The Safety of Gadolinium-Based Contrast Media (GBCM) in Patients with Sickle Cell Disease

Early in vitro research dealing with the effects of MRI on red blood cells (erythrocytes) suggested that fully deoxygenated sickle erythrocytes align perpendicularly to a magnetic field. It was hypothesized that this alignment could further restrict sickle erythrocyte flow through small vessels and, thus conceivably could promote vaso-occlusive complications in sickle cell patients . The further supposition that the IV administration of GBCM might potentiate sickle erythrocyte alignment, thereby additionally increasing the risk of vaso-occlusive complications, is mentioned in the FDA package inserts (as of 2009) for two GBCM approved for use in the United States (gadoversetamide [OptiMARK, Mallinckrodt] and gadoteridol [Prohance, Bracco Diagnostics]). To the best of our knowledge and noted in a review  of the literature, there has been no documented in vivo vaso-occlusive or hemolytic complication directly related to the IV administration of a GBCM in a sickle cell disease patient. A small retrospective study by Dillman et al with a control group showed no significantly increased risk of vaso-occlusive or hemolytic adverse events when administering GBCM to sickle cell disease patients . Additionally, several small scientific studies  of patients with sickle cell disease have employed MR imaging with GBCM without reported adverse effects. Therefore, it is our opinion that any special risk to sickle cell patients from IV administered GBCM at currently approved dosages must be extremely low, and there is no reason to withhold these agents from patients with sickle cell disease. However, as in all patients, GBCM should be administered only when clinically indicated.