Bariatric Surgery Impact on Sickle Cell Disease Pain Crisis: A Case Report

Sickle cell disease (SCD) is an autosomal genetic blood disorder resulting in multiple end-organ complications. Malnutrition is a stress factor that can cause a SCD crisis. Bariatric surgery is a weight reduction surgery that involves the binding or removing a part of the stomach or resecting and re-routing the small intestine to a small stomach pouch. It is known to cause malnutrition and stress. Malnutrition affects more than two billion people of all ages worldwide due to different causes. Long-term deficiency of micronutrients leads to reduced immunity, leukopenia, and diseases affecting the psychological, skeletal, and central nervous system. We here present the case of a 20-year-old woman with SCD and class III obesity. She underwent sleeve gastrectomy in 2018 following psychological distress caused by being severely overweight. She had mild SCD pain, but after the bariatric surgery, it became severe, requiring morphine treatment and monthly exchange transfusion beside the NSAID which become not much effective as before bariatric surgery. Our findings show that bariatric surgery, which leads to a stressful condition, can aggravate the SCD pain crisis, thereby highlighting the need for alternative methods of weight reduction in these patients. Controlled studies are required for the proper assessment of bariatric surgery in SCD.