Acute and chronic hepatobiliary manifestations of sickle cell disease: A review

Table 2 Chronic hepatobiliary manifestations of sickle cell disease

Chronic hepatobiliary manifestations of SCD	Clinical presentation	Biochemical changes			Management
		Transaminase (AST, ALT) levels	Bilirubin	Alkaline phosphatase
Cholelithiasis	RUQ pain, fever, jaundice	Normal or elevated	Normal or elevated	Normal	Cholecystectomy
Choledocholithiasis	RUQ pain, fever, jaundice, cholangitis	Normal or elevated	Elevated	Elevated	ERCP
Iron overload	Asymptomatic elevated LFTs to frank cirrhosis	Normal or elevated	Normal to mild elevation	Normal	Iron chelation
Viral hepatitis	Viral prodrome, fever, hepatomegaly, jaundice	Acute-elevated	Acute-elevated	Acute - normal to slightly elevated;	Based on AASLD guidelines
		Chronic-normal or elevated	Chronic-normal or elevated	Chronic - mostly normal
Sickle cell cholangiopathy	Obstructive jaundice, itching, cholestatic LFTs	Normal or elevated	Elevated	Elevated	ERCP
					liver transplant

SCD: Sickle cell disease; AST: Aspartate transaminase; ALT: Alanine transaminase; RUQ: Right upper quadrant; ERCP: Endoscopic retrograde cholangiopancreatography; LFTs: Liver function tests; AASLD: American Association for the Study of Liver Diseases.