We evaluated spleen function in 193 children with sickle cell anemia 8 to 18 months of age by 99m Tc sulfur-colloid liver-spleen scan and correlated results with clinical and laboratory parameters, including 2 splenic biomarkers: pitted cell counts (PIT) and quantitative Howell-Jolly bodies (HJB) enumerated by flow cytometry. Loss of splenic function began before 12 months of age in 86% of infants in association with lower total or fetal hemoglobin and higher white blood cell or reticulocyte counts, reinforcing the need for early diagnosis and diligent preventive care. PIT and HJB correlated well with each other and liver-spleen scan results. Previously described biomarker threshold values did define patients with abnormal splenic function, but our data suggest that normal spleen function is better predicted by PIT of < 1.2% or HJB < 55/10 6 red blood cells and absent function by PIT > 4.5% or HJB > 665/10 6 . HJB is methodologically advantageous compared with PIT, but both are valid biomarkers of splenic function. This trial was registered at www.clinicaltrials.gov as #NCT00006400. (Blood. 2011;117(9): 2614-2617)
IntroductionThe spleen is one of the first organs damaged in sickle cell anemia (SCA). Consequences of this damage, increased risk of invasive pneumococcal infection and splenic sequestration, are difficult to predict for a given child. The "gold standard" for assessment of splenic filtrative function is a 99m Tc sulfur-colloid liver-spleen (LS) scan. However, LS scans yield qualitative results and require low-dose radiation exposure.BABY HUG, the Pediatric Hydroxyurea phase 3 Clinical Trial, is an National Heart, Lung, and Blood Institute and National Institute of Child Health and Human Development-sponsored 14-center, randomized double-blind placebo-controlled trial of the efficacy of hydroxyurea in preventing chronic organ damage in infants with SCA. The trial was approved by the institutional review boards of all participating centers. Prevention of loss of splenic function is a primary endpoint. 1 After written informed consent in accordance with the Declaration of Helsinki, splenic filtrative function of children in BABY HUG was assessed by LS scan and compared with 2 surrogate biomarkers: pitted erythrocyte (PIT) counts by Nomarski optics and Howell-Jolly Bodies (HJBs) quantitated by flow cytometry. These pretreatment baseline data form the largest reported assessment of spleen function in young children with SCA by LS scan, define parameters of loss of function, and validate both biomarkers as accurate noninvasive measures of splenic function.
Methods
LS scanA standardized dose of 0.05 mCi/kg (minimum 0.5 mCi, 1 mCi if local practice) of 99m Tc sulfur-colloid was injected into a peripheral vein. Liver and spleen were imaged 30 minutes later in the posterior, anterior, left anterior oblique, and right posterior oblique planes. Splenic uptake was qualitatively interpreted on de-identified films by structured consensus of 3 pediatric nuclear medicine physicians as normal (spleen uptake equal to li...