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Moukalled NM, Bou Fakhredin R, Taher AT. Pregnancy and sickle cell disease: an overview of complications and suggested perinatal care. Expert Rev Hematol 2022; 15:1055-1061. [PMID: 36413684 DOI: 10.1080/17474086.2022.2151432] [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: 11/24/2022]
Abstract
INTRODUCTION Pregnancy in women with sickle cell disease (SCD) has been identified as high risk owing to increased incidence of materno-fetal complications across various studies and reports. These complications include consequences related to the underlying hemoglobinopathy; chronic anemia/associated inflammation, and pregnancy related including the risk for thromboembolism, bleeding and maternal mortality. Outcomes of neonates born to women with SCD has been suboptimal over the years with recent improvement due to strict monitoring, preventive and therapeutic measures. Much is yet to be unraveled regarding the optimal management of women with SCD during pregnancy, identifying target hemoglobin, delivery mode or timing among others. AREAS COVERED This review includes a summary of available data of the maternal and fetal outcomes; in addition to current recommendations for monitoring and management of women with SCD during pregnancy. EXPERT OPINION To have a successful pregnancy, women should be closely monitored, and interventions provided as needed to guarantee adequate management of anemia, as well as prevention, diagnosis and management of disease. They should also be educated regarding their reproductive health, emphasizing that pregnancy is possible, and achieving optimal results depends on providing adequate care in a health care facility with expertise in high-risk pregnancies and SCD.
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Affiliation(s)
- Nour M Moukalled
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayan Bou Fakhredin
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ali T Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Gohal GA, Gosadi IM, Cittana Iqbal BA, Ghazwani YH, Daghriri AM, Shugairi AA, Daghriri KA, Zurayyir AJ, Nemri AA, Abdulhaq MA. Utilization of Hydroxyurea Among Patients Diagnosed with Sickle Cell Disease in Jazan, Saudi Arabia. Patient Prefer Adherence 2022; 16:3059-3067. [PMID: 36387052 PMCID: PMC9653045 DOI: 10.2147/ppa.s390568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The early diagnosis of sickle cell disease (SCD) patients and getting appropriate treatment are crucial for improving clinical outcomes. This study aims to assess the use of hydroxyurea among patients diagnosed with SCD and assess factors influencing the attitude toward the medication and the reasons for discontinuation. METHODS This study was a cross-sectional investigation targeting parents or caregivers of children diagnosed with SCD in the Jazan region of Saudi Arabia. Data were collected from tertiary healthcare hospitals via a self-administered questionnaire. The questionnaire was composed of sections measuring the participants' demographics, the number of children diagnosed with SCD, the use of hydroxyurea, and the parents' beliefs about hydroxyurea. RESULTS There were 301 parents or caregivers recruited. The majority of the recruited participants were mothers (54.5%), and nearly half of the sample were older than 35. More than 80% of the participants declare that one or more of their children are receiving hydroxyurea to manage SCD. The majority of participants declared that using hydroxyurea reduced the frequency of body pain episodes, emergency department visits, and hospital admissions. Participants' major concern about the use of hydroxyurea was related to the fear of weakening their immunity (29.5%) and hydroxyurea's perceived effect on fertility (16.8%). Furthermore, 52 (18%) of the participants declared that the use of hydroxyurea to manage the disease was stopped; the main reasons for stopping was their belief that hydroxyurea had side effects and its impact on weakening of their immune system. CONCLUSION The findings indicate the importance of increasing the role of clinicians in educating patients and caregivers about the use of hydroxyurea and its benefits.
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Affiliation(s)
- Gassem A Gohal
- Department of Pediatrics, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ibrahim M Gosadi
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
- Correspondence: Ibrahim M Gosadi, Department of Family and Community Medicine, Faculty of Medicine, Jazan University, P.O. Box: 2349, Jazan, 82621, Saudi Arabia, Tel +966 562137711, Email
| | | | - Yahya H Ghazwani
- Department of Pediatric Hematology and Oncology, Prince Mohammed Bin Nasser Hospital, Jazan, Saudi Arabia
| | - Amal M Daghriri
- Department of Pediatric Hematology and Oncology, Prince Mohammed Bin Nasser Hospital, Jazan, Saudi Arabia
| | - Ahmad A Shugairi
- Department of Adult Hematology and Oncology, Prince Mohammed Bin Nasser Hospital, Jazan, Saudi Arabia
| | - Khaled A Daghriri
- Department of Internal Medicine, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Atyaf J Zurayyir
- Department of Obstetrics and Gynecology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulrhman A Nemri
- Department of General Surgery, Security Force Hospital, Riyadh, Saudi Arabia
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Garba SR, Makwe CC, Osunkalu VO, Kalejaiye OO, Soibi-Harry AP, Aliyu AU, Afolabi BB. Ovarian reserve in nigerian women with sickle cell anaemia: a cross- sectional study. J Ovarian Res 2021; 14:174. [PMID: 34895288 PMCID: PMC8666009 DOI: 10.1186/s13048-021-00927-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 11/23/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Sickle cell disease is the most common monogenetic disorder worldwide. There have been reports of endocrine dysfunction and gonadal failure among affected individuals, especially in males. The findings on ovarian reserve and failure in women with sickle anaemia have been inconsistent. AIM AND OBJECTIVE The aim of this study was to determine and compare the ovarian reserve of Nigerian women with and without sickle cell anaemia attending a University Teaching Hospital. STUDY DESIGN This cross-sectional study was carried out at the Adult Sickle Cell Clinic and the Community Health Clinic of the Lagos University Teaching Hospital. METHODOLOGY A total of 166 participants who met the selection criteria, were recruited for the study. The study population consisted of two groups of women matched for age: 83 women with HbSS and 83 women with HbAA. The haemoglobin phenotype of each participant was determined on alkaline electrophoresis (pH 8.4) before analysis. Serum Anti-Mullerian Hormone (AMH) was determined using Enzyme-linked immunosorbent assay (ELISA) method (Calbiotech Inc. USA, Catalog no AM448T). RESULTS The mean ± SD of serum AMH level in women with HbSS was 3.64 ± 0.65 ng/mL and was lower than that of women with HbAA 7.35 ±1.19 ng/mL (p < 0.001). Serum AMH negatively correlated with age in both study groups (HbAA and HbSS). Also, a significant negative correlation was found between serum AMH and BMI in women with HbAA. CONCLUSION The study showed diminished ovarian reserve in women with HbSS when compared to age-matched women with HbAA.
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Affiliation(s)
- Sunusi Rimi Garba
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria P.M.B. 12003, Surulere, Lagos, Nigeria
| | - Christian Chigozie Makwe
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria P.M.B. 12003, Surulere, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Vincent Oluseye Osunkalu
- Department of Obstetrics and Gynaecology, College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Hematology and Blood Transfusion, College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
| | - Olufunto Olufela Kalejaiye
- Department of Obstetrics and Gynaecology, College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
- Department of Medicine, College of Medicine University of Lagos, Lagos, Nigeria
| | - Adaiah Priscillia Soibi-Harry
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria P.M.B. 12003, Surulere, Lagos, Nigeria
| | - Amina Umar Aliyu
- Department of Nursing, Lagos University Teaching Hospital, Idi-Araba Lagos, Lagos, Nigeria
| | - Bosede Bukola Afolabi
- Department of Obstetrics and Gynaecology, Lagos University Teaching Hospital, Idi-Araba Lagos, Nigeria P.M.B. 12003, Surulere, Lagos, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine University of Lagos, Idi-Araba, Lagos, Nigeria
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Lu R, Zhang X, Cai X, Wang X, Li H, Wang L, Zhou Y, Shen J, Liu Q, Zhang H, Ni Z. Efficacy and safety of polysaccharide iron complex capsules compared with iron sucrose in hemodialysis patients: study protocol for a randomized, open-label, positive control, multicenter trial (IHOPE). Trials 2021; 22:691. [PMID: 34629085 PMCID: PMC8503988 DOI: 10.1186/s13063-021-05663-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 09/27/2021] [Indexed: 11/25/2022] Open
Abstract
Background Anemia is one of the main complications of chronic kidney disease especially kidney failure, which includes treatment with erythropoiesis-stimulating agents and iron supplementation, including intravenous and oral iron. However, intravenous iron may pose limitations, such as potential infusion reactions. Oral iron is mainly composed of divalent iron, which can excessively stimulate the gastrointestinal tract. Iron polysaccharide complex capsules are a novel oral iron trivalent supplement with higher iron content and lower gastrointestinal irritation. However, since high-quality evidence-based medicinal support is lacking, it is necessary to conduct clinical studies to further evaluate the effectiveness and safety of oral iron polysaccharide complex in chronic kidney disease patients. Methods This randomized controlled trial uses an open-label, parallel group design, where the efficacy and safety of maintenance hemodialysis (MHD) participants is evaluated. The experimental group is assigned erythropoietins and iron polysaccharide complex (two capsules each time, bid), and the control group is assigned erythropoietin and sucrose iron (100mg, 2w) injection. Participants (aged 18–75 years) undergoing maintenance hemodialysis were considered for screening. Inclusion criteria included hemoglobin (Hb) ≥110g/L and < 130g/L, transferrin saturation (TSAT) > 20% and < 50%, and serum ferritin (SF) > 200μg/L and < 500μg/L. Exclusion criteria included acute or chronic bleeding, serum albumin < 35g/L, hypersensitive C-reactive protein (HsCRP) > 10 mg/L, and severe secondary hyperparathyroidism (iPTH ≥ 800 pg/mL). Full inclusion and exclusion criteria are described in the “Methods” section. The primary endpoint is TSAT of the participants at week 12. Secondary endpoints include Hb, SF, hematocrit (Hct), HsCRP, pharmacoeconomic evaluation, drug costs, quality of life, and indicators of oxidative stress. The treatment will last for 24 weeks with a follow-up visit at baseline (within 7 days prior to initial treatment) and weeks 4, 8, 12, 16, 20, and 24 after initial treatment. This clinical research includes 9 hemodialysis centers in mainland China and plans to enroll 186 participants. Discussion It is expected that it will provide strong evidence to reveal the clinical efficacy and safety of oral iron in the treatment of chronic CKD-related anemia in MHD patients through this clinical trial. Trial registration Chinese Clinical Trial Registry ChiCTR2000031166. Registered on March 23, 2020
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Affiliation(s)
- Renhua Lu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Xu Zhang
- Department of Nephrology, Taixing People's Hospital, Taizhou, Jiangsu, China
| | - Xudong Cai
- Department of Nephrology, Ningbo Hospital of Traditional Chinese Medicine, Ningbo, Zhejiang, China
| | - Xiaoxia Wang
- Department of Nephrology, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hua Li
- Department of Nephrology, Sir Run Shaw Hospital affiliated to Zhejiang University School of Medicine, Zhejiang, Hangzhou, China
| | - Li Wang
- Department of Nephrology, Shandong Qianfoshan Hospital, Jinan, Shandong, China
| | - Yijun Zhou
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Jianxiao Shen
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Qian Liu
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Haifen Zhang
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China
| | - Zhaohui Ni
- Department of Nephrology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 160 Pujian Road, Shanghai, China.
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Mostafa GG, Zahran FE, Omer SA, Ibrahim A, Elhakeem H. The Effect of Serum Ferritin Level on Gonadal, Prolactin, Thyroid Hormones, and Thyroid Stimulating Hormone in Adult Males with Sickle Cell Anemia. J Blood Med 2020; 11:27-32. [PMID: 32095088 PMCID: PMC6995285 DOI: 10.2147/jbm.s232562] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/15/2020] [Indexed: 01/16/2023] Open
Abstract
Background Sickle cell anaemia (SCA) is an inherited hemoglobinopathy resulting in sickling of erythrocytes that cause micro-vascular obstruction leading to acute complications and chronic organ damage. Adults with SCA have endocrine complications and metabolic alterations. The aim of this study was to assess the association between gonadal and thyroid hormones with iron indices and to explore the potential association between serum ferritin levels and sex hormones in adult males with sickle cell disease in New Prince Saud Bin Jalawy Hospital (NPSBJH) in Hofuf city (Eastern region of Saudi Arabia) where there are many patients with SCA. Methods A cross-sectional analytical study was carried out in the Haematology Clinic at NPSBJH in 2018. A total of eighty (80) male patients with sickle cell anaemia were included in this study and were divided into two groups according to serum ferritin level. Group I (G-I): Included 40 male patients with high serum ferritin level and group II (G-II): included 40 male patients with normal serum ferritin level. Results There was a significant difference in height/cm between GI and Gil, P value= 0.006. Serum ferritin was significantly higher in GI (P value= 0.000), and serum TIBC was significantly higher in G-II. (P value= 0.022). Testosterone level was significantly higher in G-II (P value= 0.018). Luteinizing hormone (LH) was significantly higher in group I (P-value 0.019). There was a significant relation between serum ferritin level in G-I and the following: serum iron, TIBC, serum testosterone, LH, prolactin, free T3 and free T4. Conclusion Adult males with SCD with high serum ferritin level were shorter than adult males with SCD who had normal serum ferritin level and had a significant lower level of serum testosterone and significant high level of LH and this was most likely due to endocrine dysfunction secondary to high ferritin level and iron overload.
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Affiliation(s)
- Gamal G Mostafa
- Department of Clinical Adult Hematology, Faculty of Medicine, Aswan University, Aswan, Egypt; Haematology, Hereditary Blood Disease Centre- Hofuf, Hofuf, Kingdom of Saudi Arabia
| | - Fawkia E Zahran
- Department of Internal Medicine, Faculty of Medicine for Girls, Al- Azhar University, Cairo, Egypt.,King Fahad Hospital, Hofuf, Al Hofuf, Kingdom of Saudi Arabia
| | - Sawsan A Omer
- King Fahad Hospital, Hofuf, Al Hofuf, Kingdom of Saudi Arabia.,Department of Internal Medicine, Faculty of Medicine, University of Gezira, Wad Madani, Sudan
| | - Ahmed Ibrahim
- Department of Community Medicine, Faculty of Medicine, University of Western Kordofan, Al-Foula, Sudan; Prince Sultan Cardiac Center, Al Hassa, Al Hasa, Kingdom of Saudi Arabia
| | - Heba Elhakeem
- Clinical Pathology Department, Faculty of Medicine for Girls, Alazhar University, Cairo, Egypt
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Sickle Cell Disease and Pregnancy. Mediterr J Hematol Infect Dis 2019; 11:e2019040. [PMID: 31308916 PMCID: PMC6613624 DOI: 10.4084/mjhid.2019.040] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/30/2019] [Indexed: 01/19/2023] Open
Abstract
Sickle cell disease (SCD) is the most common inherited hemoglobinopathy and is associated with increased risk of complications and early mortality. Nowadays, with improved health care facilities, antibiotic prophylaxis, vaccination, and availability of drugs like hydroxyurea, the life expectancy of SCD patients has improved. More women are reaching reproductive age group and are expressing their desire to reproduce. Though SCD adversely affects pregnancy, leading to increased incidence of maternal and perinatal complications like pre-eclampsia, preterm labor, IUGR, abortions etc., adequate care throughout pregnancy ensures a better outcome. Also, recent advancements in the fields of prenatal diagnosis and preimplantation genetic diagnosis, help couples suffering from SCD to have a healthy baby. This paper focuses on the effects of SCD on pregnancy outcomes and effective management of complications during pregnancy, also comparing maternal and perinatal outcomes in studies conducted in different countries. The second part of the paper summarizes pregnancy management in SCD for better maternal and fetal outcomes.
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Condorelli M, Demeestere I. Challenges of fertility preservation in non-oncological diseases. Acta Obstet Gynecol Scand 2019; 98:638-646. [PMID: 30771251 DOI: 10.1111/aogs.13577] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 02/11/2019] [Indexed: 12/15/2022]
Abstract
Clinicians should provide fertility counseling to all patients receiving gonadotoxic treatment. International scientific societies have mainly focused on oncological patients, and fewer efforts have been made to apply these recommendations to women diagnosed with benign disease (eg benign hematological diseases, autoimmune diseases, and gynecological or genetic disorders). However, these indications account for 8%-13% of the demand for fertility preservation. The risk of premature ovarian failure due to treatment, or to the disease itself, can be considered fairly high for many young women. Counseling and adequate management of these women require particular attention due to the severe health conditions that are associated with some of these diseases. In this review, we address specific issues related to providing adequate fertility counseling and management for women who have been diagnosed with the major non-oncological indications, based on the literature and on our clinical experience.
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Affiliation(s)
- Margherita Condorelli
- Research Laboratory on Human Reproduction and Fertility Clinic, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Demeestere
- Research Laboratory on Human Reproduction and Fertility Clinic, CUB-Erasme, Université Libre de Bruxelles, Brussels, Belgium
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Mandese V, Bigi E, Bruzzi P, Palazzi G, Predieri B, Lucaccioni L, Cellini M, Iughetti L. Endocrine and metabolic complications in children and adolescents with Sickle Cell Disease: an Italian cohort study. BMC Pediatr 2019; 19:56. [PMID: 30744584 PMCID: PMC6371531 DOI: 10.1186/s12887-019-1423-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 01/30/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with Sickle Cell Disease (SCD) show endocrine complications and metabolic alterations. The physiopathology of these conditions is not completely understood: iron overload due to chronic transfusions, ischemic damage, and inflammatory state related to vaso-occlusive crises may be involved. Aims of this study were to evaluate the growth pattern, endocrine complications, and metabolic alterations and to detect the relationship between these conditions and the SCD severity in affected children and adolescents. METHODS Fifty-two children and adolescents with SCD [38 homozygous sickle hemoglobin (HbSS) and 14 heterozygous sickle hemoglobin (HbSC); age range 3-18 years] were recruited. Anthropometric [height, body mass index (BMI), arm span, sitting height, target height (TH), and pubertal status] and laboratory [blood cell counts, hemolysis indices, metabolic and nutritional status indices and hormonal blood levels] data were evaluated. The SCD severity was defined according to hematological and clinical parameters. RESULTS Height-SDS adjusted for TH and BMI-SDS were significantly higher in HbSC children than in HbSS ones. Forty-eight out of 52 patients (92%) had at least one metabolic and/or endocrine alteration: insufficiency/deficiency of vitamin D (84.7%), insulin resistance (11.5%), growth hormone deficiency (3.8%), subclinical hypothyroidism (3.8%), and hypogonadism (1.9%). Levels of vitamin D were significantly and negatively correlated with clinical indicators of the SCD severity. Subjects with HbSS genotype show significant lower levels of both insulin-like growth factor-1 (IGF-1) and insulin-like growth factor binding protein 3 than children with HbSC. In the study population IGF-1 values were significantly and positively correlated with Hb and negatively with lactate dehydrogenase. CONCLUSIONS Metabolic alterations and endocrine complications are very common in children and adolescents with SCD. A regular follow-up is necessary to identify subjects at risk for complications to precociously start an appropriate treatment and to improve the quality of life of SCD patients.
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Affiliation(s)
- V Mandese
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - E Bigi
- Oncology and Hematology Pediatric Unit Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - P Bruzzi
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - G Palazzi
- Oncology and Hematology Pediatric Unit Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - B Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - L Lucaccioni
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy
| | - M Cellini
- Oncology and Hematology Pediatric Unit Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy
| | - L Iughetti
- Post Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 71, 41124, Modena, Italy. .,Oncology and Hematology Pediatric Unit Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy. .,Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, 41124, Modena, Italy.
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Mandal P, Baul S, Dolai T, Sahana P, De R, Chakrabarti P. Does Thyroid dysfunction correlates with iron overload in Eβ thalassemia patients? A study from a tertiary care thalassemia center in India. ARCHIVES OF MEDICINE AND HEALTH SCIENCES 2019. [DOI: 10.4103/amhs.amhs_61_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Hagag AA, El-Asy HM, Badraia IM, Hablas NM, El-Latif AEA. Thyroid Function in Egyptian Children with Sickle Cell Anemia in Correlation with Iron Load. Endocr Metab Immune Disord Drug Targets 2018; 19:46-52. [PMID: 30207251 DOI: 10.2174/1871530318666180912153349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 06/01/2018] [Accepted: 08/22/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Sickle Cell Disease (SCD) is characterized by defective hemoglobin synthesis, hemolytic anemia, frequent thrombosis and chronic organ damage including endocrine organs. AIM To assess thyroid function in children with SCD in correlation and iron load. PATIENTS AND METHOD This study was conducted on 40 children with SCD with iron overload (serum ferritin more than 1000 ng/ml) including 22 males and 18 females with their ages ranging from 11-14 years and mean age value of 11.63±1.36 years and 40 healthy children of matched age and sex as a control group. For all patients; complete blood count, hemoglobin electrophoresis, serum ferritin, serum iron, iron binding capacity and thyroid function including Free Thyroxine (FT4), Free Triiodothyronine (FT3), Thyroid Stimulating Hormone (TSH), Thyroid Peroxidase Antibody (TPOAb) and Thyroglobulin Antibody (TgAb) were done. RESULTS Significantly higher serum ferritin and iron and significantly lower Total Iron Binding Capacity (TIBC) were found in patients compared with controls (mean serum ferritin was 1665.2±1387.65ng/ml in patients versus 192.55±107.2ng/ml in controls with p-value of 0. 007, mean serum iron was 164±83.9 ug/dl in patients versus 89.5±4.5ug/dl in controls with p-value of 0.039, mean TIBC was 238±44.5ug/dl in patients versus 308±11ug/dl in controls with p-value of 0.001). Significantly higher serum TSH and significantly lower Free T3 and Free T4 were found in patients compared with controls with no significant correlation between thyroid hormones and serum ferritin (mean serum TSH was 4.61±1.2 µIU/mL in patients versus 2.11 ± 0.54 µIU /mL in controls with p-value of 0. 045, mean serum FT3 was 2.61 ±1.3 pg/mL versus 3.93±0.47pg/mL in controls with p-value of 0.027, mean serum FT4 was 0.91±0.174 ng/dL versus 1.44± 0.164 ng/dLin controls with p-value of 0.047, r = - 0. 008 and p-value was 0. 973 for correlation between free T4 and serum ferritin, r = -0. 028 and p-value was 0. 9 for correlation between TSH and serum ferritin and r= - 0.259 and p-value was 0.27 for correlation betweenT3 and serum ferritin). There were no significant differences between patients and controls regarding thyroid peroxidase antibody and thyroglobulin antibody (mean serum thyroid peroxidase antibody was 22.45± 4.32 in patients versus 22.45 ± 3.21 in controls with p-value of 0.98 while mean serum thyroglobulin antibody was 12.32 ± 2.65 in patients versus 12.99 ± 2.34 in controls with p-value of 0.76. CONCLUSION Thyroid hormones deficiency may occur in some patients with SCD. RECOMMENDATIONS Regular assessment of thyroid function in children with SCD may be recommended as they are more vulnerable to develop hypothyroidism and may require replacement therapy.
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Affiliation(s)
- Adel A Hagag
- Pediatrics Departments, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Hassan M El-Asy
- Pediatrics Departments, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Ibrahim M Badraia
- Pediatrics Departments, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Nahed M Hablas
- Pediatrics Departments, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Amal Ezzat Abd El-Latif
- Clinical Pathology Departments, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
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Yassin MA, Soliman AT, De Sanctis V, Abdula MAJ, Riaz LM, Ghori FF, Yousaf A, Nashwan AJ, Abusamaan S, Moustafa A, Kohla S, Soliman DS. Statural Growth and Prevalence of Endocrinopathies in Relation to Liver Iron Content (LIC) in Adult Patients with Beta Thalassemia Major (BTM) and Sickle Cell Disease (SCD). ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:33-40. [PMID: 29451227 PMCID: PMC6179035 DOI: 10.23750/abm.v89i2-s.7085] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 02/07/2018] [Indexed: 01/17/2023]
Abstract
Despite regular blood transfusion and iron chelation therapy, growth impairment and pubertal delay are commonly seen in children and adolescents with transfusion-dependent Beta thalassaemia major (BTM) and sickle cell disease (SCD). We evaluated growth parameters and endocrine disorders in relation to the liver iron concentration (LIC) assessed by the Ferriscan® method in a cohort of adults with SCD (n =40) and BTM (n = 52) receiving blood transfusions and iron chelation therapy since early childhood. Before transfusion, hemoglobin concentration had not been less than 9 g/dl in the past 12 years; subcutaneous daily desferrioxamine was administered for all of them since early childhood (2- 5 years of age). All patients were shifted to oral therapy with deferasirox iron chelation, 20 mg/daily for the past 5 years. BTM patients with higher LIC (> 15 mg Fe/g dry weight) had significantly shorter stature, lower insulin-like growth factor-I SDS (IGF-I SDS), higher alanine transferase (ALT) and serum ferritin concentrations compared to thalassemic patients with lower LIC. Patients with SCD with LIC > 8 mg Fe/g dry weight had significantly shorter stature, lower IGF-I SDS and higher ALT compared to SCD patients with lower LIC. Patients with BTM had significantly shorted final height (Ht-SDS) , IGF-I SDS and FT4 level compared to patients with SCD. LIC and mean fasting blood glucose (FBG) were significantly higher in patients with BTM compared to those with SCD. The linear regression analysis showed a significant correlation between LIC and serum ferritin level in SCD and BTM. LIC and serum ferritin level were also correlated significantly with IGF-I level in patients with BTM. LIC was correlated significantly with ALT in patients with BTM. In conclusion, the prevalence of endocrinopathies especially hypothyroidism, DM, and hypogonadism were significantly higher in BTM patients versus SCD patients and higher in patients with higher LIC versus those with lower LIC. These complications occurred less frequently, but still considerable, in chronically transfused patients with SCD.
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Affiliation(s)
- Mohamed A Yassin
- Department of Medical Oncolology Hematology Section, NCCCR, Hamad Medical Corporaton, Doha.
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Ghafuri DL, Stimpson SJ, Day ME, James A, DeBaun MR, Sharma D. Fertility challenges for women with sickle cell disease. Expert Rev Hematol 2017; 10:891-901. [PMID: 28891355 DOI: 10.1080/17474086.2017.1367279] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) represents one of the most common monogenic blood disorders worldwide, with an incidence of over 300,000 newborns affected per year. Reproductive challenges for men and women with SCD have been previously reviewed; however, evidence-based strategies to prevent and manage infertility and increase fecundity are lacking in women with SCD, which is one of the most important factors for quality of life. Areas covered: This review article summarizes the known risk factors for infertility, low fecundity, and premature menopause related to SCD. Expert commentary: Women with SCD have unique risk factors that may impact their ability to conceive, including chronic inflammation, oxidative stress, transfusion-related hemochromatosis, and ovarian sickling, causing ischemia and reperfusion injury to the ovary. Contraception is strongly recommended while on hydroxyurea therapy during reproductive years and discontinuing hydroxyurea for family planning and during pregnancy based on teratogenicity in animal studies. Hematopoietic stem cell transplantation (HSCT), the only curative therapy, sometimes involves conditioning regimens containing alkylating agents and total body irradiation that contribute to infertility and premature ovarian failure. Prior to HSCT or gene therapy, we strongly recommend referral to a reproductive endocrinologist to discuss fertility preservation and surrogacy options for all women with SCD.
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Affiliation(s)
- Djamila L Ghafuri
- a Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry-Matthew Walker Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Sarah-Jo Stimpson
- a Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry-Matthew Walker Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Melissa E Day
- a Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry-Matthew Walker Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Andra James
- b Department of Obstetrics & Gynecology , Duke University , Durham , NC , USA
| | - Michael R DeBaun
- a Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry-Matthew Walker Center for Excellence in Sickle Cell Disease , Vanderbilt University Medical Center , Nashville , TN , USA
| | - Deva Sharma
- b Department of Obstetrics & Gynecology , Duke University , Durham , NC , USA
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