Fat embolism syndrome due to bone marrow necrosis in patients with hemoglobinopathies: A life‐threatening complication mimicking thrombotic thrombocytopenic purpura

Revisiting fat embolism in sickle syndromes: diagnostic and emergency therapeutic measures

“…Pre‐emptive treatment with RCE ± TPE before the development of organ failure must also be considered. Very high levels of serum ferritin and LDH in the context of FES have been reported, and this is certainly our own experience (Blacker & Tsitsikas, ; Gangaraju et al , ). Patients fitting the very characteristic at‐risk profile presenting with unusually severe pain, and ferritin and LDH levels more than 10–20 times the upper end of the reference range may benefit from such an approach.…”

“…Laboratory data show a drop in haemoglobin and more characteristically – platelets, and markedly elevated lactic dehydrogenase (LDH) and ferritin. (Blacker & Tsitsikas, ; Gangaraju et al , ). In patients with neurological involvement, computed tomography may be normal and only magnetic resonance imaging (MRI) may detect the characteristic “starfield” pattern (Kang et al , ).…”

“…Furthermore, the constellation of fever, neurological signs and thrombocytopenia mimics thrombotic thrombocytopenic purpura (TTP). The degree of thrombocytopenia is more severe in TTP compared to FES and the peripheral smear can be very helpful in distinguishing the two conditions (Adamski et al , ; Gangaraju et al , ).…”

Fat Embolism Syndrome in Sickle Cell β-Thalassemia Patient With Osteonecrosis: An Uncommon Presentation in a Young Adult

“…Patients undergoing BMN and are at the early stages of FES are often misdiagnosed as TTP, as both subsets of patients will suffer from thrombocytopenia, encephalopathy, acute anemia, fever, and acute kidney injury. 14 The severity of thrombocytopenia and peripheral smear are the differentiating findings between FES and TTP as thrombocytopenia is more severe in TTP. Common peripheral smear finding reported in FES is leukoerythroblastosis and less commonly schistocytes than TTP.…”

“…Common peripheral smear finding reported in FES is leukoerythroblastosis and less commonly schistocytes than TTP. 14 However, in patients with TTP, the RC is elevated; while in FES, due to BMN, there is a low RC. 5 Thus prompt recognition of FES can be done via clinical signs or symptoms, especially if the patient has a documented history of sickle cell disorders, regardless of homozygous or heterozygous.…”