Systemic thrombolysis for acute central retinal artery occlusion in sickle cell disease: Case report

We describe a 42-year-old African- American man with SCD (HbSS) who presented with an acute central retinal artery occlusion (CRAO) within an hour of onset and subsequently received IV thrombolysis with alteplase. His labs were significant for HbS 91%. He had no central vascular access to undergo emergent red blood cell (RBC) exchange so interventional radiology was consulted to minimize his bleeding risk after receiving tissue plasminogen activator (tPA). A right internal jugular catheter was placed with fluoro-guidance, resulting in minimal blood loss. After two sessions of RBC exchange, his HbS decreased to 26%. He reported an improvement of vision in his left eye the day following acute management and followed up with Hematology for secondary stroke prevention.IMPLICATIONS: In reviewing this case, we recommend that current clinical trials for management of acute stroke including an acute CRAO carefully consider including patients with sickle cell disease to receive simultaneous IV thrombolysis and RBC exchange. The benefits outweigh the risk of a permanent disabling deficit with significant functional impairment. And while considering care plans tailored to the projected needs of acute care management for this patient population, we also recommend implementing healthcare models that improve access to preventative care in settings where the majority of children and adults with SCD live.PMID:36163059 | DOI:10.1016/j.jnma.2022.09.003
Source: Journal of the National Medical Association - Category: General Medicine Authors: Source Type: research