Acute chest syndrome (ACS) is the leading cause of death in sickle cell dis
ease, Severe ACS often develops in the course of a vasoocclusive crisis (VO
C), but currently there are no predictors for its development. Secretory ph
ospholipase A(2) (sPLA(2)), a potent inflammatory mediator, is elevated in
ACS, and previous work suggests that sPLA(2) predicts impending ACS. We pro
spectively evaluated sPLA(2) concentration during 21 admissions for VOC; 6
of these patients went on to develop ACS, Elevation of sPLA(2) was detected
all 6 patients 24 to 48 hours before ACS was clinically diagnosed. Adding
the requirement for fever raised the specificity of sPLA(2) to 87% while re
taining 100% sensitivity. These data indicate that sPLA(2) can be useful in
alerting the clinician to patients with impending ACS, In addition, sPLA(2
) may be useful for instituting early therapies to prevent or reduce the cl
inical morbidity of ACS, (C) 2000 by The American Society Hematology.