BACKGROUND Elevated liver
enzymes is a common clinical problem with many possible etiologies, yet some are rare and can be missed. Patients with
sickle cell disease (SCD) may be at risk of
liver disease due to recurrent
blood transfusion predisposing to viral
hepatitis. Furthermore, recurrent transfusions can increase the risk of
iron overload, which can create deposits in the liver, eventually resulting in chronic
liver disease. Liver biopsy is an essential tool to establish a diagnosis of
liver disease in many patients with unexplained elevation of liver
enzymes. Recently, endosocpic ultrasound (EUS)-guided liver biopsy has been shown to be safe and effective in obtaining adequate liver tissue. However, the safety and efficacy has not been established in patients with SCD. CASE REPORT A 59-year-old man with SCD and
beta-thalassemia minor was evaluated for persistently elevated liver
enzymes (mainly cholestatic). He had a background history of treated hepatitis C virus
infection. He had multiple
blood transfusions in the past for sickle cell crisis. A diagnostic work-up revealed negative viral and autoimmiune serology and no evidence of biliary obstruction on abdominal imaging. The
iron profile was elevated, consistent with
iron overload. An EUS-guided liver biopsy confirmed a diagnosis hepatic
hemosiderosis secondary to long-term
blood transfusions. CONCLUSIONS This report emphasizes the importance of careful monitoring of
iron levels in patients with hematological conditions requiring long-term
blood transfusions. In addition, it highlights the emerging role of EUS-guided liver biopsy as a safe and accurate alternative to percutaneous liver biopsy.