Acute-on-Chronic Liver Failure From Acquired Hemochromatosis in a Patient With Sickle Cell Disease

Late presentations of liver failure were previously rare in clinical practice given the high mortality of sickle cell disease (SCD) and shorter life expectancy compared to the general population. With advancements in therapeutics for SCD, patients with SCD have increased lifespans, and with them, patients are placed at increased risk for differing patterns of chronic and end-organ failures. We describe a case of an elderly patient who had multiple chronic complications from her years of SCD, including end-stage renal disease (ESRD) on hemodialysis, acquired hemochromatosis, cirrhosis, and pulmonary hypertension. During this presentation for shortness of breath, she developed acute-on-chronic liver failure (ACLF) with a significant lower gastrointestinal bleed and hemorrhagic shock. Her family ultimately elected to pursue comfort care measures, and she passed later that day.