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Mougin L, Riccetti M, Merlet AN, Bartolucci P, Gellen B, Blervaque L, D'Humières T, Galactéros F, Emhoff CAW, Féasson L, Messonnier LA. Endurance training improves oxygen uptake/demand mismatch, metabolic flexibility and recovery in patients with sickle cell disease. Haematologica 2024; 109:2628-2638. [PMID: 38572551 PMCID: PMC11290513 DOI: 10.3324/haematol.2023.284474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 03/26/2024] [Indexed: 04/05/2024] Open
Abstract
Patients with sickle cell disease (SCD) display lower slope coefficients of the oxygen uptake (V̇O2) versus work rate (W) relationship (delineating an O2 uptake/demand mismatch) and a poor metabolic flexibility. Because endurance training improves the microvascular network and increases the activity of oxidative enzymes, including one involved in lipid oxidation, endurance training might improve the slope coefficient of the V̇O2 versus W curve and the metabolic flexibility of SCD patients. Endurance training may also contribute to improve patients' post-exercise cardiopulmonary and metabolic recovery. Fifteen patients with SCD performed a submaximal incremental test on a cycle ergometer before (SIT1) and after (SIT2) 8 weeks of endurance training. Minute ventilation (V̇ E), ventilation rate, heart rate, V̇O2, carbon dioxide production (V̇CO2), respiratory exchange ratio, carbohydrate/lipid utilization and partitioning (including %Lipidox) and blood lactate concentration were measured during and after SIT1 and SIT2. At baseline, the slope coefficient of the V̇O2 versus W curve positively correlated with total hemoglobin, mean corpuscular hemoglobin and percentage of HbF. After training, the slope coefficient of the V̇O2 versus W curve was significantly higher and the increase in blood lactate concentration was delayed. If patients' energy metabolism apparently relied largely on carbohydrate sources during SIT1, %Lipidox tended to increase at low exercise intensities during SIT2, supporting a training-induced improvement of metabolic flexibility in patients with SCD. Post-exercise recovery of ventilation rate, V̇ E/V̇CO2, heart rate and blood lactate concentration was faster after training. We concluded that exercise training in patients with SCD: (i) ameliorated the oxygen uptake/ demand mismatch, (ii) blunted the metabolic inflexibility, and (iii) improved post-exercise cardiopulmonary and metabolic responses.
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Affiliation(s)
- Loïs Mougin
- Inter-university Laboratory of Human Movement Sciences, University Savoie Mont Blanc, Chambéry
| | - Manon Riccetti
- Inter-university Laboratory of Human Movement Sciences, University Savoie Mont Blanc, Chambéry
| | - Angèle N Merlet
- Inter-university Laboratory of Human Movement Sciences, University Jean Monnet, Saint-Etienne, France; Myology Unit, Department of Clinical Physiology and Exercise, Saint-Etienne University Hospital, Saint-Etienne
| | - Pablo Bartolucci
- Department of Internal Medicine, Henri-Mondor Hospital (AP-HP), University Paris-Est Créteil (UPEC), Créteil, France; Sickle Cell Referral Centre - UMGGR, Great Paris East Rare Diseases Expertise Platform, UPEC, FHU SENEC, Henri-Mondor Hospital (AP-HP), Créteil
| | - Barnabas Gellen
- Department of Cardiac Rehabilitation, Henri-Mondor Hospital (AP-HP), Créteil
| | - Léo Blervaque
- Inter-university Laboratory of Human Movement Sciences, University Savoie Mont Blanc, Chambéry
| | - Thomas D'Humières
- Sickle Cell Referral Centre - UMGGR, Great Paris East Rare Diseases Expertise Platform, UPEC, FHU SENEC, Henri-Mondor Hospital (AP-HP), Créteil, France; Department of Physiology, FHU SENEC, Henri-Mondor Hospital (AP-HP), Créteil, France; INSERM IMRB U955, Team 8, University Paris Est (UPEC), Créteil
| | - Frédéric Galactéros
- Department of Internal Medicine, Henri-Mondor Hospital (AP-HP), University Paris-Est Créteil (UPEC), Créteil, France; Sickle Cell Referral Centre - UMGGR, Great Paris East Rare Diseases Expertise Platform, UPEC, FHU SENEC, Henri-Mondor Hospital (AP-HP), Créteil
| | - Chi-An W Emhoff
- Inter-university Laboratory of Human Movement Sciences, University Savoie Mont Blanc, Chambéry, France; Department of Kinesiology, Saint Mary's College of California, Moraga, California
| | - Léonard Féasson
- Inter-university Laboratory of Human Movement Sciences, University Jean Monnet, Saint-Etienne, France; Myology Unit, Department of Clinical Physiology and Exercise, Saint-Etienne University Hospital, Saint-Etienne
| | - Laurent A Messonnier
- Inter-university Laboratory of Human Movement Sciences, University Savoie Mont Blanc, Chambéry, France; Institut universitaire de France (IUF).
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2
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Feugray G, Grall M, Dumesnil C, Brunel V, Benhamou Y, Quillard Muraine M, Billoir P. Lipid and hemolysis parameters predicting acute chest syndrome in adulthood with sickle cell disease. Lipids Health Dis 2024; 23:140. [PMID: 38755670 PMCID: PMC11100209 DOI: 10.1186/s12944-024-02135-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
Sickle cell disease (SCD) is a lifelong blood disorder affecting approximately 100,000 people in the United States and is one of the most common monogenic diseases. A serious complication of SCD is acute chest syndrome (ACS). ACS is a condition with a high rate of morbidity and mortality. The aim of the study was to assess hemolysis and lipid parameters in a cohort of confirmed SCD patients to predict ACS development in the following year.Standard lipid were performed (triglycerides, total cholesterol, high-density cholesterol, low-density cholesterol) panel to calculate of non-HDL-C, large buoyant LDL cholesterol (lbLDL-C) and small dense LDL cholesterol (sdLDL-C) with Sampson equation. Hemolysis and hematologic parameters were also evaluated.Among 91 patients included between September 2018 and June 2021, thirty-seven patients had history of ACS and 6 patients developed ACS during following year. In unadjusted logistic regression, total bilirubin was associated with ACS occurrence (RR: 1.2 [1.05-1.51] p = 0.013). Concerning lipid profile, non-HDL-C (RR: 0.87 [0.0.67-0.99] p = 0.04) and sdLDL-C (RR: 0.78 [0.49-0.96] p = 0.03) were associated with ACS occurrence decrease. C-reactive protein was associated with ACS occurrence (RR: 1.27 [1.065-1.85] p = 0.011).Based on these findings, this study demonstrated that several biomarker easily available can be used at steady state to predict ACS in the following year. The validation of these results are required to ensure the reproducibility of the findings.
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Affiliation(s)
- Guillaume Feugray
- Department of General Biochemistry, Normandie Univ, UNIROUEN, INSERM U1096 EnVI, CHU Rouen, Rouen, F-76000, France.
- Service de Biochimie, Centre hospitalier Universitaire Charles Nicolle, 1 rue de Germont, Rouen, 76031, France.
| | - Maximilien Grall
- Department of Internal Medicine, CHU Rouen, Rouen, F-76000, France
| | - Cécile Dumesnil
- Department of Pediatric Onco-Hematology, CHU Rouen, Rouen, F-76000, France
| | - Valéry Brunel
- Department of General Biochemistry, CHU Rouen, Rouen, F-76000, France
| | - Ygal Benhamou
- Department of Internal Medicine, Normandie Univ, UNIROUEN, INSERM U1096, CHU Rouen, Rouen, F-76000, France
| | - Muriel Quillard Muraine
- Department of General Biochemistry, Normandie Univ, UNIROUEN, INSERM U1404 INSERMU1073 ADEN, CHU Rouen, CIC-CRB, Rouen, F-76000, France
| | - Paul Billoir
- Normandie Univ, UNIROUEN, INSERM U1096 EnVI, CHU Rouen, Vascular Hemostasis Unit, Rouen, F-76000, France
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3
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Pelinski Y, Guindo A, Kassasseya C, Diallo D, Arlet J, Dessap AM, Habibi A, Bartolucci P. Is chest X-ray still relevant for acute chest syndrome diagnosis? Health Sci Rep 2024; 7:e2053. [PMID: 38698794 PMCID: PMC11063255 DOI: 10.1002/hsr2.2053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 01/12/2024] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Affiliation(s)
- Yanis Pelinski
- Sickle Cell Referral Center, Department of Internal MedicineHenri‐Mondor University Hospital‐ UPEC, AP‐HPCréteilFrance
| | - Aldiouma Guindo
- Centre de Recherche et de Lutte contre la DrépanocytoseBamakoMali
| | - Christian Kassasseya
- Emergency Department, Hôpital Henri, MondorAssistance Publique ‐ Hôpitaux de ParisCréteilFrance
| | - Dapa Diallo
- Centre de Recherche et de Lutte contre la DrépanocytoseBamakoMali
| | - Jean‐Benoît Arlet
- Sickle Cell Referral Center, France, Internal Medicine Department, Georges Pompidou European HospitalAssistance Publique‐Hôpitaux de Paris (AP‐HP)ParisFrance
| | - Armand Mekontso Dessap
- Department of Intensive CareHenri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Université Paris‐Est CréteilFrance
| | - Anoosha Habibi
- Sickle Cell Referral Center, Department of Internal MedicineHenri‐Mondor University Hospital‐ UPEC, AP‐HPCréteilFrance
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Department of Internal MedicineHenri‐Mondor University Hospital‐ UPEC, AP‐HPCréteilFrance
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4
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Hagry J, Monnet X, Mekontso-Dessap A, Chantalat C, de Prost N, Razazi K, Teboul JL, Pham T. Comprehensive assessment, pain and ventilatory management during acute complications of adult sickle cell disease: A clinical practice survey in French intensive care units. Br J Haematol 2024; 204:e37-e40. [PMID: 38553972 DOI: 10.1111/bjh.19408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 05/15/2024]
Affiliation(s)
- Julien Hagry
- Medical Intensive Care Unit, DMU CORREVE, FHU SEPSIS, CARMAS Research Group, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- Medical Intensive Care Unit, DMU CORREVE, FHU SEPSIS, CARMAS Research Group, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Armand Mekontso-Dessap
- Medical Intensive Care Unit, Henri Mondor University Hospital, CARMAS Research Group, Créteil, France
| | - Christelle Chantalat
- Department of Internal Medicine, Bicetre University Hospital, Le Kremlin-Bicêtre, France
| | - Nicolas de Prost
- Medical Intensive Care Unit, Henri Mondor University Hospital, CARMAS Research Group, Créteil, France
| | - Keyvan Razazi
- Medical Intensive Care Unit, Henri Mondor University Hospital, CARMAS Research Group, Créteil, France
| | - Jean-Louis Teboul
- Medical Intensive Care Unit, DMU CORREVE, FHU SEPSIS, CARMAS Research Group, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
| | - Tài Pham
- Medical Intensive Care Unit, DMU CORREVE, FHU SEPSIS, CARMAS Research Group, Hôpital de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France
- Medical Intensive Care Unit, Henri Mondor University Hospital, CARMAS Research Group, Créteil, France
- Department of Internal Medicine, Bicetre University Hospital, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm U1018, Équipe d'Épidémiologie Respiratoire intégrative, CESP, Villejuif, France
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5
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Alghamdi FA, Al-Kasim F, Alshhada F, Ghareeb E, Azmet FR, Almudaibigh A, Baitalmal L, Alnawfal B, Alluqmani R. Risk factors for acute chest syndrome among children with sickle cell anemia hospitalized for vaso-occlusive crises. Sci Rep 2024; 14:5978. [PMID: 38472301 DOI: 10.1038/s41598-023-48527-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 03/14/2024] Open
Abstract
Sickle cell anemia (SCA) is a globally prevalent inherited condition, with acute chest syndrome (ACS) being one of its most severe complications. ACS frequently leads to hospitalization, requires intensive care unit (ICU) admission, and can even result in death. This study aimed to discern the early indicators of impending ACS in children with SCA who were initially hospitalized due to painful vaso-occlusive crises (VOC). This was a retrospective, case‒control investigation of 120 patients aged 1-14 years seen at the King Saud Medical City in Riyadh, Saudi Arabia from January 2021 to December 2022. Patients were classified into cases and controls: those who developed and did not develop ACS during hospital stay, respectively. Demographic factors, laboratory results, vital and clinical signs, and treatment protocols were compared between these groups. The following were significant predictors of impending ACS: previous diagnosis of asthma, history of ACS, recent upper respiratory tract symptoms prior to admission, and need for a blood transfusion within the first 24 h of admission due to a drop in hemoglobin levels. Further regression analysis indicated that elevated steady-state mean corpuscular volume, leukocyte count, total bilirubin, and an increased absolute neutrophil count level 24 h after admission also foreshadowed impending ACS among patients admitted for VOC. The location of pain was also significant; the incidence of ACS was higher in patients with back pain, but lower in those with pain confined to the limbs. The ACS group had a longer average duration of hospital stay compared to those with VOC alone, (7.6 vs. 5.8 days). Among patients initially admitted for VOC, 15.7% were diagnosed with ACS. Most ACS cases were managed with transfusions and antibiotics, and nearly one-third of patients needed admission to an ICU or a high-dependency area.
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Affiliation(s)
- Faisal A Alghamdi
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Fawaz Al-Kasim
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Forat Alshhada
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
- Medical Specialized Center, Riyadh, Saudi Arabia
| | - Eatedal Ghareeb
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Fauzia R Azmet
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Adel Almudaibigh
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Lobna Baitalmal
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bedah Alnawfal
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rehab Alluqmani
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
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6
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Feugray G, Dumesnil C, Grall M, Benhamou Y, Girot H, Fettig J, Brunel V, Billoir P. Lactate dehydrogenase and hemolysis index to predict vaso-occlusive crisis in sickle cell disease. Sci Rep 2023; 13:21198. [PMID: 38040880 PMCID: PMC10692321 DOI: 10.1038/s41598-023-48324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/24/2023] [Indexed: 12/03/2023] Open
Abstract
Sickle cell disease (SCD) is an inherited hemoglobinopathy disorder associated with chronic hemolysis. A major complication is vaso-occlusive crisis (VOC), associating frequent hospitalization, morbidity and mortality. The aim of this study was to investigate whether hemolysis biomarkers were able to predict VOC risk in adult patients with SCD requiring hospitalization within 1 year. This single-center prospective study included adult patients with SCD at steady state or during VOC. A total of 182 patients with SCD were included, 151 at steady state and 31 during VOC. Among the 151 patients at steady state 41 experienced VOC within 1 year (median: 3.0 months [2.0-6.5]). We observed an increase of lactate dehydrogenase (LDH) (p = 0.01) and hemolysis index (HI) (p = 0.0043) during VOC compared to steady state. Regarding patients with VOC requiring hospitalization, LDH (p = 0.0073) and HI (p = 0.04) were increased. In unadjusted logistic regression, LDH > median (> 260 U/L) (RR = 3.6 [1.29-10.88], p = 0.0098) and HI > median (> 8 UA/L) (RR = 3.13 [1.91-5.33]; p < 0.001) were associated with VOC. The association of LDH > 260 U/L and HI > 12 UA/L presented a sensitivity of 90%, and a specificity of 72.9% to predict VOC. The association of LDH and HI cut-off was able to predict VOC risk in SCD.
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Affiliation(s)
- Guillaume Feugray
- Department of General Biochemistry, UNIROUEN, INSERM U1096, CHU Rouen, Normandie Univ, 76000, Rouen, France.
- Service de Biochimie Générale, Centre Hospitalier Universitaire Charles Nicolle, 1 Rue de Germont, 76031, Rouen, France.
| | - Cécile Dumesnil
- Department of Pediatric Onco-Hematology, CHU Rouen, 76000, Rouen, France
| | - Maximilien Grall
- Department of Internal Medicine, CHU Rouen, 76000, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, UNIROUEN, INSERM U1096, CHU Rouen, Normandie Univ, 76000, Rouen, France
| | - Helene Girot
- Department of General Biochemistry, CHU Rouen, 76000, Rouen, France
| | - Julie Fettig
- Department of General Biochemistry, CHU Rouen, 76000, Rouen, France
| | - Valery Brunel
- Department of General Biochemistry, CHU Rouen, 76000, Rouen, France
| | - Paul Billoir
- UNIROUEN, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Normandie Univ, 76000, Rouen, France
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7
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Zhang X, Han J, Shah BN, Saraf SL, Gordeuk VR. Platelet count decline and high neutrophil count within the first day of admission for painful sickle cell vaso-occlusive episodes predict severe complications. Br J Haematol 2023; 202:e20-e23. [PMID: 37248069 DOI: 10.1111/bjh.18898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 05/31/2023]
Affiliation(s)
- Xu Zhang
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Jin Han
- College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Binal N Shah
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Santosh L Saraf
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Victor R Gordeuk
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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8
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Allali S, Elie J, Mayrand L, de Montalembert M, Taylor M, Brice J, Maire A, Rignault-Bricard R, Heilbronner C, Cohen JF, Maciel TT, Hermine O. Sputum IL-6 level as a potential predictor of acute chest syndrome during vaso-occlusive crisis in children with sickle cell disease: Exploratory prospective prognostic accuracy study. Am J Hematol 2023. [PMID: 37096490 DOI: 10.1002/ajh.26939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Affiliation(s)
- Slimane Allali
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Université Paris Cité, Imagine Institute, Inserm U1163, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Juliette Elie
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Université Paris Cité, Imagine Institute, Inserm U1163, Paris, France
| | - Lara Mayrand
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Université Paris Cité, Imagine Institute, Inserm U1163, Paris, France
| | - Mariane de Montalembert
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Melissa Taylor
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Joséphine Brice
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Amandine Maire
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Rachel Rignault-Bricard
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Université Paris Cité, Imagine Institute, Inserm U1163, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Claire Heilbronner
- Department of Pediatric Intensive care, Necker-Enfants malades Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Jérémie F Cohen
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants malades Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Centre of Research in Epidemiology and Statistics-CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Université Paris Cité, Paris, France
| | - Thiago T Maciel
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Université Paris Cité, Imagine Institute, Inserm U1163, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Olivier Hermine
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Université Paris Cité, Imagine Institute, Inserm U1163, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
- Department of Hematology, Necker-Enfants malades Hospital, AP-HP, Université Paris Cité, Paris, France
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9
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Hamzaoui A, Louhaichi S, Hamdi B. [Lung manifestations of sickle-cell disease]. Rev Mal Respir 2023:S0761-8425(23)00107-9. [PMID: 37059617 DOI: 10.1016/j.rmr.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 03/04/2023] [Indexed: 04/16/2023]
Abstract
Sickle-cell disease is an autosomal recessive genetic disorder of hemoglobin that causes systemic damage. Hypoxia is the main actor of sickle-cell disease. It initiates acutely the pathogenic cascade leading to tissue damages that in turn induce chronic hypoxia. Lung lesions represent the major risk of morbidity and mortality. Management of sickle-cell disease requires a tight collaboration between hematologists, intensivists and chest physicians. Recurrent episodes of thrombosis and hemolysis characterize the disease. New therapeutic protocols, associating hydroxyurea, transfusion program and stem cell transplantation in severe cases allow a prolonged survival until the fifth decade. However, recurrent pain, crisis, frequent hospital admissions due to infection, anemia or acute chest syndrome and chronic complications leading to organ deficiencies degrade the patients' quality of life. In low-income countries where the majority of sickle-cell patients are living, the disease is still associated with a high mortality in childhood. This paper focuses on acute chest syndrome and chronic lung manifestations.
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Affiliation(s)
- A Hamzaoui
- Pavillon B/LR19SP02, hôpital Abderrahmen-Mami, 2080 Ariana, Tunisie; Faculté de médecine de Tunis, 1006 Tunis, Tunisie.
| | - S Louhaichi
- Pavillon B/LR19SP02, hôpital Abderrahmen-Mami, 2080 Ariana, Tunisie; Faculté de médecine de Tunis, 1006 Tunis, Tunisie
| | - B Hamdi
- Pavillon B/LR19SP02, hôpital Abderrahmen-Mami, 2080 Ariana, Tunisie; Faculté de médecine de Tunis, 1006 Tunis, Tunisie
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10
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Cheminet G, Brunetti A, Khimoud D, Ranque B, Michon A, Flamarion E, Pouchot J, Jannot AS, Arlet JB. Acute chest syndrome in adult patients with sickle cell disease: The relationship with the time to onset after hospital admission. Br J Haematol 2023. [PMID: 36965115 DOI: 10.1111/bjh.18777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/23/2023] [Accepted: 03/15/2023] [Indexed: 03/27/2023]
Abstract
Data on acute chest syndrome (ACS) in adult sickle cell disease patients are scarce. In this study, we describe 105 consecutive ACS episodes in 81 adult patients during a 32-month period and compare the characteristics as a function of the time to onset after hospital admission for a vaso-occlusive crisis (VOC), that is early-onset episodes (time to onset ≤24 h, 42%) versus secondary episodes (>24 h, 58%; median [interquartile range] time to onset: 2 [2-3] days). The median age was 27 [22-34] years, 89% of the patients had an S/S or S/β0 -thalassaemia genotype; 81% of the patients had a history of ACS (median: 3 [2-5] per patient), only 61% were taking a disease-modifying treatment at the time of the ACS. Fever and chest pain were noted in respectively 54% and 73% of the episodes. Crackles (64%) and bronchial breathing (32%) were the main abnormal auscultatory findings. A positive microbiological test was found for 20% of episodes. Fifty percent of the episodes required a blood transfusion; ICU transfer and mortality rates were respectively 29% and 1%. Secondary and early-onset forms of ACS did not differ significantly. Disease-modifying treatments should be revaluated after each ACS episode because the recurrence rate is high.
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Affiliation(s)
- Geoffrey Cheminet
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Antoine Brunetti
- Service d'Informatique, de biostatistique et santé publique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
| | - Djamal Khimoud
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Brigitte Ranque
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
- Hôpital Européen Georges Pompidou, AP-HP, Université Paris Cité, INSERM U970 Equipe 4 "Epidémiologie cardiovasculaire et mort subite", Paris Centre de Recherche Cardiovasculaire, Paris, France
| | - Adrien Michon
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Edouard Flamarion
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Jacques Pouchot
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
| | - Anne-Sophie Jannot
- Université Paris Cité, Paris, France
- Service d'Informatique, de biostatistique et santé publique, AP-HP, Hôpital Européen Georges Pompidou, Paris, France
- HEKA, Centre de Recherche des Cordeliers, INSERM, INRIA, Paris, France
| | - Jean-Benoît Arlet
- Université Paris Cité, Paris, France
- AP-HP, Hôpital Européen Georges Pompidou, DMU ENDROMED, Service de Médecine Interne, Centre National de Référence de la drépanocytose et autres maladies rares des globules rouges, Paris, France
- Laboratoire d'excellence GR-Ex, Hôpital Necker, AP-HP, Université Paris Cité, INSERM U1163, CNRS 8254, institut IMAGINE, Paris, France
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11
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Hafiani EM, Dupeyrat S, Quesnel C. Prise en charge périopératoire du patient adulte drépanocytaire. ANESTHÉSIE & RÉANIMATION 2023. [DOI: 10.1016/j.anrea.2023.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
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12
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Bin Zuair A, Aldossari S, Alhumaidi R, Alrabiah M, Alshabanat A. The Burden of Sickle Cell Disease in Saudi Arabia: A Single-Institution Large Retrospective Study. Int J Gen Med 2023; 16:161-171. [PMID: 36659915 PMCID: PMC9844992 DOI: 10.2147/ijgm.s393233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
Purpose Sickle cell disease (SCD) is a significant burden for patients and healthcare systems due to multiple factors, including high readmission rates. This study aimed to determine the general characteristics, etiology of admissions, annual admission rate, length of stay, and readmission rate of patients with SCD. Patients and Methods This retrospective observational study included all adult patients with SCD admitted to the General Internal Medicine (GIM) unit between 2016 and 2021. Results There were 160 patients (mean age, 31.08 ± 9.06 years; 51.25% female) with SCD included in this study. Most originated from southern Saudi Arabia (45.62%). The average annual number of emergency department (ED) visits was 4, and approximately 19% of patients had ≥3 annual admissions. The mean length of stay was 6 days. The readmission rates at 7, 30, 60, and 90 days were 8%, 24.5%, 13.6%, and 10.8%, respectively. Conclusion SCD generates a significant economic burden on the Saudi society and the effects on the healthcare system and patients' quality of life are evident in the high ED visits, readmission rates and prolonged hospitalization. Thereupon we advocate the implementation of sickle cell disease-specialized multidisciplinary clinics.
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Affiliation(s)
- Amerah Bin Zuair
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia,Correspondence: Amerah Bin Zuair, Internal Medicine, King Saud University Medical City, Riyadh, Saudi Arabia, Tel +966558765609, Email
| | - Sheikhah Aldossari
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Rand Alhumaidi
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Maha Alrabiah
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulmajeed Alshabanat
- Department of Internal Medicine, College of Medicine, King Saud University and King Saud University Medical City, Riyadh, Saudi Arabia
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13
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Feugray G, Kasonga F, Grall M, Dumesnil C, Benhamou Y, Brunel V, Le Cam Duchez V, Lahary A, Billoir P. Investigation of thrombin generation assay to predict vaso-occlusive crisis in adulthood with sickle cell disease. Front Cardiovasc Med 2022; 9:883812. [PMID: 36277754 PMCID: PMC9579298 DOI: 10.3389/fcvm.2022.883812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Sickle cell disease (SCD) is an inherited hemoglobinopathy disorder. The main consequence is synthesis of hemoglobin S leading to chronic hemolysis associated with morbidity. The aim of this study was to investigate Thrombin Generation Assay (TGA) to assess hypercoagulability in SCD and TGA parameters as biomarkers of vaso-occlusive crisis (VOC) risk and hospitalization within 1 year. Materials and methods We performed TGA in platelet poor plasma (PPP) with 1 pM of tissue factor and 4 μM of phospholipid-standardized concentration, in duplicate for patients and controls. We measured thrombomodulin (TM), soluble endothelial Protein C Receptor and Tissue Factor Pathway Inhibitor (TFPI). Results A total of 113 adult patients with SCD, 83 at steady state and 30 during VOC, and 25 healthy controls matched on age and gender were included. Among the 83 patients at steady state, (36 S/S-1 S/β0, 20 S/Sα3.7, and 19 S/C-7 S/β+) 28 developed a VOC within 1 year (median: 4 months [2.25–6]). We observed an increase of peak and velocity associated with a shortening of lagtime and time to peak (TTP) and no difference of endogenous thrombin potential (ETP) in patients compared to controls. TFPI (p < 0.001) and TM (p = 0.006) were significantly decreased. TGA confirmed hypercoagulability in all SCD genotypes and clinical status. The association of ETP > 1,207 nM.min and peak >228.5 nM presented a sensitivity of 73.5% and a specificity of 93.9% to predict VOC development within 1 year. Conclusion We have demonstrated a hypercoagulable state in SCD associated with chronic hemolysis. These preliminary findings suggest that TGA parameters, as ETP and peak, could be used to predict VOC development within 1 year.
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Affiliation(s)
- Guillaume Feugray
- Vascular Hemostasis Unit, CHU Rouen, Normandie Université, UNIROUEN, INSERM U1096, Rouen, France
| | | | | | - Cécile Dumesnil
- Department of Pediatric Onco-Hematology, CHU Rouen, Rouen, France
| | - Ygal Benhamou
- Department of Internal Medicine, CHU Rouen, Normandie Université, UNIROUEN, INSERM U1096, Rouen, France
| | - Valery Brunel
- Department of General Biochemistry, CHU Rouen, Rouen, France
| | - Véronique Le Cam Duchez
- Vascular Hemostasis Unit, CHU Rouen, Normandie Université, UNIROUEN, INSERM U1096, Rouen, France
| | | | - Paul Billoir
- Vascular Hemostasis Unit, CHU Rouen, Normandie Université, UNIROUEN, INSERM U1096, Rouen, France,*Correspondence: Paul Billoir, ; orcid.org/0000-0001-5632-7713
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14
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Cheminet G, Mekontso-Dessap A, Pouchot J, Arlet JB. [Acute chest syndrome in adult sickle cell patients]. Rev Med Interne 2022; 43:470-478. [PMID: 35810055 DOI: 10.1016/j.revmed.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/26/2022] [Accepted: 04/09/2022] [Indexed: 11/17/2022]
Abstract
Sickle cell disease is a frequent genetic condition, due to a mutation of the β-globin gene, leading to the production of an abnormal S hemoglobin and characterized by multiple vaso-occlusive events. The acute chest syndrome is a severe complication associated with a significant disability and mortality. It is defined by the association of one or more clinical respiratory manifestations and a new infiltrate on lung imaging. Its pathophysiology is complex and implies vaso-occlusive phenomena (pulmonary vascular thrombosis, fat embolism), infection, and alveolar hypoventilation. S/S or S/β0-thalassemia genotype, a history of vaso-occlusive crisis or acute chest syndrome, a low F hemoglobin level (<5%), a high steady-state hemoglobin level (> 10 g/dL), or a high steady-state leukocytosis (>10 G/L) are the main risk factors. Febrile chest pain, dyspnea, sometimes cough with expectorations are its main clinical manifestations, and bi-basal crackles are found at auscultation. Inferior alveolar opacities with or without pleural effusions are identified on chest X-ray or CT-scan. Management of the acute chest syndrome should be prompt and implies, besides the recognition of severity signs, a multimodal analgesia, oxygen supplementation, sometimes a parenteral antibiotic treatment and the frequent use of blood transfusions especially in the most severe cases. Prevention is important and includes a regular monitoring of hospitalized patients and the use of incentive spirometry.
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Affiliation(s)
- G Cheminet
- Service de médecine interne, Centre de référence national des syndromes drépanocytaires majeurs de l'adulte, hôpital européen Georges Pompidou, Assistance-Publique hôpitaux de Paris, 75015 Paris, France; Faculté de médecine Paris Centre, université de Paris, 75006 Paris, France.
| | - A Mekontso-Dessap
- Service de médecine intensive-réanimation, hôpitaux Universitaires Henri-Mondor, Assistance-Publique hôpitaux de Paris, 94010 Créteil, France; Université Paris Est Créteil, INSERM, IMRB, CARMAS, Créteil, 94010, France
| | - J Pouchot
- Service de médecine interne, Centre de référence national des syndromes drépanocytaires majeurs de l'adulte, hôpital européen Georges Pompidou, Assistance-Publique hôpitaux de Paris, 75015 Paris, France; Faculté de médecine Paris Centre, université de Paris, 75006 Paris, France
| | - J-B Arlet
- Service de médecine interne, Centre de référence national des syndromes drépanocytaires majeurs de l'adulte, hôpital européen Georges Pompidou, Assistance-Publique hôpitaux de Paris, 75015 Paris, France; Faculté de médecine Paris Centre, université de Paris, 75006 Paris, France; Laboratoire d'excellence sur le globule rouge GR-ex, 75015 Paris, France; Inserm U1163, CNRS 8254, institut IMAGINE, hôpital Necker, Assistance-Publique hôpitaux de Paris, 75015 Paris, France
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15
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Kassasseya C, Bressand S, Khellaf M. Prise en charge d’un patient drépanocytaire aux urgences. ANNALES FRANCAISES DE MEDECINE D URGENCE 2022. [DOI: 10.3166/afmu-2022-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La drépanocytose est aujourd’hui la première maladie génétique en France avec environ 30 000 patients adultes. Une mutation ponctuelle sur le chromosome 11 conduit à la production d’une hémoglobine pathologique qui polymérise sous l’effet de facteurs endo-ou exogènes induisant la falciformation des globules rouges à l’origine d’une vasoocclusion artérielle dont une des conséquences est l’oblitération des vaisseaux à destinée osseuse. Les infarctus osseux sont particulièrement douloureux, conduisant les patients aux urgences où l’enjeu est de soulager rapidement les douleurs par l’utilisation de morphine principalement par analgésie autocontrôlée après titration morphinique. Le risque majeur au cours de ces crises vaso-occlusives (CVO) est l’apparition d’un syndrome thoracique aigu (STA) pouvant mettre en jeu le pronostic vital du patient. La spirométrie incitative est un moyen préventif du STA important à instituer dès les urgences. Une antibiothérapie sera mise en place en cas de fièvre chez ces patients aspléniques à risque d’infections à germes encapsulés notamment par le pneumocoque. L’échange transfusionnel est une des pierres angulaires du traitement des CVO ou du STA mais le risque d’accident hémolytique aigu post transfusionnel doit en limiter l’usage à des situations mettant en jeu le pronostic vital ou fonctionnel d’organe. Plusieurs scores clinicobiologiques permettent de décider de l’utilité d’un angioscanner thoracique au cours du STA à la recherche d’une embolie pulmonaire ou pour décider de la pertinence d’une sortie vers une hospitalisation à domicile (Programme DREPADOM). L’utilisation de la morphine en dehors de l’hôpital de façon prolongée doit être prudente en raison du risque d’addiction.
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16
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Feugray G, Kasonga F, Grall M, Benhamou Y, Bobée-Schneider V, Buchonnet G, Daliphard S, Le Cam Duchez V, Lahary A, Billoir P. Assessment of Reticulocyte and Erythrocyte Parameters From Automated Blood Counts in Vaso-Occlusive Crisis on Sickle Cell Disease. Front Med (Lausanne) 2022; 9:858911. [PMID: 35492334 PMCID: PMC9044919 DOI: 10.3389/fmed.2022.858911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/21/2022] [Indexed: 12/18/2022] Open
Abstract
Sickle cell disease is a complex genetic disease involving cell adhesion between red blood cells, white blood cells, platelets and endothelial cells, inducing painful vaso-occlusive crisis (VOC). We assessed reticulocyte and erythrocyte parameters in a cohort of confirmed SCD patients, and investigated whether a combination of these routine laboratory biomarkers of haemolysis could be used to predict VOC development. Reticulocyte and erythrocyte parameters were evaluated using the Sysmex XN-9000 analyser. A total of 98 patients with SCD were included, 72 in steady state and 26 in VOC. Among the 72 patients in steady state, 22 developed a VOC in the following year (median: 3 months [2-6]). The following parameters were increased in SCD patients with VOC development compared to SCD patients without VOC development in the following year: reticulocyte count (94.6 109/L [67.8-128] vs. 48.4 109/L [24.9-87.5]), immature reticulocyte count (259 109/L [181-334] vs. 152 109/L [129-208]) reticulocyte/immature reticulocyte fraction (IRF) ratio (6.63 109/(L*%) [4.67-9.56] vs. 4.94 109/(L*%) [3.96-6.61]), and medium fluorescence reticulocytes (MFR) (19.9% [17.4-20.7] vs. 17.1% [15.95-19.75]). The association of a reticulocyte count of >189.4 109/L and an MFR of >19.75% showed a sensitivity of 81.8% and a specificity of 88% to predict VOC development in the following year. Based on our findings, a combination of routine laboratory biomarkers, as reticulocyte count, immature reticulocyte count and fluorescent reticulocyte fraction at steady state, could be used to predict VOC development in SCD.
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Affiliation(s)
- Guillaume Feugray
- General Biochemistry, Normandie Univ, Rouen University, INSERM U1096, CHU Rouen, Rouen, France
| | | | | | - Ygal Benhamou
- Department of Internal Medecine, Normandie Univ, Rouen University, INSERM U1096, CHU Rouen, Rouen, France
| | | | | | | | - Véronique Le Cam Duchez
- Normandie Univ, Rouen University, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Rouen, France
| | | | - Paul Billoir
- Normandie Univ, Rouen University, INSERM U1096, CHU Rouen, Vascular Hemostasis Unit, Rouen, France
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17
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Klings ES, Steinberg MH. Acute chest syndrome of sickle cell disease: genetics, risk factors, prognosis and management. Expert Rev Hematol 2022; 15:117-125. [PMID: 35143368 DOI: 10.1080/17474086.2022.2041410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
IntroductionSickle cell disease, one of the world's most prevalent Mendelian disorders, is a chronic hemolytic anemia punctuated by acute vasoocclusive events. Both hemolysis and vasoocclusion lead to irreversible organ damage and failure. Among the many sub-phenotypes of sickle cell disease is the acute chest syndrome (ACS) characterized by combinations of chest pain, cough, dyspnea, fever, abnormal lung exam, leukocytosis, hypoxia, and new radiographic opacities. ACS is a major cause of morbidity and mortality.Area coveredWe briefly review the diagnosis, epidemiology, etiology, and current treatments for ACS and focus on understanding and estimating the risks for developing this complication, how prognosis and outcomes might be improved and the genetic elements that might impact the risk of ACS.Expert opinionThe clinical heterogeneity of ACS has hindered our understanding of risk stratification. Lacking controlled clinical trials most treatment is based on expert opinion. Fetal hemoglobin levels and coexistent α thalassemia affect the incidence of ACS; other genetic associations are tenuous. Transfusions, whose use not innocuous, should be targeted to the severity and likelihood of ACS progression. Stable, non-hypoxic patients with favorable hematologic and radiographic findings usually do not need transfusion; severe progressive ACS is best managed with exchange transfusion.
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Affiliation(s)
- Elizabeth S Klings
- Sections of Pulmonary, Allergy, Sleep and Critical Care Medicine, Boston University School of Medicine, Boston, USA
| | - Martin H Steinberg
- Hematology and Medical Oncology, Center of Excellence for Sickle Cell Disease, Boston University School of Medicine and Boston Medical Center, Boston, USA
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18
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Yildirim N, Unal S, Yalcinkaya A, Karahan F, Oztas Y. Evaluation of the relationship between intravascular hemolysis and clinical manifestations in sickle cell disease: decreased hemopexin during vaso-occlusive crises and increased inflammation in acute chest syndrome. Ann Hematol 2021; 101:35-41. [PMID: 34564750 DOI: 10.1007/s00277-021-04667-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
The aims of this study were to determine the possible relationships between the levels of hemin, hemopexin, acid sphingomyelinase, nitrite/nitrate (NOx), and other parameters in patients with SCD and to assess whether they were associated with vaso-occlusive crises (VOCs) or acute chest syndrome (ACS). Patients with SCD (homozygous or sickle beta-thalassemia) who were confirmed to have VOC or ACS were included. Blood samples were obtained at admission, on the third day of hospitalization, and at steady state. Demographic characteristics, pain (visual analog scale), complication history, complete blood count, lactate dehydrogenase, and C-reactive protein levels were recorded. Hemin, hemopexin, acid sphingomyelinase, and NOx were measured via ELISA. A total of 31 patients (22 VOC, 9 ACS) were included. Mean age was 16.4 ± 4.7 years. Admission white blood cell count and C-reactive protein levels were significantly higher in the ACS group. Patients with ACS also demonstrated a significant decreasing trend of LDH and an increasing trend of NOx values from admission to steady state. Notably, hemopexin levels were significantly lower on the third day of hospitalization compared to steady-state levels. Despite limited patient count in the ACS group, these patients appear to have strikingly greater inflammatory activation at admission, and the progression of ACS may be associated with LDH and NOx levels. Lower hemopexin levels during hospitalization versus steady state appear to support a role for the administration of hemopexin therapy during crises.
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Affiliation(s)
- Nazim Yildirim
- Department of Pediatric Hematology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Selma Unal
- Department of Pediatric Hematology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ahmet Yalcinkaya
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, 06100 Sıhhiye, Ankara, Turkey.
| | - Feryal Karahan
- Department of Pediatric Hematology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Yesim Oztas
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, 06100 Sıhhiye, Ankara, Turkey
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19
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Telfer P, Bestwick J, Elander J, Osias A, Khalid N, Skene I, Nzouakou R, Challands J, Barroso F, Kaya B. A non-injected opioid analgesia protocol for acute pain crisis in adolescents and adults with sickle cell disease. Br J Pain 2021; 16:179-190. [PMID: 35419195 PMCID: PMC8998522 DOI: 10.1177/20494637211033814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Initial management of the acute pain crisis (APC) of sickle cell disease (SCD) is often unsatisfactory, and might be improved by developing a standardised analgesia protocol. Here, we report the first stages in developing a standard oral protocol for adolescents and adults. Initially, we performed a dose finding study to determine the maximal tolerated dose of sublingual fentanyl (MTD SLF) given on arrival in the acute care facility, when combined with repeated doses of oral oxycodone. We used a dose escalation algorithm with two dosing ranges based on patient’s weight (<50 kg or >50 kg). We also made a preliminary evaluation of the safety and efficacy of the protocol. The study took place in a large tertiary centre in London, UK. Ninety patients in the age range 14–60 years were pre-consented and 31 treatment episodes were evaluated. The first 21 episodes constituted the dose escalation study, establishing the MTD SLF at 600 mcg (>50 kg) or 400 mcg (<50 kg). Further evaluation of the protocol indicated no evidence of severe opioid toxicity, nor increased incidence of acute chest syndrome (ACS). Between 0 and 6 hours, the overall gradient of reduction of visual analogue pain score (visual analogue scale (VAS)) was 0.32 centimetres (cm) per hour (95% confidence interval (CI) = 0.20 to 0.44, p < 0.001). For episodes on MTD SLF, there was median (interquartile range (IQR)) reduction in VAS score of 2.8 cm (0–4.2) and 59% had at least a 2.6-cm reduction. These results are supportive of further evaluation of this protocol for acute analgesia of APC in a hospital setting and potentially for supervised home management.
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Affiliation(s)
- Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London, UK
- Department of Hematology, Royal London Hospital, Barts Health NHS Trust, London UK
| | - Jonathan Bestwick
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - James Elander
- School of Psychology, University of Derby, Derby, UK
| | - Arlene Osias
- Department of Hematology, Royal London Hospital, Barts Health NHS Trust, London UK
| | - Nosheen Khalid
- Childrens Research Facility, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Imogen Skene
- Emergency Medicine Research Facility, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Ruben Nzouakou
- Department of Hematology, Royal London Hospital, Barts Health NHS Trust, London UK
| | - Joanne Challands
- Department of Anesthetics, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Filipa Barroso
- Department of Hematology, Royal London Hospital, Barts Health NHS Trust, London UK
| | - Banu Kaya
- Department of Hematology, Royal London Hospital, Barts Health NHS Trust, London UK
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Messonnier LA, Riccetti M, Chatel B, Galactéros F, Gellen B, Rupp T, Féasson L, Bartolucci P. How to implement endurance exercise training in sickle cell disease. Haematologica 2021; 106:1476-1479. [PMID: 32855281 PMCID: PMC8094104 DOI: 10.3324/haematol.2020.267047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Indexed: 11/09/2022] Open
Affiliation(s)
- Laurent A Messonnier
- Interuniversity Laboratory of Human Movement Biology, University Savoie Mont Blanc, Chambery, France
| | - Manon Riccetti
- Interuniversity Laboratory of Human Movement Biology, University Savoie Mont Blanc, Chambery, France
| | | | - Frédéric Galactéros
- Sickle Cell Referral Center, UMGGR, Henri-Mondor University Hospital (AP-HP), Creteil, France
| | - Barnabas Gellen
- Department of Cardiac Rehabilitation, Henri-Mondor University Hospital, AP-HP, Creteil, France
| | - Thomas Rupp
- Interuniversity Laboratory of Human Movement Biology, University Savoie Mont Blanc, Chambery, France
| | - Léonard Féasson
- Interuniversity Laboratory of Human Movement Biology, Myology Unit, University Hospital Saint-Etienne, Saint-Etienne, France
| | - Pablo Bartolucci
- Sickle Cell Referral Center, UMGGR, Henri-Mondor University Hospital (AP-HP), Creteil, France
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21
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Messonnier LA, Bartolucci P, d'Humières T, Dalmais E, Lacour JR, Freund H, Galactéros F, Féasson L. Preventive measures for the critical postexercise period in sickle cell trait and disease. J Appl Physiol (1985) 2021; 130:485-490. [PMID: 33270510 DOI: 10.1152/japplphysiol.00855.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The immediate postexercise/physical activity period is critical for sickle cell trait (SCT) carriers and disease (SCD) patients. Exercise-related blood acidosis is known to trigger the cascade of HbS deoxygenation and polymerization, leading to red blood cell sickling and subsequent complications. Unfortunately, two facts worsen exercise-related blood acidosis during the initial postexercise period: First, blood lactate and H+ concentrations continue to increase for several minutes after exercise completion, exacerbating blood acidosis. Second, blood lactate concentration remains elevated and pH altered for 20-45 min during inactivity after intense exercise, keeping acid/base balance disturbed for a long period after exercise. Therefore, the risk of complications (including vasoocclusive crises and even sudden death) persists and even worsens several minutes after intense exercise completion in SCT carriers or SCD patients. Light physical activity following intense exercise (namely, active recovery) may, by accelerating lactate removal and acid/base balance restoration, reduce the risk of complications. Scientific evidence suggests that light exercise at or below the first lactate threshold is an appropriate strategy.
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Affiliation(s)
- Laurent A Messonnier
- Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Université Savoie Mont Blanc, Chambéry, France
| | - Pablo Bartolucci
- INSERM U955, Equipe 2 Transfusion et maladies du globule rouge, Laboratoire d'Excellence GRex, Créteil, France.,Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est-Créteil (UPEC) Faculté de Médecine, Créteil, France.,Reference Center for Sickle Cell Disease, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Thomas d'Humières
- Service de Physiologie Cardiovasculaire, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Etienne Dalmais
- Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Université Savoie Mont Blanc, Chambéry, France.,Centre d'Evaluation et de Prévention Articulaire, Challes-les-Eaux, France
| | - Jean-René Lacour
- Laboratoire de Physiologie de l'Exercice, Faculté de Médecine Lyon-Sud, Université de Lyon, Université Claude Bernard Lyon 1, Oullins, France
| | - Hubert Freund
- Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Université Savoie Mont Blanc, Chambéry, France
| | - Frédéric Galactéros
- Institut Mondor de Recherche Biomédicale (IMRB), Université Paris Est-Créteil (UPEC) Faculté de Médecine, Créteil, France.,Reference Center for Sickle Cell Disease, Henri Mondor University Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France
| | - Léonard Féasson
- University Hospital of Saint-Etienne, Myology Unit, Department of Clinical and Exercise Physiology, Referent Center of Neuromuscular Diseases, Euro-NmD, Saint-Etienne, France.,Laboratoire Interuniversitaire de Biologie de la Motricité, EA 7424, Université de Lyon, Université Jean Monnet, Saint-Etienne, France
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22
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Rech JS, Yao K, Bachmeyer C, Bailleul S, Javier O, Grateau G, Lionnet F, Steichen O. Prognostic Value of Hyponatremia During Acute Painful Episodes in Sickle Cell Disease. Am J Med 2020; 133:e465-e482. [PMID: 32199810 DOI: 10.1016/j.amjmed.2020.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 11/22/2019] [Accepted: 02/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Low plasma sodium concentration has been recognized as a prognostic factor in several disorders but never evaluated in sickle cell disease. The present study evaluates its value at admission to predict a complication in adult patients with sickle cell disease hospitalized for an initially uncomplicated acute painful episode. METHODS The primary outcome of this retrospective study, performed between 2010 and 2015 in a French referral center for sickle cell disease, was a composite criterion including acute chest syndrome, intensive care unit transfer, red blood cell transfusion or inpatient death. Analyses were adjusted for age, sex, hemoglobin genotype and concentration, lactate dehydrogenase (LDH) concentration, and white blood cell count. RESULTS We included 1218 stays (406 patients). No inpatient death occurred during the study period. Hyponatremia (plasma sodium ≤135 mmol/L) at admission in the center was associated with the primary outcome (adjusted odds ratio [OR] 1.95, 95% confidence interval [CI] 1.3-2.91, P = 0.001), with acute chest syndrome (OR 1.95 [95% CI 1.2-3.17, P = 0.008]), and red blood cell transfusion (OR 2.71 [95% CI 1.58-4.65, P <0.001]) but not significantly with intensive care unit transfer (OR 1.83 [95% CI 0.94-3.79, P = 0.074]). Adjusted mean length of stay was longer by 1.1 days (95% CI 0.5-1.6, P <0.001) in patients with hyponatremia at admission. CONCLUSIONS Hyponatremia at admission in the medical department for an acute painful episode is a strong and independent prognostic factor of unfavorable outcome and, notably, acute chest syndrome. It could help targeting patients who may benefit from closer monitoring.
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Affiliation(s)
- Jean-Simon Rech
- Department of Internal Medicine, Sickle Cell Disease Reference Center, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Groupe de Recherche Clinique Drépanocytose Recherche à Paris Sorbonne Université, Sorbonne University, Paris, France
| | - Kan Yao
- Department of Information Systems, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Claude Bachmeyer
- Department of Internal Medicine, Sickle Cell Disease Reference Center, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sophie Bailleul
- Department of Biochemistry, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Orlando Javier
- Department of Medical Information, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Gilles Grateau
- Department of Internal Medicine, Sickle Cell Disease Reference Center, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Department of Medical Information, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Lionnet
- Department of Internal Medicine, Sickle Cell Disease Reference Center, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Groupe de Recherche Clinique Drépanocytose Recherche à Paris Sorbonne Université, Sorbonne University, Paris, France
| | - Olivier Steichen
- Department of Internal Medicine, Sickle Cell Disease Reference Center, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Groupe de Recherche Clinique Drépanocytose Recherche à Paris Sorbonne Université, Sorbonne University, Paris, France.
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23
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Messonnier LA, Gellen B, Lacroix R, Peyrot S, Rupp T, Mira J, Peyrard A, Berkenou J, Galactéros F, Bartolucci P, Féasson L. Physiological Evaluation for Endurance Exercise Prescription in Sickle Cell Disease. Med Sci Sports Exerc 2020; 51:1795-1801. [PMID: 30920486 DOI: 10.1249/mss.0000000000001993] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE Although strenuous exercise may expose sickle cell disease (SCD) patients to risks of vaso-occlusive crisis, evidence suggests that regular endurance exercise may be beneficial. This study aimed to test (i) the safety and usefulness of a submaximal incremental exercise in evaluating physical ability of SCD patients and identify a marker for the management of endurance exercise and (ii) the feasibility of endurance exercise sessions in SCD patients. METHODS Twenty adults with SCD (12 men and 8 women) performed a submaximal incremental exercise used to determine the first lactate threshold (LT1) and stopped as soon as blood lactate concentration ([lactate]b) reached ≥4 mmol·L. Fifteen of those patients (8 men and 7 women) also performed three 30-min endurance exercise sessions at ~2.5 mmol·L of [lactate]b on separate occasions. RESULTS LT1 occurred at 47 ± 3 and 33 ± 3 W for men and women, respectively, demonstrating the extreme deconditioning and, thus, low physical ability of adult SCD patients. During endurance exercise, peripheral oxygen saturation and [lactate]b most often remained stable and within acceptable ranges. CONCLUSIONS The proposed strategy of submaximal incremental exercise allowed safe determination of LT1, an important parameter of patients' physical ability. The study also demonstrated the feasibility and safety of individually tailored endurance exercises at ~2.5 mmol·L of [lactate]b. These latter results suggest that endurance training programs may be considered for adult SCD patients and that the method proposed here may be helpful in that regard.
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Affiliation(s)
- Laurent A Messonnier
- University Savoie Mont Blanc, Inter-university Laboratory of Human Movement Sciences, Chambéry EA7424, FRANCE
| | - Barnabas Gellen
- Department of Cardiac Rehabilitation, Henri-Mondor University Hospital, AP-HP, Creteil, FRANCE.,ELSAN, Polyclinique de Poitiers, Poitiers, FRANCE
| | - Roxane Lacroix
- University Savoie Mont Blanc, Inter-university Laboratory of Human Movement Sciences, Chambéry EA7424, FRANCE
| | - Sandrine Peyrot
- Department of Cardiac Rehabilitation, Henri-Mondor University Hospital, AP-HP, Creteil, FRANCE
| | - Thomas Rupp
- University Savoie Mont Blanc, Inter-university Laboratory of Human Movement Sciences, Chambéry EA7424, FRANCE
| | - José Mira
- University Savoie Mont Blanc, Inter-university Laboratory of Human Movement Sciences, Chambéry EA7424, FRANCE
| | - Arthur Peyrard
- University Savoie Mont Blanc, Inter-university Laboratory of Human Movement Sciences, Chambéry EA7424, FRANCE
| | - Jugurtha Berkenou
- Sickle Cell Referral Center, Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, AP-HP, Créteil, FRANCE
| | - Frédéric Galactéros
- Sickle Cell Referral Center, Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, AP-HP, Créteil, FRANCE.,IMRB, Henri-Mondor Hospital-UPEC, GRex, Créteil, FRANCE
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Department of Internal Medicine, Henri-Mondor University Hospital-UPEC, AP-HP, Créteil, FRANCE.,IMRB, Henri-Mondor Hospital-UPEC, GRex, Créteil, FRANCE
| | - Léonard Féasson
- Inter-university Laboratory of Human Movement Sciences, University of Lyon, UJM-Saint-Etienne, EA7424, Saint-Etienne, FRANCE.,Myology Unit, Referent Center of Rare Neuromuscular Diseases, Euro-NmD, University Hospital of Saint-Etienne, Saint-Etienne, FRANCE
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24
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Abstract
Acute chest syndrome (ACS) and transfusion requirements are common and difficult to predict during hospitalizations for acute vaso-occlusive episodes (VOE) among individuals with sickle cell disease (SCD). This study examined the relationship between nucleated red blood cell (NRBC) counts during hospitalization for VOE and development of ACS or transfusion requirement among children with SCD. Retrospective chart review was performed for 264 encounters of patients with SCD hospitalized for uncomplicated VOE who had NRBC count data at admission during a 5-year period. Multivariable logistic regression analysis was conducted to determine the relationship of admission and change in NRBC ([INCREMENT]NRBC) to ACS/transfusion requirement. Overall, 44 of 264 (16.7%) encounters resulted in ACS, transfusion, or both. Admission NRBC was not associated with development of ACS/transfusion requirement. Among 125 of 264 (47.3%) encounters in which a subsequent CBC was obtained, greater increases in NRBCs and greater decrease in hemoglobin were significantly associated with ACS/transfusion requirement (OR, 2.72; 95% CI, 1.16, 6.35; P=0.02 and OR, 2.52; 95% CI, 1.08, 5.89; P=0.03, respectively). Our finding that an increase in NRBC counts was associated with development of ACS/transfusion requirement suggests that [INCREMENT]NRBCs may represent a useful biomarker for predicting complications in children with SCD hospitalized for VOE.
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25
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Identification of Clinical and Laboratory Parameters Associated with the Development of Acute Chest Syndrome during Vaso-Occlusive Episodes in Children with Sickle Cell Disease: A Preliminary Step before Assessing Specific and Early Treatment Strategies. J Clin Med 2019; 8:jcm8111839. [PMID: 31683997 PMCID: PMC6912589 DOI: 10.3390/jcm8111839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/12/2019] [Accepted: 10/27/2019] [Indexed: 01/01/2023] Open
Abstract
This prospective observational study sought to ascertain clinical and laboratory parameters associated with the development of acute chest syndrome (ACS) during vaso-occlusive episodes (VOE) in children with sickle cell disease (SCD). It was performed at the pediatric department of the university Intercommunal Créteil hospital. All children with SCD (all sickle genotypes) consecutively admitted from November 2013 to December 2016 for painful VOEs and no evidence of ACS were included. Clinical and laboratory parameters collected at admission and within 48 h after admission were compared for children in whom ACS developed or not. Variables that were statistically significant on univariate analysis or considered to be clinically relevant were included in a multivariable model to ascertain the risk factors associated with the development of ACS during a VOE. The variables retained in the multivariate model were used to construct a predictive score for ACS. For each included child and during the study period, only data from the first VOE and/or the first ACS were analyzed. Among 191 hospitalizations for painful VOEs, for 176 children with SCD, ACS developed in 35 during hospitalization. Mean hospital stay was longer for children with ACS versus VOEs alone (7.6 (±2.3) vs. 3.3 (±1.8) days, p < 0.0001), and all children with ACS versus 28/156 (17.9%) with VOEs alone received red blood cell transfusion (p < 0.0001). The multivariate model retained pain score (≥9/10), pain localization (abdominal or spinal pain or involving more than two limbs), and high reticulocyte (≥260 × 109/L) and neutrophil (>10 × 109/L) counts, at admission, as independently associated with ACS development. The area under the receiver operating characteristic curve for the ACS predictive score was 0.82 (95% CI: 0.74–0.89), and the negative predictive value was 97.7%. The evolution profiles during the first 48 h differed between children with ACS and VOEs alone, with a more rapid decline of pain score and leucocytosis in children with VOEs. Clinical and laboratory measurements at admission may be simple parameters to identify children with increased risk of ACS development during VOEs and to facilitate early diagnosis of this respiratory complication. Also, the persistent elevation of leukocyte count on day 2 may be considered a sign of evolving ACS.
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Telfer P, Barroso F, Newell K, Challands J, Kaya B. Evaluation of a Non-Parenteral Opioid Analgesia Protocol for Acute Sickle Cell Pain Episodes in Children. J Clin Med 2019; 8:jcm8101728. [PMID: 31635344 PMCID: PMC6832342 DOI: 10.3390/jcm8101728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 11/16/2022] Open
Abstract
We evaluated a protocol comprising intranasal diamorphine (IND) combined with oral short and modified-release morphine for children at the emergency department (ED) with acute painful episodes of sickle cell disease (SCD). In a retrospective audit of 83 episodes in 38 children, the mean time between arrival in the treatment area and the administration of IND was 10 min (range <5 min to 1.39 h). IND was administered in <5 min in 43 (51.6%), and in <20 min in 75 (90.4%) episodes. Persisting pain, requiring background analgesia with modified-release oral morphine, was required in 25 (30.1%) episodes. Inadequate control of pain requiring a switch to intravenous morphine PCA was required in eight episodes in four patients. Acute chest syndrome (ACS) developed in four of 83 episodes (4.8%, 95% CI 0.2-9.4%) and in four of 38 children (10.5%, 95% CI 0.7-20.5%). In conclusion, this protocol enabled the rapid administration of strong opioid analgesia in an ED setting, and may reduce the short and long-term adverse effects associated with parenteral opioids in children. There was no evidence of an increased incidence of ACS associated with use of oral morphine.
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Affiliation(s)
- Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Queen Mary University of London, London E1 2AT, UK.
| | - Filipa Barroso
- Department of Paediatric Haematology, Royal London Hospital, Bart's Health NHS Trust, London E1 2ES, UK.
| | - Kim Newell
- Department of Paediatric Haematology, Royal London Hospital, Bart's Health NHS Trust, London E1 2ES, UK.
| | - Jo Challands
- Department of Paediatric Anaesthetics, Royal London Hospital, Bart's Health NHS Trust, London E1 1BB, UK.
| | - Banu Kaya
- Department of Paediatric Haematology, Royal London Hospital, Bart's Health NHS Trust, London E1 2ES, UK.
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Merlet AN, Chatel B, Hourdé C, Ravelojaona M, Bendahan D, Féasson L, Messonnier LA. How Sickle Cell Disease Impairs Skeletal Muscle Function: Implications in Daily Life. Med Sci Sports Exerc 2019; 51:4-11. [PMID: 30095751 DOI: 10.1249/mss.0000000000001757] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sickle cell disease (SCD) is the most frequent life-threatening genetic hemoglobinopathy in the world and occurs due to the synthesis of abnormal hemoglobin S (HbS). hemoglobin S-containing red blood cells (RBC) are fragile, leading to hemolysis and anemia, and adhere to the endothelium, leading to hemorheological and hemodynamical disturbances. In its deoxygenated form, HbS may polymerize, leading to sickling of red blood cells and potentially to vasoocclusive crises. Recent findings observed that SCD patients demonstrate significant skeletal muscle remodeling and display reduced muscle functional capacities, contributing to exercise intolerance and poor quality of life. Although acute high-intensity exercise is not recommended for SCD patients because it may increase the risk of sickling, regular moderate-intensity physical activity could have beneficial effects on skeletal muscle and more generally on the well-being of SCD patients. This article reviews the literature regarding the impact of the disease on muscular tissue characteristics and function, as well as the corresponding implications for SCD patients' quality of life.
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Affiliation(s)
- Angèle N Merlet
- Inter-university Laboratory of Human Movement Sciences, University of Lyon, UJM Saint-Etienne, Saint-Etienne, FRANCE
| | - Benjamin Chatel
- Inter-university Laboratory of Human Movement Sciences, University of Savoie Mont Blanc, Chambéry, FRANCE.,Aix-Marseille University, Marseille, FRANCE
| | - Christophe Hourdé
- Inter-university Laboratory of Human Movement Sciences, University of Savoie Mont Blanc, Chambéry, FRANCE
| | - Marion Ravelojaona
- Inter-university Laboratory of Human Movement Sciences, University of Lyon, UJM Saint-Etienne, Saint-Etienne, FRANCE.,Myology Unit, Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, FRANCE
| | | | - Léonard Féasson
- Inter-university Laboratory of Human Movement Sciences, University of Lyon, UJM Saint-Etienne, Saint-Etienne, FRANCE.,Inter-university Laboratory of Human Movement Sciences, University of Savoie Mont Blanc, Chambéry, FRANCE.,Aix-Marseille University, Marseille, FRANCE.,Myology Unit, Department of Clinical and Exercise Physiology, University Hospital of Saint-Etienne, Saint-Etienne, FRANCE
| | - Laurent A Messonnier
- Inter-university Laboratory of Human Movement Sciences, University of Savoie Mont Blanc, Chambéry, FRANCE
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Zanette DL, Santiago RP, Leite IPR, Santana SS, da Guarda C, Maffili VV, Ferreira JRD, Adanho CSA, Yahouedehou SCMA, Menezes IL, Goncalves MS. Differential gene expression analysis of sickle cell anemia in steady and crisis state. Ann Hum Genet 2019; 83:310-317. [PMID: 30698275 DOI: 10.1111/ahg.12290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 09/21/2018] [Accepted: 09/25/2018] [Indexed: 11/27/2022]
Abstract
Sickle cell anemia is one of the most prevalent genetic diseases worldwide, showing great clinical heterogeneity. This study compared the gene expression patterns between sickle cell anemia pediatric patients in steady state and in crisis state, as compared to age-paired, healthy individuals. RNA sequencing was performed from these groups of patients/controls using Illumina HiSeq 2500 equipment. The resulting differentially expressed genes were loaded into QIAGEN's ingenuity pathway analysis. The results showed that EIF2 pathway and NRF2-mediated oxidative stress-response pathways were more highly activated both in steady state and in crisis patients, as compared to healthy individuals. In addition, we found increased activation of eIF4 and p70S6K signaling pathways in crisis state compared to healthy individuals. The transcription factor GATA-1 was found exclusively in steady state while SPI was found exclusively in crisis state. IL6 and VEGFA were found only in crisis state, while IL-1B was found exclusively in steady state. The regulator effects analysis revealed IgG1 as an upstream regulator in steady state compared to healthy individuals, resulting in invasion of prostate cancer cell lines as the disease/function outcome. For crisis-state patients versus healthy individuals, two networks of regulator effects revealed STAT1, CD40LG, TGM2, IRF7, IRF4, and IRF1 acting as upstream regulators, resulting in disease/function outcomes, including engulfment of cells and aggregation of blood cells and inflammation of joints. Our results indicated genes and pathways that can provide clues on the molecular events involved in the severity of sickle cell disease.
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Affiliation(s)
- Dalila L Zanette
- Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz - Fiocruz/BA, 40296710, Salvador, Bahia, Brazil
| | - Rayra P Santiago
- Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz - Fiocruz/BA, 40296710, Salvador, Bahia, Brazil
| | - Ivana Paula Ribeiro Leite
- Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz - Fiocruz/BA, 40296710, Salvador, Bahia, Brazil.,Hospital Pediátrico Professor Hosannah de Oliveira, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Sanzio S Santana
- Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz - Fiocruz/BA, 40296710, Salvador, Bahia, Brazil
| | - Caroline da Guarda
- Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz - Fiocruz/BA, 40296710, Salvador, Bahia, Brazil
| | - Vitor V Maffili
- Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz - Fiocruz/BA, 40296710, Salvador, Bahia, Brazil
| | | | | | | | - Isa Lyra Menezes
- Hospital Pediátrico Professor Hosannah de Oliveira, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Marilda Souza Goncalves
- Fundação Oswaldo Cruz, Centro de Pesquisas Gonçalo Moniz - Fiocruz/BA, 40296710, Salvador, Bahia, Brazil.,Faculdade de Farmácia, Universidade Federal da Bahia, 40170115, Salvador, Bahia, Brasil
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Sabrie M, Cannas G, Tazarourte K, Poutrel S, Connes P, Hot A, Renoux C, Fattoum J, Joly P. Drepa-Opia: A Pilot Study to Determine the Predictive Factors of Morphine Use and Consumption in Hospitalized Adult Patients with Sickle Cell Disease. Hemoglobin 2019; 42:217-224. [PMID: 30604640 DOI: 10.1080/03630269.2018.1529602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to evaluate the clinical, biological and genetic factors that could be associated with the use and dose of morphine during hospitalization for vaso-occlussive crisis (VOC) in adults with sickle cell disease. Ninety-nine hospitalizations for acute VOC (58 sickle cell disease patients aged 18 to 60 years, one to six hospitalizations each) were recorded; we investigated the associations between qualitative and quantitative opioid requirements and several biological, clinical, epidemiological and genetic parameters. Visual analog pain scale (VAS) was the only independent predictor of the qualitative need for morphine (mean value of 8.5 vs. 6.1 for the 77 hospitalizations that required morphine). A higher total administered morphine dose, which relates mainly to the overall crisis severity, was associated with a lower hemoglobin (Hb) level at entry. The mean daily morphine dose, which is more influenced by the individual sensitivity to morphine, was not influenced by the studied genetic parameters [sickle cell disease type, α-thalassemia (α-thal) status, UGT2B7 and ABCB1 genotypes] but a very slight negative association was found with the total bilirubin (BIL) level at entry. Our study demonstrated that physicians are often reluctant to prescribe morphine in sickle cell disease as a VAS of 6 corresponds to the usual threshold of administration in other instances. Total Hb at entry was also associated for the first time with higher total morphine consumption and could be used in a predictive VOC severity score. These results have to be confirmed and completed on larger cohorts.
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Affiliation(s)
- Marie Sabrie
- a Service des Urgences Hôpital Edouard-Herriot, Hospices Civils de Lyon , Université de Lyon, Equipe d'Accueil , , Services de Santé et Recherche sur la Performance (HESPER), 7425, Lyon, France
| | - Giovanna Cannas
- b Service de Médecine Interne, Hôpital Edouard-Herriot, Centre de Référence Constitutif 'Syndromes Drépanocytaires Majeurs , Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse', Hospices Civils de Lyon, Lyon, France.,c Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge' , Université Claude Bernard Lyon 1 , Communauté d'Universités et d'Establissments (COMUE) de Lyon, France.,d Laboratoire d'Excellence sur le Globule Rouge (Labex GR-Ex) , Paris , France
| | - Karim Tazarourte
- a Service des Urgences Hôpital Edouard-Herriot, Hospices Civils de Lyon , Université de Lyon, Equipe d'Accueil , , Services de Santé et Recherche sur la Performance (HESPER), 7425, Lyon, France
| | - Solène Poutrel
- b Service de Médecine Interne, Hôpital Edouard-Herriot, Centre de Référence Constitutif 'Syndromes Drépanocytaires Majeurs , Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse', Hospices Civils de Lyon, Lyon, France
| | - Philippe Connes
- c Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge' , Université Claude Bernard Lyon 1 , Communauté d'Universités et d'Establissments (COMUE) de Lyon, France.,d Laboratoire d'Excellence sur le Globule Rouge (Labex GR-Ex) , Paris , France.,e Institut Universitaire de France , Paris , France
| | - Arnaud Hot
- b Service de Médecine Interne, Hôpital Edouard-Herriot, Centre de Référence Constitutif 'Syndromes Drépanocytaires Majeurs , Thalassémies et Autres Pathologies Rares du Globule Rouge et de l'Erythropoïèse', Hospices Civils de Lyon, Lyon, France
| | - Céline Renoux
- c Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge' , Université Claude Bernard Lyon 1 , Communauté d'Universités et d'Establissments (COMUE) de Lyon, France.,d Laboratoire d'Excellence sur le Globule Rouge (Labex GR-Ex) , Paris , France.,f Laboratoire de Biochimie et Biologie Moléculaire Grand Est, Groupement Hospitalier Est, Hospices Civils de Lyon , Bron , France
| | - Jihane Fattoum
- a Service des Urgences Hôpital Edouard-Herriot, Hospices Civils de Lyon , Université de Lyon, Equipe d'Accueil , , Services de Santé et Recherche sur la Performance (HESPER), 7425, Lyon, France
| | - Philippe Joly
- c Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Equipe 'Biologie Vasculaire et du Globule Rouge' , Université Claude Bernard Lyon 1 , Communauté d'Universités et d'Establissments (COMUE) de Lyon, France.,d Laboratoire d'Excellence sur le Globule Rouge (Labex GR-Ex) , Paris , France.,f Laboratoire de Biochimie et Biologie Moléculaire Grand Est, Groupement Hospitalier Est, Hospices Civils de Lyon , Bron , France
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30
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Gellen B, Messonnier LA, Galactéros F, Audureau E, Merlet AN, Rupp T, Peyrot S, Martin C, Féasson L, Bartolucci P, Habibi A, Guillet E, Gellen-Dautremer J, Ribeil JA, Arlet JB, Mattioni S, Berkenou J, Delrieux N, Lionnet F, Grenot JF, Mira J, Peyrard A, Lacroix R, Garcin A, Di Liberto G, Hourdé C. Moderate-intensity endurance-exercise training in patients with sickle-cell disease without severe chronic complications (EXDRE): an open-label randomised controlled trial. LANCET HAEMATOLOGY 2018; 5:e554-e562. [PMID: 30389037 DOI: 10.1016/s2352-3026(18)30163-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 01/17/2023]
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Colla JS, Kotini-Shah P, Soppet S, Chen YF, Molokie R, Prajapati P, Prendergast HM. Bedside ultrasound as a predictive tool for acute chest syndrome in sickle cell patients. Am J Emerg Med 2018; 36:1855-1861. [DOI: 10.1016/j.ajem.2018.07.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 01/19/2023] Open
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Basishvili G, Gotesman J, Vandervoort K, Jacobs C, Vattappally L, Minniti CP. Comprehensive management reduces incidence and mortality of acute chest syndrome in patients with sickle cell disease. Am J Hematol 2018; 93:E64-E67. [PMID: 29205462 DOI: 10.1002/ajh.24994] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 02/02/2023]
Affiliation(s)
| | | | | | | | | | - Caterina P. Minniti
- Albert Einstein College of Medicine; Bronx New York
- Montefiore Medical Center; Bronx New York
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van Tuijn CFJ, Sins JWR, Fijnvandraat K, Biemond BJ. Daily pain in adults with sickle cell disease-a different perspective. Am J Hematol 2017; 92:179-186. [PMID: 27880985 DOI: 10.1002/ajh.24612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 02/02/2023]
Abstract
Previous reports demonstrated that patients with sickle cell disease (SCD) experience pain on more than half of the observed days. Yet, these high incidences do not seem to match observations in our population. In this prospective cohort study, we aimed to assess the frequency and characteristics of daily, self-reported pain among adult SCD patients in the Netherlands. Consecutive patients were enrolled during routine outpatient visits and followed up to 6 months. A total of 55 patients completed 5,982 diary observation days. Median age was 27 years (IQR 23-43). Patients reported SCD related pain on 17% of the observed days; on 13% of these days this pain was not defined as a painful crisis, while 3% was reported as a painful crisis but managed at home, and on 1% of the observed days patients were admitted to the hospital. Analgesics were used on 52% of days with pain with a relatively infrequent use of oral opioids (9% of pain days). This first European study on pain in SCD indicates that pain appears to be significantly less frequent in our population as compared to previous study cohorts from the United States, and may be more representative for current SCD populations in other Western countries. Besides a more widespread use of hydroxycarbamide in modern disease management, differences in organization and accessibility of healthcare between countries may also explain this discrepancy.
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Affiliation(s)
| | - Joep W. R. Sins
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
| | - Bart J. Biemond
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
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