. He had difficulty in walking with history of recurrent falls. He also complained of decreased urine output for the past two to three days. He was a known case of type 2 diabetes mellitus and coronary artery disease and a past history of pulmonary tuberculosis, treated with anti-tubercular drugs. He was diagnosed with SCA and was on treatment since 5 years. However, he had stopped medications for the past 2 months. High Performance Liquid Chromatography (HPLC) done 5 years back had showed 79.5% HbS, 17% HbF, 3.5% HbA2, and no HbA, suggestive of HbS (sickle cell homozygous) disease. He also had a similar history of pain over both legs 6 months back that resolved with treatment. On admission patient was tachypneic with visible pallor and icteric sclera. Chest auscultation showed bilateral crepitations. Abdominal examination showed guarding and rigidity. Yellowish discoloration of urine was also noted. Routine blood investigations showed mild anemia, along with leukocytosis and thrombocytosis. Elevated urea (293 mg/dL), creatinine (3.6 gm/dL), hyponatremia and hyperkalaemia (7.3 meq/L) were also noted. Liver function test showed hyperbilirubinemia, grossly elevated transaminases and prolonged PT and APTT levels. Ultrasound abdomen was unremarkable with normal sized liver and spleen. Peripheral smear showed sickled red cells with hemolysis, anisopoikilocytosis and neutrophilic leukocytosis suggestive of sickle cell crisis (Figure 1). Reticulocyte count was 10%. Hemoglobin electrophoresis showed prominent HbS band (Figure 2). Treatment was started with Intravenous fluids (IV), analgesics and IV antibiotics. Fresh frozen plasma was also transfused.