Shear wave elastography as a screening modality for liver fibrosis in a comprehensive sickle cell disease clinic.

Abstract

Background: Sickle cell disease (SCD) is associated with hepatobiliary complications including liver fibrosis and cirrhosis, driven by chronic hemolysis, intrahepatic sickling, and transfusion-related iron overload. Standardized screening strategies for liver fibrosis in SCD are lacking. Shear wave elastography (SWE) is a noninvasive ultrasound-based technique that measures liver stiffness and may provide an accessible tool for fibrosis assessment. The objective is to determine the proportion of adults with SCD with liver fibrosis detected using SWE and to explore associated clinical and laboratory characteristics.

Research design and methods: We conducted a retrospective cohort study of adults with SCD who underwent routine outpatient SWE between 2021 and 2025. Findings were categorized using METAVIR-equivalent stages (F0-F4), with ≥F2 defined as clinically significant fibrosis. Clinical, laboratory, and imaging data within six months were collected.

Results: Of 219 eligible patients, 153 (70%) underwent SWE. Median age was 35.0 years and 59% were female. Most (92%) had no or mild fibrosis, while 12 (8%) had SWE-defined clinically significant fibrosis. Abnormal SWE was associated with higher bilirubin, gamma-glutamyl transferase, and ferritin. Hepatology consultation occurred in seven patients; three required iron chelation.

Conclusions: SWE-defined fibrosis was identified in 8% of patients, and may provide a feasible noninvasive approach for identifying previously unrecognized hepatic involvement.