All
patients more than 14 years old with sickle-
cell disease (SCD) discharged from
hospital with a
diagnosis of
acute chest syndrome (ACS) from January, 1980 to December, 1981 were enrolled in this
retrospective study. Data were collected from
patients'
records to investigate frequency,
risk factors, effect of intravenous
heparin and outcome in ACS. There were 109
adult SCD
patients of whom 53 (49 per cent) were admitted for 81 episodes of ACS. Hb SS and Hb SC
patients were affected equally often.
Chest pain was the most frequent presenting symptom (64 per cent) and 91 per cent of
patients had pulmonary
abnormalities on
physical examination, but only 45 per cent had radiological evidence of ACS at
diagnosis. Forty-three per cent of
sputum cultures grew pathogenic micro-organisms. The overall case-fatality rate was 6 per cent. All 5 non-
survivors were
female Hb SS
patients.
Intention-to-treat
analysis revealed no benefit of intravenous
heparin on outcome (
mortality 5 per cent versus 11 per cent in non-
heparin-treated
patients, p = 0.3),
hospital stay (p = 0.7) or duration of hypoxaemia (p = 0.4) (AU)