Safety of Iodinated Intravenous Contrast Medium Administration in Sickle Cell Disease

doi:10.1016/j.amjmed.2011.06.010

The American Journal of Medicine

Volume 125, Issue 1, January 2012, Pages 100.e11-100.e16

https://doi.org/10.1016/j.amjmed.2011.06.010 Get rights and content

Abstract

Background

Increased sickling of erythrocytes following intravenous iodinated contrast has been described in patients with sickle cell disease. In vitro, the effect is correlated with the tonicity, viscosity, acidity, and ionic nature of contrast media. Less erythrocyte sickling is observed in vitro with second-generation low- and iso-osmolar contrast agents. Clinical impact of these newer intravenous contrast agents has not been investigated.

Purpose

To review adverse outcomes following contrast administration in a cohort of patients with sickle cell disease.

Methods

Inpatients with sickle cell disease who received iodinated intravenous were identified. Medical records were reviewed for evidence of worsening crisis and occurrence of adverse events within 48 hours of contrast administration. Data points were further analyzed with the goal of identifying predictors of adverse outcome.

Results

There were 132 imaging studies that met inclusion criteria in 79 patients, mostly with homozygous hemoglobin S. The low-osmolar contrast Optiray (Coviden Imaging Inc., Hazelwood, Mo) was used in 45%. Administration of fluids, Mucomyst (Bristol-Myers Squibb, New York, NY), oxygen, or blood transfusion preceded 58% of studies. Minor adverse events followed 16% of studies, with new or worsening pain being most common (12%). Contrast-induced nephropathy occurred in 1.5%, resolving in all cases. Prehydration was associated with a decreased incidence of adverse events (P = .02).

Conclusion

Adverse events related to intravenous contrast occur in sickle cell disease patients at a rate similar to the general population, without an increase in contrast-induced nephropathy. Subjective reports of new or worsening pain crisis do not translate to objective findings. Beneficial diagnostic imaging can be performed without increased risk of serious complication in this population.

Section snippets

Methods

This retrospective, single-center study evaluated the outcomes from intravenous contrast administration in patients with sickle cell disease. Hospital encounters January 1, 2000 through June 30, 2006 were reviewed for the primary or secondary diagnosis of sickle cell anemia (International Classification of Diseases, 9^th Revision [ICD-9] codes 282.60-282.69). “Current procedural terminology” coding and radiographic imaging reports were used to identify encounters that included the administration

Results

Review of diagnostic ICD-9 coding identified 338 patients with sickle cell disease receiving care at Thomas Jefferson University Hospital from January 1, 2000 through June 30, 2006. This cohort underwent 187 radiologic imaging studies utilizing intravenous iodinated contrast agents during the 5.5-year period. Of these, 132 studies performed in 79 patients met the inclusion criteria for our investigation. Studies were excluded for the following reasons: 38 studies had insufficient patient

Discussion

The incidence of adverse events following intravenous iodinated contrast in this population of patients with sickle cell disease was 16%. The incidence of iodinated contrast medium reactions in the general population has been described up to 15%,¹⁴ but varies widely depending on the characteristics of contrast medium used. In the largest case series involving 337,647 Japanese patients, the prevalence of adverse drug reaction varied from 12.7% for ionic to 3.1% for nonionic iodinated contrast

References (21)

Sickle cell anemia: National Heart, Lung, and Blood Institute Diseases and Conditions Index
A. Ashey-Koch et al.
Sickle hemoglobin (HbS) allele and sickle cell disease: a HuGE review
Am J Epidemiol
(2000)
B.L. McClennan et al.
Hickey Memorial Lecture: Ionic and nonionic iodinated contrast media: evaluation and strategies for use
AJR Am J Roentgenol
(1990)
M.L. Cheatham et al.
Problems in the management of subarachnoid hemorrhage in sickle cell anemia
J Neurosurg
(1965)
D. Richards et al.
Angiographic media and the sickling phenomenon
Surg Forum
(1971)
V.M. Rao et al.
The effect of ionic and nonionic contrast media on the sickling phenomenon
Radiology
(1982)
P. Losco et al.
Comparison of the effects of radiographic contrast media on dehydration and filterability of red blood cells from donors homozygous for hemoglobin A or hemoglobin S
Am J Hematol
(2001)
A.K. Rao et al.
Angiographic contrast agent-induced acute hemolysis in a patient with hemoglobin SC disease
Arch Intern Med
(1985)
M. Darr et al.
Hemolytic anemia associated with a radiopaque contrast agent in a patient with hemoglobin SC disease
South Med J
(1981)
M. Banna
Post-angiographic blindness in a patient with sickle cell disease
Invest Radiol
(1992)

There are more references available in the full text version of this article.

Cited by (15)

Newer Updates in Pediatric Vascular Diseases
2023, Seminars in Roentgenology
Citation Excerpt :
In the acute setting, computed tomography (CT) is the workhorse for the evaluation of ischemia and intracranial hemorrhage. The use of intravenous iodinated contrast media in the setting of SCD is controversial, but recent studies have shown no significantly increased risk of adverse events following iodinated or gadolinium-based contrast.42,43 Acute stroke MR protocols can be used and typically include diffusion weighted imaging (DWI), FLAIR, susceptibility-weighted imaging (SWI), and time-of-flight MRA.
Pediatric neurovascular pathology directly involves or is in close proximity to the central nervous system (CNS). These vascular pathologies can occur in isolation or in association with broader syndromes. While some vascular pathologies are unique to the pediatric population, the full spectrum of adult neurovascular lesions can also affect children however, may present differently both clinically and on diagnostic imaging. Non-invasive (Ultrasound, CT, MRI) imaging plays a critical role in the diagnosis, treatment planning, and follow-up of vascular lesions involving the CNS. The modality can be chosen based on the age of the child, urgency of diagnosis, and local availability. Each modality has sensitivities and specificities which vary based on the location and imaging findings of a specific neurovascular pathology. In addition to non-invasive options, digital subtraction angiography (DSA) may be used as both a diagnostic and therapeutic imaging method for pediatric vascular lesions of the central nervous system. The diagnosis and management of pediatric cerebrovascular disease requires the close collaboration between pediatricians and pediatric specialists including neuroradiologists, neurologists, neurosurgeons, cardiologists, neurointerventionalists, and anesthesiologists among others. A detailed understanding of imaging findings, natural history, and treatment options is essential to guide and monitor imaging and treatment. The goal of this review is to provide the reader with an overview on pediatric neurovascular pathologies, provide examples of pathognomonic imaging findings, and present a brief review of endovascular treatment options, if applicable.
Abdominal Manifestations of Sickle Cell Disease
2021, Current Problems in Diagnostic Radiology
Citation Excerpt :
Computed tomography (CT) with and without intravenous contrast material has been a mainstay in the evaluation of abdominal manifestations of sickle cell disease. Both acute and chronic diseases can be described and evaluated, and low-osmolar iodinated intravenous contrast material is not contraindicated.11 Magnetic resonance (MR) imaging also is useful in evaluation of these different pathologies with improved evaluation of the biliary system and acute osseous abnormalities including infection or infarction.
Sickle cell disease is a debilitating hematologic process that affects the entire body. Disease manifestations in the abdomen most commonly result from vaso-occlusion, hemolysis, or infection due to functional asplenia. Organ specific manifestations include those involving the liver (eg, hepatopathy, iron deposition), gallbladder (eg, stone formation), spleen (eg, infarction, abscess formation, sequestration), kidneys (eg, papillary necrosis, infarction), pancreas (eg, pancreatitis), gastrointestinal tract (eg, infarction), reproductive organs (eg, priapism, testicular atrophy), bone (eg, marrow changes, avascular necrosis), vasculature (eg, vasculopathy), and lung bases (eg, acute chest syndrome, infarction). Imaging provides an important clinical tool for evaluation of acute and chronic disease manifestations and complications. In summary, there are multifold abdominal manifestations of sickle cell disease. Recognition of these sequela helps guide management and improves outcomes. The purpose of this article is to review abdominal manifestations of sickle cell disease and discuss common and rare complications of the disease within the abdomen.
Sickle Cell Disease in the Emergency Department
2017, Hematology/Oncology Clinics of North America
Citation Excerpt :
However, a negative D-dimer has clinical usefulness in patients deemed to have a low pretest probability and is an avenue to avoid further testing with radiologic imaging. Despite concerns and reports regarding intravenous contrast inducing nephropathy or increasing sickling of erythrocytes, there are data47 indicating no difference in adverse events compared with patients without SCD. However, as an alternative, lung ventilation-perfusion scanning or lower extremity venous duplex evaluation may be considered.
Sickle cell disease in the emergency department
2014, Emergency Medicine Clinics of North America
Citation Excerpt :
However, a negative D-dimer has clinical usefulness in patients deemed to have a low pretest probability and is an avenue to avoid further testing with radiologic imaging. Despite concerns and reports regarding intravenous contrast inducing nephropathy or increasing sickling of erythrocytes, there are data47 indicating no difference in adverse events compared with patients without SCD. However, as an alternative, lung ventilation-perfusion scanning or lower extremity venous duplex evaluation may be considered.
Safety of Ultrasound Contrast Agents in Pediatric Patients With Sickle Cell Disease and Trait
2024, Journal of Ultrasound in Medicine
Early recognition of pulmonary complications of sickle cell disease
2023, Saudi Medical Journal

View all citing articles on Scopus

: Funding: None.

: Conflict of Interest: None.

: Authorship: All authors had access to the data and were involved in writing the manuscript.

View full text

AJM onlineClinical research studySafety of Iodinated Intravenous Contrast Medium Administration in Sickle Cell Disease

Abstract

Background

Purpose

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Sickle cell anemia: National Heart, Lung, and Blood Institute Diseases and Conditions Index

Sickle hemoglobin (HbS) allele and sickle cell disease: a HuGE review

Am J Epidemiol

Hickey Memorial Lecture: Ionic and nonionic iodinated contrast media: evaluation and strategies for use

AJR Am J Roentgenol

Problems in the management of subarachnoid hemorrhage in sickle cell anemia

J Neurosurg

Angiographic media and the sickling phenomenon

Surg Forum

The effect of ionic and nonionic contrast media on the sickling phenomenon

Radiology

Comparison of the effects of radiographic contrast media on dehydration and filterability of red blood cells from donors homozygous for hemoglobin A or hemoglobin S

Am J Hematol

Angiographic contrast agent-induced acute hemolysis in a patient with hemoglobin SC disease

Arch Intern Med

Hemolytic anemia associated with a radiopaque contrast agent in a patient with hemoglobin SC disease

South Med J

Post-angiographic blindness in a patient with sickle cell disease

Invest Radiol

AJM online
Clinical research study
Safety of Iodinated Intravenous Contrast Medium Administration in Sickle Cell Disease