Hepatobiliary Abnormalities in Children With Sickle Cell Anemia Attending a Tertiary Hospital in Northwestern Tanzania

Hepatobiliary complications are common in children with sickle cell anemia (SCA) due to chronic hemolysis and vaso-occlusion, but are often underdiagnosed in low-resource settings where imaging is limited. This hospital-based cross-sectional study, conducted from March to May 2023, assessed the prevalence and characteristics of hepatobiliary abnormalities using ultrasound among children younger than 18 years with SCA at a tertiary hospital in Tanzania. Demographic and clinical characteristics, laboratory findings, and abdominal ultrasonography were obtained. Logistic regression was used to identify factors associated with hepatobiliary abnormalities. A total of 194 children aged 2 to 16 years were enrolled, of whom 52% were male and 47.9% were receiving hydroxyurea. The overall prevalence of hepatobiliary abnormalities was 57.2%. The most common findings were hepatomegaly (41%), low portal vein peak systolic velocity (14%), and biliary calculi or sludge (9%). Children aged 6 to 10 years (aOR=0.1, 95% CI: 0.05-0.3; P<0.001) and 11 to 16 years (aOR=0.1, 95% CI: 0.03-0.2; P<0.001) had lower odds of abnormalities compared with those aged 2 to 5 years, while biliary calculi or sludge were more frequent in older children (P=0.005). Hepatobiliary abnormalities are highly prevalent and often asymptomatic, highlighting the importance of early screening and routine monitoring.