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Jordan LC, King AA, Kanter J, Lebensburger J, Ford AL, Varughese TE, Garrett L, Mullis L, Saint Jean L, Davis S, Dumas J, Kassim AA, Rodeghier M, Hikima MS, Suwaid MA, Saleh MK, DeBaun MR. Incidence and Risk Factors for New and Recurrent Infarcts in Adults With Sickle Cell Disease. J Am Heart Assoc 2024; 13:e033278. [PMID: 38842282 DOI: 10.1161/jaha.123.033278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/30/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Most adults with sickle cell disease will experience a silent cerebral infarction (SCI) or overt stroke. Identifying patient subgroups with increased stroke incidence is important for future clinical trials focused on stroke prevention. Our 3-center prospective cohort study tested the primary hypothesis that adults with sickle cell disease and SCIs have a greater incidence of new stroke or SCI compared with those without SCI. A secondary aim focused on identifying additional risk factors for progressive infarcts, particularly traditional risk factors for stroke in adults. METHODS AND RESULTS This observational study included adults with sickle cell disease and no history of stroke. Magnetic resonance imaging scans of the brain completed at baseline and >1 year later were reviewed by 3 radiologists for baseline SCIs and new or progressive infarcts on follow-up magnetic resonance imaging. Stroke risk factors were abstracted from the medical chart. Time-to-event analysis was utilized for progressive infarcts. Median age was 24.1 years; 45.3% of 95 participants had SCIs on baseline magnetic resonance imaging. Progressive infarcts were present in 17 participants (17.9%), and the median follow-up was 2.1 years. Incidence of new infarcts was 11.95 per 100 patient-years (6.17-20.88) versus 3.74 per 100 patient-years (1.21-8.73) in those with versus without prior SCI. Multivariable Cox regression showed that baseline SCI predicts progressive infarcts (hazard ratio, 3.46 [95% CI, 1.05-11.39]; P=0.041); baseline hypertension was also associated with progressive infarcts (hazard ratio, 3.23 [95% CI, 1.16-9.51]; P=0.025). CONCLUSIONS Selecting individuals with SCIs and hypertension for stroke prevention trials in sickle cell disease may enrich the study population with those at highest risk for infarct recurrence.
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Affiliation(s)
- Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics Vanderbilt University Medical Center Nashville TN
| | - Allison A King
- Division of Hematology & Oncology, Department of Pediatrics Washington University School of Medicine St. Louis MO
| | - Julie Kanter
- Division of Hematology-Oncology, Department of Medicine University of Alabama at Birmingham Heersink School of Medicine Birmingham AL
| | - Jeff Lebensburger
- Division of Hematology-Oncology, Department of Pediatrics University of Alabama at Birmingham, Heersink School of Medicine Birmingham AL
| | - Andria L Ford
- Department of Neurology Washington University School of Medicine St. Louis MO
| | - Taniya E Varughese
- Division of Hematology & Oncology, Department of Pediatrics Washington University School of Medicine St. Louis MO
| | - Lisa Garrett
- Division of Hematology, Department of Medicine Washington University School of Medicine St. Louis MO
| | - Lauren Mullis
- Division of Hematology-Oncology, Department of Pediatrics University of Alabama at Birmingham, Heersink School of Medicine Birmingham AL
| | - LeShana Saint Jean
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease Vanderbilt University Medical Center Nashville TN
| | - Samantha Davis
- Division of Pediatric Neurology, Department of Pediatrics Vanderbilt University Medical Center Nashville TN
| | - Jeanine Dumas
- Division of Hematology-Oncology, Department of Pediatrics University of Alabama at Birmingham, Heersink School of Medicine Birmingham AL
| | - Adetola A Kassim
- Division of Hematology/Oncology, Department of Medicine Vanderbilt University Medical Center Nashville TN
| | | | - Mustapha S Hikima
- Department of Radiology Muhammad Abdullahi Wase Teaching Hospital Kano Nigeria
| | | | - Mohammed K Saleh
- Department of Radiology Aminu Kano Teaching Hospital Kano Nigeria
| | - Michael R DeBaun
- Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease Vanderbilt University Medical Center Nashville TN
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Early ML, Raja M, Luo A, Solow M, Matusiak K, Eke AC, Shehata N, Kuo KH, Lanzkron S, Malinowski AK, Pecker LH. Blood pressure thresholds for the diagnosis of hypertensive disorders of pregnancy in sickle cell disease. Br J Haematol 2024; 204:1039-1046. [PMID: 38093478 PMCID: PMC10939908 DOI: 10.1111/bjh.19248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/11/2023] [Accepted: 11/27/2023] [Indexed: 01/19/2024]
Abstract
In this retrospective cohort study of singleton pregnancies in people with sickle cell disease (SCD) delivered at two academic centres between 1990 and 2021, we collected demographic and SCD-related data, pregnancy outcomes, and the highest systolic and diastolic blood pressure (SBP and DBP) at seven time periods. We compared the characteristics of subjects with new or worsening proteinuria (NWP) during pregnancy to those without. We then constructed receiver operating characteristic (ROC) curves to determine the blood pressure (BP) that best identifies those with NWP. The SBP or DBP thresholds which maximized sensitivity and specificity were 120 mmHg SBP (sensitivity: 55.2%, specificity: 73.5%) and 70 mmHg DBP (sensitivity: 27.6%, specificity: 67.7%). The existing BP threshold of 140/90 mmHg lacked sensitivity in both genotype groups (HbSS/HbSβ0 : SBP = 21% sensitive, DBP = 5.3% sensitive; HbSS/HbSβ+ : SBP = 10% sensitive, DBP = 0% sensitive). Finally, percent change in SBP, DBP and MAP were all poor tests for identifying NWP. Existing BP thresholds used to diagnose hypertensive disorders of pregnancy (HDP) are not sensitive for pregnant people with SCD. For this population, lowering the BP threshold that defines HDP may improve identification of those who need increased observation, consideration of early delivery and eclampsia prophylaxis.
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Affiliation(s)
- Macy L. Early
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maidah Raja
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Amy Luo
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Marissa Solow
- Division of Haematology, Department of Medicine, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Kristine Matusiak
- Division of Haematology, Department of Medicine, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Ahizechukwu C. Eke
- Division of Maternal-Fetal Medicine & Clinical Pharmacology
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nadine Shehata
- Division of Hematology, Sinai Health System, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin H.M. Kuo
- Division of Haematology, Department of Medicine, University Health Network, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Sophie Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ann Kinga Malinowski
- Division of Hematology, Sinai Health System, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Maternal-Fetal Medicine, Sinai Health System
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Lydia H. Pecker
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Nawaiseh MB, Yassin AM, Al-Sabbagh MQ, AlNawaiseh A, Zureigat H, Aljbour AlMajali D, Haddadin RR, El-Ghanem M, Abu-Rub M. Abnormal Neurologic Findings in Patients With Sickle Cell Disease Without a History of Major Neurologic Events. Neurol Clin Pract 2024; 14:e200215. [PMID: 38173541 PMCID: PMC10759091 DOI: 10.1212/cpj.0000000000200215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/12/2023] [Indexed: 01/05/2024]
Abstract
Background and Objectives Patients with sickle cell disease (SCD) are prone to symptomatic neurologic complications. Previous studies reported accrual of neural injury starting at early age, even without having symptomatic neurologic events. The aim of this study was to assess the prevalence and risk factors of abnormal neurologic findings in patients with SCD with no history of major symptomatic neurologic events. Methods Our study extracted patients diagnosed with SCD from the Cooperative Study of Sickle Cell Disease. Patients who underwent a neurologic evaluation were included in our analysis. Patients with previous documented major symptomatic neurologic events were excluded. We compared patients with SCD with abnormal neurologic findings with those without in terms of clinical and laboratory parameters using multivariate binary logistic regression. Results A total of 3,573 patients with SCD were included (median age = 11 [IQR = 19] years, male = 1719 [48.1%]). 519 (14.5%) patients had at least one abnormal neurologic finding. The most common findings in descending order were abnormal reflexes, gait abnormalities, cerebellar dysfunction, language deficits, nystagmus, abnormal muscle tone and strength, Romberg sign, Horner syndrome, and intellectual impairment. History of eye disease (odds ratio [OR] = 2.76, 95% confidence interval [CI] = 1.63-4.68) and history of osteomyelitis (OR = 2.55, 95% CI 1.34-4.84) were the strongest predictors of abnormal neurologic findings, followed by smoking (OR = 1.59, 95% CI 1.08-2.33), aseptic necrosis (OR = 1.57, 95% CI 1.06-2.33), hand-foot syndrome (OR = 1.48, 95% CI 1.04-2.12), and male sex (OR = 1.42, 95% CI 1.01-2.02). Discussion Neurologic deficits are relatively common in patients with SCD, even without documented major neurologic insults. They range from peripheral and ophthalmic deficits to central and cognitive disabilities. Patients with SCD should have early regular neurologic evaluations and risk factor modification, particularly actively promoting smoking cessation.
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Affiliation(s)
- Mohammed B Nawaiseh
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Ahmed M Yassin
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Mohammed Q Al-Sabbagh
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Ahmad AlNawaiseh
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Hadil Zureigat
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Dina Aljbour AlMajali
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Rund R Haddadin
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Mohammad El-Ghanem
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
| | - Mohammad Abu-Rub
- Department of Ophthalmology (MBN), Jordanian Royal Medical Services, Amman; Department of Neurology (AMY), Jordan University of Science and Technology, Irbid, Jordan; Department of Neurology (MQAS), Kansas University Medical Center, Kansas City; Department of Internal Medicine (AA), St. Elizabeth's Medical Center, Boston, MA; Department of Internal Medicine (HZ), Cleveland Clinic, OH; Department of Internal Medicine (DAA), Henry Ford Health System, Detroit, MI; Department of Internal Medicine (RRH), JCESOM, Marshall University, WV; Department of Clinical Sciences (ME-G), College of Medicine, University of Houston, HCA Northwest Medical Center, Houston, TX; and Department of Neurology (MA-R), George Washington University, Washington, DC
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Yu X, Majumdar S, Pollard JD, Jackson E, Knudson J, Wolfe D, Kato GJ, Maher JF. Clinical and Laboratory Correlates of QTc Duration in Adult and Pediatric Sickle Cell Disease. AMERICAN JOURNAL OF MEDICINE OPEN 2023; 10:100045. [PMID: 38222852 PMCID: PMC10785202 DOI: 10.1016/j.ajmo.2023.100045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
Background Sickle cell disease, a common genetic disorder in African Americans, manifests an increased risk of sudden death, the basis of which is incompletely understood. Prolongation of heart rate-corrected QT (QTc) interval on the electrocardiogram, a standard clinical measure of cardiac repolarization, may contribute to sudden death by predisposing to torsades de pointes ventricular tachycardia. Methods We established a cohort study of 293 adult and 121 pediatric sickle cell disease patients drawn from the same geographic region as the Jackson Heart Study (JHS) cohort, in which significant correlates of QT duration have been characterized and quantitatively modeled. Herein, we establish clinical and laboratory correlates of QTc duration in our cohort using stepwise multivariate linear regression analysis. We then compared our adult sickle cell disease data to effect-size predictions from the published JHS statistical model of QT interval duration. Results In adult sickle cell disease, gender, diuretic use, QRS duration, serum ALT levels, anion gap, and diastolic blood pressure show positive correlation; hemoglobin levels show inverse correlation; in pediatric sickle cell disease, age, hemoglobin levels, and serum bicarbonate and creatinine levels show inverse correlation. The mean QTc in our adult sickle cell disease cohort is 7.8 milliseconds longer than in the JHS cohort, even though the JHS statistical model predicts that the mean QTc in our cohort should be > 11 milliseconds shorter than in the much older JHS cohort, a differential of > 18 milliseconds. Conclusion Sickle cell disease patients have substantial QTc prolongation relative to their age, driven by factors some overlapping, in adult and pediatric sickle cell disease, and distinct from those that have been defined in the general African American community.
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Affiliation(s)
- Xue Yu
- Departments of Data Science, University of Mississippi Medical Center, Jackson, MS
| | - Suvankar Majumdar
- Division of Hematology, Children’s National Hospital, Washington, DC
| | - J. Daryl Pollard
- Medicine/Division of Cardiology, University of Mississippi Medical Center, Jackson, MS
| | - Erin Jackson
- Pediatrics/Division of Hematology-Oncology, University of Mississippi Medical Center, Jackson, MS
| | - Jarrod Knudson
- Pediatrics/Division of Cardiology, University of Mississippi Medical Center, Jackson, MS
| | - Douglas Wolfe
- Medicine/Division of Cardiology, University of Mississippi Medical Center, Jackson, MS
| | - Gregory J. Kato
- Hematology Therapeutic Area, Clinical Research and Development, CSL Behring, King of Prussia, Pa
| | - Joseph F. Maher
- Medicine/Division of Medical Genetics, University of Mississippi Medical Center, Jackson, Miss
- Cancer Genetics, Roswell Park Comprehensive Cancer Center, Buffalo, NY
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Afangbedji N, Jerebtsova M. Glomerular filtration rate abnormalities in sickle cell disease. Front Med (Lausanne) 2022; 9:1029224. [PMID: 36341242 PMCID: PMC9633850 DOI: 10.3389/fmed.2022.1029224] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/04/2022] [Indexed: 12/03/2022] Open
Abstract
Sickle cell disease (SCD) is a group of inherited blood disorders affecting the β-globin gene, resulting in the polymerization of hemoglobin and subsequent sickling of the red blood cell. Renal disease, the most common complication in SCD, begins in childhood with glomerular hyperfiltration and then progresses into albuminuria, a fast decline of glomerular filtration, and renal failure in adults. This mini-review focuses on glomerular filtration abnormalities and the mechanisms of hyperfiltration, explores genetic modifiers and methods of estimating glomerular filtration rates, and examines novel biomarkers of glomerular filtration in SCD.
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Affiliation(s)
- Nowah Afangbedji
- Department of Physiology and Biophysics, Howard University, Washington, DC, United States
| | - Marina Jerebtsova
- Department of Microbiology, Howard University, Washington, DC, United States
- *Correspondence: Marina Jerebtsova,
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Francis DK, Awuah EB, Field MS, Karakochuk CD, Dixit R, Cassano PA. Vitamin B supplementation for sickle cell disease. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2022. [PMCID: PMC9578011 DOI: 10.1002/14651858.cd014368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effectiveness of vitamin B supplementation in children and adults with sickle cell disease (SCD), compared to no intervention or an alternative vitamin B supplementation given as part of standard care.
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Affiliation(s)
| | - Damian K Francis
- School of Health and Human PerformanceGeorgia College and State UniversityMilledgevilleGeorgiaUSA,Cochrane CaribbeanMonaJamaica
| | - Eunice B Awuah
- Division of Nutritional SciencesCornell UniversityIthacaNYUSA
| | - Martha S Field
- Division of Nutritional SciencesCornell UniversityIthacaNYUSA
| | | | - Ruchita Dixit
- Department of Community MedicineMelaka-Manipal Medical College (Manipal Academy of Higher Education)MelakaMalaysia
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Jackson E, Karlson CW, Herring W, Okhomina VI, Lim CS, Morrow A, Daggett C, Arnold L, McNaull M. Prevalence of raised body mass index in paediatric sickle cell disease. J Paediatr Child Health 2022; 58:1829-1835. [PMID: 35822947 DOI: 10.1111/jpc.16118] [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: 10/14/2021] [Revised: 05/16/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
AIM Children with sickle cell disease (SCD) have historically weighed less than their healthy peers. More recently, a retrospective chart review from six institutions in New England reported nearly one-quarter of children and adolescents with SCD had raised body mass index (BMI). This study aimed to examine rates of children with SCD with raised BMI in Mississippi compared to state and national norms and assess the correlation between haemoglobin and BMI. METHODS A retrospective chart review of paediatric patients with SCD at the University of Mississippi Medical Center (UMMC) was conducted using data from the most recent clinic visit. Mississippi and national weight status estimates for youth 10-17 years were obtained from the 2016-2017 National Survey of Children's Health. RESULTS For youth 10-17 years with SCD (n = 345), 21.4.% of children with SS/Sβ° and 36.1% with SC/Sβ+ had raised BMI compared to Mississippi and national rates, 39.2 and 31%, respectively. The prevalence of children with raised BMI with SC/Sβ+ did not differ from state and national rates, while children with SS/Sβ° were half as likely as their Mississippi peers to have raised BMI. Haemoglobin levels were different among children with SCD who had low BMI (8.80 g/dL), average BMI (9.2 g/dL) and raised BMI (10.5 g/dL) (P < 0.001). CONCLUSIONS Children with SCD evaluated at UMMC have similar rates of raised BMI compared to state and national norms. Children with raised BMI have higher mean haemoglobin levels compared to children with SCD with low or average BMI. IMPLICATIONS AND CONTRIBUTION Historically, patients with SCD have been underweight and normal weight. Our paediatric and adolescent patients with SCD now have prevalence rates of raised BMI that approach state and national rates. Further work must be done to determine whether this reflects healthier children with SCD or raises concerns about life-style-related comorbidities.
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Affiliation(s)
- Erin Jackson
- Division of Pediatric Hematology Oncology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Cynthia W Karlson
- Division of Pediatric Hematology Oncology, University of Mississippi Medical Center, Jackson, Mississippi, United States.,Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Whitney Herring
- Mississippi Center for Advanced Medicine, Jackson, Mississippi, United States
| | - Victoria I Okhomina
- Department of Data Science, University of Mississippi Medical center, Jackson, Mississippi, United States
| | - Crystal S Lim
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Anne Morrow
- Department of Psychology, Florida International University, Miami, Florida, United States.,College of Psychology, Nova Southeastern University, Fort Lauderdale, Florida, United States
| | - Caroline Daggett
- School of Medicine, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Laura Arnold
- Division of Pediatric Hematology Oncology, University of Mississippi Medical Center, Jackson, Mississippi, United States
| | - Melissa McNaull
- Division of Pediatric Hematology Oncology, University of Mississippi Medical Center, Jackson, Mississippi, United States
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8
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Blood pressure in children with sickle cell disease is higher than in the general pediatric population. BMC Pediatr 2022; 22:549. [PMID: 36109730 PMCID: PMC9476310 DOI: 10.1186/s12887-022-03584-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/30/2022] [Indexed: 11/10/2022] Open
Abstract
Background Sickle cell disease (SCD) is associated with an increased risk of cardiovascular disease that may be due to a variety of possible risk factors, including abnormal blood pressure. Blood pressure (BP) of children and adolescents with SCD has been reported to be lower compared to the BP of the general pediatric population. Methods To confirm this prior observation, we compared reference BP values for children with SCD with reference BP values of the general pediatric population. We hypothesized that children with SCD do not have lower BPs than children without SCD. Results Systolic BP differed for both males and females, over the different age groups between pediatric subjects with and without SCD. Systolic BP was higher in children with SCD, in both obese and non-obese populations. Diastolic BP did not differ between the groups. Conclusions Our analysis demonstrated that systolic BP values are indeed higher in children with SCD than in the general pediatric population. This finding is consistent with the most recent literature showing abnormal BP patterns in the SCD pediatric population utilizing 24-hour BP monitoring devices. This is an important step for recognizing abnormal BP as a risk factor for cardio- and neurovascular events in SCD. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03584-9.
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9
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Bernit E, Romana M, Alexis‐Fardini S, Tarer V, Roger P, Doumdo L, Petras E, Charneau C, Tressières B, Dessources MDH, Etienne‐Julan M. Sickle cell disease patients with COVID‐19 in Guadeloupe: Surprisingly favorable outcomes. EJHAEM 2022; 3:636-643. [PMID: 35935270 PMCID: PMC9347453 DOI: 10.1002/jha2.449] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/29/2022] [Accepted: 04/08/2022] [Indexed: 11/09/2022]
Abstract
We investigate risk factors for hospitalization and difference between sickle cell syndromes in a cohort of COVID‐19 sickle cell disease (SCD) adult patients managed in the Reference Center of Guadeloupe. We retrospectively collected data of symptomatic SCD adult patients infected with SARS‐CoV‐2 between March and December 2020. Thirty‐eight SCD adult patients with symptomatic COVID‐19 infection were included during the first wave, representing 9.6% of the active patient file at our center. The median age (IQR) was 39 years (24–47). Four patients were obese and two had moderate renal failure. The median duration of symptoms (IQR) was 10 days (5–15). Seventeen (44.7%) patients were hospitalized, including two in intensive care unit (ICU) for acute chest syndrome. An 85‐year‐old SC patient with prostate cancer died. No difference was detected between inpatient and outpatient groups in terms of age, gender, BMI, SCD clinical complications, and in history SCD treatment. There was no difference for severity, hospitalization, length of stay, ICU stay, or death between SS or Sβ°‐thal patients and SC or Sβ+‐thal patients. These overall favorable outcomes among symptomatic patients may be related to the low prevalence of comorbidity known to be linked to the more severe forms of COVID‐19, but also to the prompt coordinated management of SCD patients in the Reference Center.
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Affiliation(s)
- Emmanuelle Bernit
- Sickle Cell Disease Unit Reference Centre for Sickle Cell Disease Thalassemia and Other Red Cell Rare Diseases CHU de la Guadeloupe Pointe‐à‐Pitre Guadeloupe France
| | - Marc Romana
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
- Université des Antilles UMR_S1134/Inserm BIGR Pointe‐à‐Pitre Guadeloupe France
- Université de Paris UMR_S1134 BIGR INSERM Paris France
| | - Scylia Alexis‐Fardini
- Sickle Cell Disease Unit Reference Centre for Sickle Cell Disease Thalassemia and Other Red Cell Rare Diseases CHU de la Guadeloupe Pointe‐à‐Pitre Guadeloupe France
| | - Vanessa Tarer
- Sickle Cell Disease Unit Reference Centre for Sickle Cell Disease Thalassemia and Other Red Cell Rare Diseases CHU de la Guadeloupe Pointe‐à‐Pitre Guadeloupe France
| | - Pierre‐Marie Roger
- Service d'infectiologie CHU de la Guadeloupe Pointe à Pitre Guadeloupe France
| | - Lydia Doumdo
- Sickle Cell Disease Unit Reference Centre for Sickle Cell Disease Thalassemia and Other Red Cell Rare Diseases CHU de la Guadeloupe Pointe‐à‐Pitre Guadeloupe France
| | - Eléonore Petras
- Sickle Cell Disease Unit Reference Centre for Sickle Cell Disease Thalassemia and Other Red Cell Rare Diseases CHU de la Guadeloupe Pointe‐à‐Pitre Guadeloupe France
| | - Corine Charneau
- Sickle Cell Disease Unit Centre Hospitalier de la Basse‐Terre Basse‐Terre France
| | - Benoit Tressières
- Centre d'Investigation Clinique Antilles Guyane Inserm CIC Point‐à‐Pitre Guadeloupe France
| | - Marie Dominique Hardy Dessources
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
- Université des Antilles UMR_S1134/Inserm BIGR Pointe‐à‐Pitre Guadeloupe France
- Université de Paris UMR_S1134 BIGR INSERM Paris France
| | - Maryse Etienne‐Julan
- Sickle Cell Disease Unit Reference Centre for Sickle Cell Disease Thalassemia and Other Red Cell Rare Diseases CHU de la Guadeloupe Pointe‐à‐Pitre Guadeloupe France
- Laboratoire d'Excellence du Globule Rouge (Labex GR‐Ex) PRES Sorbonne Paris France
- Université des Antilles UMR_S1134/Inserm BIGR Pointe‐à‐Pitre Guadeloupe France
- Université de Paris UMR_S1134 BIGR INSERM Paris France
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10
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Nguweneza A, Ngo Bitoungui VJ, Mnika K, Mazandu G, Nembaware V, Kengne AP, Wonkam A. Clinical characteristics and risk factors of relative systemic hypertension and hypertension among sickle cell patients in Cameroon. Front Med (Lausanne) 2022; 9:924722. [PMID: 35928290 PMCID: PMC9344053 DOI: 10.3389/fmed.2022.924722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022] Open
Abstract
Increased blood pressure (BP) has been associated with higher risk of stroke and mortality in Sickle Cell Disease (SCD). We investigated risk factors associated with Relative Systemic Hypertension (RSH) or systemic hypertension in SCD patients in Cameroon. Using R, Multivariate multinomial logistic regression modeling was used to examine the effects of the demographic, anthropometric, clinical, and laboratory factors to determine risk factors. A total of 815 individuals with SCD, including 380 (46.6%) males were analyzed. At baseline, the median age [interquartile range] was 18.0 [12.0-25.0] years, ranging from 3 to 66 years. Approximately three-quarters of the patients (n = 645; 79.1%) had normal BP, 151 (18.5%) had RSH and 19 (2.3%) had hypertension. Age (P < 0.001) and gender (P = 0.022) were significantly different across the BP categories. Weight (P < 0.001), height (P < 0.001), BMI (P < 0.001), pulse pressure (P = 0.020), history of stroke (P = 0.012), hemoglobin level (P = 0.002), red blood cell count (P = 0.031), creatinine (P < 0.001), and (estimated glomerular filtration rate) eGFR (P = 0.002) was also significantly different across the three BP categories. After adjustment, the significantly associated factors of RSH in the SCD patients were age [OR = 1.03, (95% CI = 1.01-1.06), P < 0.010], male gender [OR = 1.54, (95% CI = 1.04-2.27), P = 0.029], BMI [OR = 1.10, (95% CI = 1.04-1.17), P = 0.001]. After adjustment, the independent variables significantly associated factors of Hypertension in the SCD patients were age [OR = 1.05, (95% CI = 1.01-1.10), P = 0.034], male gender [OR = 3.31, (95% CI = 1.04-10.52), P = 0.042], BMI [OR = 1.14, (95% CI = 1.01-1.29), P = 0.027]. Creatinine was significantly associated with RSH [OR =1.31 (1.05-1.63), P = 0.016]. SCD patients with RSH or hypertension maybe at increased risk of renal dysfunction. We found relatively high prevalence of RSH and hypertension (20.8%) in SCD patients in Cameroon. Tailored Interventions that consider major risk factors (age, gender, and BMI) may lower BP pressure and prevent severe complications.
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Affiliation(s)
- Arthemon Nguweneza
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Valentina Josiane Ngo Bitoungui
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Khuthala Mnika
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gaston Mazandu
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Victoria Nembaware
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andre P. Kengne
- Non-communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- McKusick-Nathans Institute and Department of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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11
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Longitudinal Study of Glomerular Hyperfiltration in Adults with Sickle Cell Anemia: A Multicenter Pooled Analysis. Blood Adv 2022; 6:4461-4470. [PMID: 35696734 PMCID: PMC9636315 DOI: 10.1182/bloodadvances.2022007693] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/07/2022] [Indexed: 11/21/2022] Open
Abstract
Glomerular hyperfiltration is common in young sickle cell anemia patients and precedes development of overt kidney disease. In this multicenter pooled cohort, we characterized hyperfiltration and its decline to normal range in adult patients. Glomerular filtration rate (GFR) was estimated using the creatinine-based 2009 CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation omitting race adjustment and the 2021 CKD-EPI equation. Using CKD-EPI–2009, 506 patients had baseline estimated GFR (eGFR) ≥90 mL/min per 1.73 m2, median age of 24 (interquartile range [IQR], 19-34) years and 5.17 years of follow-up. The prevalence of hyperfiltration (eGFR ≥140 and ≥130 mL/min per 1.73 m2 for men and women, respectively) was 38.3%. Using CKD-EPI–2009, baseline hyperfiltration was less likely with older age (odds ratio [OR], 0.78; 95% confidence interval [CI], 0.73-0.83; P < .0001), male sex (OR, 0.32; 95% CI, 0.18-0.58; P = .0002), and higher weight (OR, 0.96; 95% CI, 0.94-0.99; P = .001). Using CKD-EPI–2021, hyperfiltration was similarly less likely with older age (OR, 0.75; 95% CI, 0.70-0.81; P < .0001), male sex (OR, 0.24; 95% CI, 0.13-0.44; P < .0001), and higher weight (OR, 0.97; 95% CI, 0.95-0.99; P = .004). In patients with baseline hyperfiltration, eGFR declined to normal values at a median age of 26.2 years. Using CKD-EPI–2009, this decline was associated with male sex (HR, 2.20; 95% CI, 1.26-3.87; P = .006), systolic blood pressure (hazard ratio [HR], 1.02; 95% CI, 1.01-1.04; P = .01), and hydroxyurea use (HR, 1.74; 95% CI, 1.002-3.03; P = .05). Using CKD-EPI–2021, decline of eGFR to normal was only associated with male sex (HR, 3.39; 95% CI, 2.01-5.69; P < .0001). Decline to normal eGFR range from hyperfiltration occurs earlier in males, those on hydroxyurea, and with higher systolic blood pressure.
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12
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Ataga KI, Saraf SL, Derebail VK. The nephropathy of sickle cell trait and sickle cell disease. Nat Rev Nephrol 2022; 18:361-377. [PMID: 35190716 PMCID: PMC9832386 DOI: 10.1038/s41581-022-00540-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 01/13/2023]
Abstract
Sickle cell syndromes, including sickle cell disease (SCD) and sickle cell trait, are associated with multiple kidney abnormalities. Young patients with SCD have elevated effective renal plasma flow and glomerular filtration rates, which decrease to normal ranges in young adulthood and subnormal levels with advancing age. The pathophysiology of SCD-related nephropathy is multifactorial - oxidative stress, hyperfiltration and glomerular hypertension are all contributing factors. Albuminuria, which is an early clinical manifestation of glomerular damage, is common in individuals with SCD. Kidney function declines more rapidly in individuals with SCD than in those with sickle cell trait or in healthy individuals. Multiple genetic modifiers, including APOL1, HMOX1, HBA1 and HBA2 variants are also implicated in the development and progression of SCD-related nephropathy. Chronic kidney disease and rapid decline in estimated glomerular filtration rate are associated with increased mortality in adults with SCD. Renin-angiotensin-aldosterone system inhibitors are the standard of care treatment for albuminuria in SCD, despite a lack of controlled studies demonstrating their long-term efficacy. Multiple studies of novel therapeutic agents are ongoing, and patients with SCD and kidney failure should be evaluated for kidney transplantation. Given the high prevalence and severe consequences of kidney disease, additional studies are needed to elucidate the pathophysiology, natural history and treatment of SCD-related nephropathy.
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Affiliation(s)
- Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Scienter Center, Memphis, TN, USA.
| | - Santosh L Saraf
- Division of Hematology/Oncology, University of Illinois, Chicago, IL, USA
| | - Vimal K Derebail
- Division of Nephrology and Hypertension, University of North Carolina, Chapel Hill, NC, USA
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13
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Long-Term Health Effects of Curative Therapies on Heart, Lungs, and Kidneys for Individuals with Sickle Cell Disease Compared to Those with Hematologic Malignancies. J Clin Med 2022; 11:jcm11113118. [PMID: 35683502 PMCID: PMC9181610 DOI: 10.3390/jcm11113118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 12/30/2022] Open
Abstract
The goal of curing children and adults with sickle cell disease (SCD) is to maximize benefits and minimize intermediate and long-term adverse outcomes so that individuals can live an average life span with a high quality of life. While greater than 2000 individuals with SCD have been treated with curative therapy, systematic studies have not been performed to evaluate the long-term health effects of hematopoietic stem cell transplant (HSCT) in this population. Individuals with SCD suffer progressive heart, lung, and kidney disease prior to curative therapy. In adults, these sequalae are associated with earlier death. In comparison, individuals who undergo HSCT for cancer are heavily pretreated with chemotherapy, resulting in potential acute and chronic heart, lung, and kidney disease. The long-term health effects on the heart, lung, and kidney for children and adults undergoing HSCT for cancer have been extensively investigated. These studies provide the best available data to extrapolate the possible late health effects after curative therapy for SCD. Future research is needed to evaluate whether HSCT abates, stabilizes, or exacerbates heart, lung, kidney, and other diseases in children and adults with SCD receiving myeloablative and non-myeloablative conditioning regimens for curative therapy.
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Nguweneza A, Oosterwyk C, Banda K, Nembaware V, Mazandu G, Kengne AP, Wonkam A. Factors associated with blood pressure variation in sickle cell disease patients: a systematic review and meta-analyses. Expert Rev Hematol 2022; 15:359-368. [PMID: 35209795 DOI: 10.1080/17474086.2022.2043743] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Blood pressure (BP) values ≥120/70 mmHg considerably increase the risk of pulmonary hypertension and renal dysfunction in Sickle Cell Disease (CSD) patients and ultimately increased morbidity and mortality. This has led to the development of the term relative systemic hypertension (RSH). RSH was defined as Systolic BP 120-139 mm Hg or diastolic BP 70-89 mm Hg, whereas systemic hypertension is defined as Systolic BP ≥ 140 mm Hg or diastolic BP ≥ 90 mm Hg. Systematic identification of BP variations and risk factors in SCD patients could promote effective management. This review aimed to identify factors associated with BP variation among SCD patients. METHODS We searched PubMed, Scopus, Web of Science, and Google Scholar up to December 2020 with no geographical or language restrictions. Two reviewers independently screened and summarized data from eligible studies. RESULTS Advancing age, gender, higher body weight, hemoglobin, eGFR, triglycerides, greater hematocrit, higher blood viscosity, history of blood transfusion, and targeted variants in DRD2 and MIR4301 genes were independently associated with the risk of hypertension in SCD patients. CONCLUSION Interventions that consider these risk factors may potentially contribute to lower BP pressure in SCD patients and prevent the development of severe complications.
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Affiliation(s)
- Arthemon Nguweneza
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Chandré Oosterwyk
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Kambe Banda
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Victoria Nembaware
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Gaston Mazandu
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Andre P Kengne
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Ambroise Wonkam
- Division of Human Genetics, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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15
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Reduced blood pressure in sickle cell disease is associated with decreased angiotensin converting enzyme (ACE) activity and is not modulated by ACE inhibition. PLoS One 2022; 17:e0263424. [PMID: 35113975 PMCID: PMC8812860 DOI: 10.1371/journal.pone.0263424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/18/2022] [Indexed: 12/11/2022] Open
Abstract
Background Sickle cell disease (SCD) incurs vaso-occlusive episodes and organ damage, including nephropathy. Despite displaying characteristics of vascular dysfunction, SCD patients tend to present relatively lower systemic blood pressure (BP), via an unknown mechanism. We investigated associations between BP and renin-angiotensin-system (RAS) components in SCD and determined whether an inhibitor of angiotensin converting enzyme (ACE; often used to slow SCD glomerulopathy) further modulates BP and RAS components in a murine model of SCD. Methods BP was compared in human subjects and mice with/without SCD. Plasma angiotensin II, ACE and renin were measured by immunoassay. BP was reevaluated after treating mice with enalapril (25 mg/kg, 5x/week) for 5 weeks; plasma and organs were stored for angiotensin II and ACE activity measurement, and quantitative real-time PCR. Results Diastolic BP and systolic BP were significantly lower in patients and mice with SCD, respectively, compared to controls. Reduced BP was associated with increased plasma renin and markers of kidney damage (mice) in SCD, as well as significantly decreased plasma ACE concentrations and ACE enzyme activity. As expected, enalapril administration lowered BP, plasma angiotensin II and organ ACE activity in control mice. In contrast, enalapril did not further reduce BP or organ ACE activity in SCD mice; however, plasma angiotensin II and renin levels were found to be significantly higher in enalapril-treated SCD mice than those of treated control mice. Conclusion Relative hypotension was confirmed in a murine model of SCD, in association with decreased ACE concentrations in both human and murine disease. Given that ACE inhibition has an accepted role in decreasing BP, further studies should investigate mechanisms by which ACE depletion, via both Ang II-dependent and alternative pathways, could contribute to reduce BP in SCD and understand how ACE inhibition confers Ang II-independent benefits on kidney function in SCD.
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Araújo CGD, Resende MBS, Tupinambás JT, Dias RCTM, Barros FC, Vasconcelos MCM, Januário JN, Ribeiro ALP, Nunes MCP. Testes Ergométricos em Pacientes com Anemia Falciforme: Segurança, Viabilidade e Possíveis Implicações no Prognóstico. Arq Bras Cardiol 2022; 118:565-575. [PMID: 35319606 PMCID: PMC8959037 DOI: 10.36660/abc.20200437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/24/2021] [Indexed: 01/20/2023] Open
Abstract
Fundamento Pacientes com anemia falciforme (AF) têm risco aumentado de complicações cardiovasculares. O teste ergométrico é usado como marcador de prognóstico em uma série de doenças cardiovasculares. Entretanto, há uma escassez de evidências sobre exercícios em pacientes com AF, especialmente em relação à sua segurança, viabilidade e possível função prognóstica. Objetivos Usamos o teste em esteira máximo para determinar a segurança e a viabilidade do teste ergométrico em pacientes com AF. Além disso, os fatores associados à duração do exercício, bem como o impacto das alterações causadas pelo exercício em resultados clínicos, também foram avaliados. Métodos 113 pacientes com AF que passaram pelo teste ergométrico e por uma avaliação cardiovascular abrangente incluindo um ecocardiograma e os níveis do peptídeo natriurético do tipo B (BNP). O desfecho de longo prazo foi uma combinação de eventos incluindo morte, crises álgicas graves, síndrome torácica aguda ou internações hospitalares por outras complicações associadas â doença falciforme. A análise de regressão de Cox foi realizada para identificar as variáveis associadas ao resultado. Um p valor <0,05 foi considerado estatisticamente significativo. Resultados A média de idade foi de 36 ± 12 anos (intervalo, 18-65 anos), e 62 pacientes eram do sexo feminino (52%). A presença de alterações isquêmicas ao esforço e resposta pressórica anormal ao exercício foram detectadas em 17% e 9 % da´população estudada respectivamente. Dois pacientes apresentaram crise álgica com necessidade de internação hospitalar no período de 48 horas da realização do exame. Fatores associados à duração do exercício foram idade, sexo, velocidade máxima de regurgitação tricúspide (RT), e relação E/e’, após a padronização quanto aos marcadores da gravidade da doença. Durante o período médio de acompanhamento de 10,1 meses (variando de 1,2 a 26), 27 pacientes (23%) apresentaram desfechos clínicos adversos. Preditores independentes de eventos adversos foram a concentração de hemoglobina, velocidade do fluxo transmitral tardio (onda A), e a resposta da PA ao exercício. Conclusões A realização de testes ergométricos em pacientes com AF, clinicamente estáveis, é viável. A duração do exercício estava associada à função diastólica e a pressão arterial pulmonar. A resposta anormal da PA foi um preditor independente de eventos adversos.
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Amarapurkar P, Roberts L, Navarrete J, El Rassi F. Sickle Cell Disease and Kidney. Adv Chronic Kidney Dis 2022; 29:141-148.e1. [PMID: 35817521 DOI: 10.1053/j.ackd.2022.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/01/2022] [Accepted: 03/10/2022] [Indexed: 11/11/2022]
Abstract
Sickle cell disease causes several kidney manifestations. They include defects in urine concentration, impaired handling of potassium and hydrogen ion, albuminuria, acute kidney injury, and chronic kidney disease to name a few. Glomerular hyperfiltration, tubular hyperfunctioning, endothelial damage from repeated sickling and vaso-occlusive episodes, and iron-induced proinflammatory changes in the glomerular mesangium and tubulointerstitium are some of the mechanisms of kidney damage. Albuminuria is one of the most and common clinical features of kidney disease and progresses with age. Kidney disease in patients with sickle cell is associated with increased mortality. Annual screening for proteinuria starting at age 10 years and limiting the use of nonsteroidal anti-inflammatory agents and the use of angiotensin-converting enzyme inhibitors may help in early detection and delaying the progression of kidney disease. Adequate hydration, angiotensin-converting enzyme inhibitors, and adequate control of sickle cell are the main stay of treatment for albuminuria. The hemoglobin goal for patients with sickle cell nephropathy is lesser (10 g/dL) than that for patients with chronic kidney disease due to other causes given that a higher hemoglobin level increases viscosity and the risk of precipitating vaso-occlusive episodes. A multidisciplinary approach is recommended for managing patients with sickle cell and kidney diseases.
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Affiliation(s)
- Pooja Amarapurkar
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, GA.
| | - Levard Roberts
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jose Navarrete
- Division of Renal Medicine, Emory University School of Medicine, Atlanta, GA
| | - Fuad El Rassi
- Associate Professor of Hematology and Medical Oncology, Emory University School of Medicine, Director of Sickle Cell Research, Georgia Comprehensive Sickle Cell Center at Grady Health System, Winship Cancer Institute of Emory University, Atlanta, GA
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18
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Cardiac complications of Sickle Cell Disease in pediatric patients: A case report and contemporary literature review. PROGRESS IN PEDIATRIC CARDIOLOGY 2022. [DOI: 10.1016/j.ppedcard.2022.101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Krishnamurti L. Hematopoietic cell transplantation for sickle cell disease: updates and future directions. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2021; 2021:181-189. [PMID: 34889368 PMCID: PMC8791142 DOI: 10.1182/hematology.2021000251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Excellent outcomes in hematopoietic cell transplantation (HCT) from HLA-identical siblings, improvements in conditioning regimens, novel graft-versus-host disease prophylaxis, and the availability of alternative donors have all contributed to the increased applicability and acceptability of HCT for sickle cell disease (SCD). In young children with symptomatic SCD with an available HLA-identical related donor, HCT should be carefully considered. HCT from alternative donors is typically undertaken only in patients with severe symptoms, causing or likely to cause organ damage, and in the context of clinical trials. Patients undergoing HCT for SCD require careful counseling and preparation. They require careful monitoring of unique organ toxicities and complications during HCT. Patients must be prospectively followed for a prolonged time to determine the long-term outcomes and late effects of HCT for SCD. Thus, there is a need for a universal, longitudinal clinical registry to follow patients after HCT for SCD in conjunction with individuals who do not receive HCT to compare outcomes. Antibody-based conditioning and ex-vivo umbilical cord blood expansion are likely to improve the availability and acceptability of HCT. In addition, new disease-modifying drugs and the emerging option of the autologous transplantation of gene-modified hematopoietic progenitor cells are likely to expand the available therapeutic options and make decision-making by patients, physicians, and caregivers even more complicated. Future efforts must also focus on determining the impact of socioeconomic status on access to and outcomes of HCT and the long-term impact of HCT on patients, families, and society.
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Affiliation(s)
- Lakshmanan Krishnamurti
- Correspondence Lakshmanan Krishnamurti, Children's Healthcare of Atlanta-Egleston, 1405 Clifton Road NE, Atlanta, GA 30322; e-mail:
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20
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Bithal PK, Jan R, Pandey VP, Ahmad P. Anesthetic Management of Moyamoya Syndrome Secondary to Sickle Cell Anemia. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2021. [DOI: 10.1055/s-0041-1739349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractMoyamoya disease (MMD) is caused by stenosis or occlusion of internal carotid artery in brain, thereby reducing its blood supply. To augment blood flow, brain develops abnormal anastomotic vessels with deranged carbon dioxide reactivity and tendency to bleed. Moyamoya syndrome (MMS) is the name given to MMD when the latter results from secondary to some associated disease. Occurrence of MMS secondary to sickle cell anemia (SCA) presents unique challenges to neuroanesthesiologists. Management of various physiological parameters for cerebral revascularization surgery for MMD under general anesthesia necessitates vigilant and balanced control of various physiological variables, as the manipulation of a particular physiological variable for one pathology may adversely impact the same physiological variable for the associated disease, which will result in poor outcome of the patient. Therefore, optimum outcome of MMS is determined by a watchful balancing of various physiological parameters under anesthesia.
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Affiliation(s)
- Parmod K. Bithal
- Division of Neuroanesthesia, Department of Anesthesia and Perioperative Medicine, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ravees Jan
- Department of Anesthesia and Perioperative Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ved P. Pandey
- Department of Anesthesia and Perioperative Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Parvaiz Ahmad
- Department of Anesthesia and Perioperative Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
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21
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Kirkham FJ, Lagunju IA. Epidemiology of Stroke in Sickle Cell Disease. J Clin Med 2021; 10:4232. [PMID: 34575342 PMCID: PMC8469588 DOI: 10.3390/jcm10184232] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 12/18/2022] Open
Abstract
Sickle cell disease is the most common cause of stroke in childhood, both ischaemic and haemorrhagic, and it also affects adults with the condition. Without any screening or preventative treatment, the incidence appears to fall within the range 0.5 to 0.9 per 100 patient years of observation. Newborn screening with Penicillin prophylaxis and vaccination leading to reduced bacterial infection may have reduced the incidence, alongside increasing hydroxyurea prescription. Transcranial Doppler screening and prophylactic chronic transfusion for at least an initial year has reduced the incidence of stroke by up to 10-fold in children with time averaged mean of the maximum velocity >200 cm/s. Hydroxyurea also appears to reduce the incidence of first stroke to a similar extent in the same group but the optimal dose remains controversial. The prevention of haemorrhagic stroke at all ages and ischaemic stroke in adults has not yet received the same degree of attention. Although there are fewer studies, silent cerebral infarction on magnetic resonance imaging (MRI), and other neurological conditions, including headache, epilepsy and cognitive dysfunction, are also more prevalent in sickle cell disease compared with age matched controls. Clinical, neuropsychological and quantitative MRI screening may prove useful for understanding epidemiology and aetiology.
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Affiliation(s)
- Fenella Jane Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, 30 Guilford Street, London WC1N 1EH, UK
- Child Health, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton SO16 6YD, UK
- Paediatric Neurosciences, King’s College Hospital, London SE5 9RS, UK
| | - Ikeoluwa A. Lagunju
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan PMB 3017, Nigeria;
- Department of Paediatrics, University College Hospital, Ibadan PMB 5116, Nigeria
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22
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d'Humières T, Savale L, Inamo J, Deux J, Deswarte S, Lionnet F, Loko G, Chantalat C, Damy T, Guillet H, Pham Hung d'Alexandry d'Orengiani AL, Galactéros F, Audureau E, Maitre B, Humbert M, Derumeaux G, Bartolucci P. Cardiovascular phenotypes predict clinical outcomes in sickle cell disease: An echocardiography-based cluster analysis. Am J Hematol 2021; 96:1166-1175. [PMID: 34143511 DOI: 10.1002/ajh.26271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 06/12/2021] [Indexed: 12/30/2022]
Abstract
This study sought to link cardiac phenotypes in homozygous Sickle Cell Disease (SCD) patients with clinical profiles and outcomes using cluster analysis. We analyzed data of 379 patients included in the French Etendard Cohort. A cluster analyses was performed based on echocardiographic variables, and the association between clusters, clinical profiles and outcomes was assessed. Three clusters were identified. Cluster 1 (n = 123) patients had the lowest cardiac output, mild left cardiac cavities remodeling, mild diastolic dysfunction, and higher tricuspid regurgitation velocity (TRV). They were predominantly female and displayed the most altered functional limitation. Cluster 2 (n = 102) patients had the highest cardiac output and the most remodeled cardiac cavities. Diastolic function and TRV were similar to cluster 1. These patients had a higher blood pressure and a severe hemolytic anemia. Cluster 3 (n = 154) patients had mild left cardiac cavities remodeling, normal diastolic function and lowest TRV values. They were younger with the highest hemoglobin value. Right heart catheterization was performed in 94 patients. Cluster 1 (n = 33) included the majority of pre-capillary PH whilst cluster 2 (n = 34) included post-capillary PH. No PH was found in cluster 3 (n = 27). After a follow-up of 11.4 ± 2 years, death occurred in 41 patients (11%). Cluster 2 patients had the worst prognosis with a 19% mortality rate versus 12% in cluster 1 and 5% in cluster 3 (p log-rank = 0.003). Cluster analysis of echocardiography variables identified three hemodynamic and clinical phenotypes among SCD patients, each predicting a different prognosis.
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Affiliation(s)
- Thomas d'Humières
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- INSERM IMRB U955, Team 8, Université Paris Est (UPEC) Créteil France
- Sickle Cell Referral Center – UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP Créteil France
| | - Laurent Savale
- Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center Hôpital Bicêtre, Assistance Publique Hôpitaux de Paris Le Kremlin‐Bicêtre France
- Université Paris‐Saclay, School of Medicine Le Kremlin‐Bicêtre France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies Hôpital Marie Lannelongue Le Plessis‐Robinson France
| | - Jocelyn Inamo
- Department of Cardiology University of the French West Indies and Guiana Fort‐de‐France Martinique France
| | - Jean‐François Deux
- INSERM IMRB U955, Team 8, Université Paris Est (UPEC) Créteil France
- Department of Radiology FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
| | - Simon Deswarte
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- INSERM IMRB U955, Team 8, Université Paris Est (UPEC) Créteil France
| | - Francois Lionnet
- Department of Internal Medicine Tenon Hospital, Assistance Publique Hôpitaux de Paris Paris France
| | - Gylna Loko
- Sickle Cell Center University of the French West Indies and Guiana Martinique France
| | - Christelle Chantalat
- Department of Hematology Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris Kremlin‐Bicêtre France
| | - Thibaud Damy
- Department of Cardiovascular Medicine FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- INSERM IMRB U955, Team 8, Université Paris Est Créteil Créteil France
| | - Henri Guillet
- Sickle Cell Referral Center – UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP Créteil France
- Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC/Assistance Publique‐Hôpitaux de Paris Créteil France
| | | | - Frédéric Galactéros
- Sickle Cell Referral Center – UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP Créteil France
- Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC/Assistance Publique‐Hôpitaux de Paris Créteil France
| | - Etienne Audureau
- Biostatistics Department Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- CEpiA IMRB U955, FHU SENEC, Université Paris Est (UPEC) Créteil France
| | - Bernard Maitre
- Pulmonary Unit FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- INSERM IMRB U955, Université Paris Est (UPEC) Créteil France
| | - Marc Humbert
- Sickle Cell Referral Center – UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP Créteil France
- Pulmonary Unit FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- INSERM IMRB U955, Université Paris Est (UPEC) Créteil France
| | - Geneviève Derumeaux
- Physiology Department, FHU SENEC, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris Créteil France
- INSERM IMRB U955, Team 8, Université Paris Est (UPEC) Créteil France
| | - Pablo Bartolucci
- Sickle Cell Referral Center – UMGGR, Plateforme d'expertise Maladies Rares Grand Paris Est, UPEC, FHU SENEC, CHU Henri Mondor APHP Créteil France
- Department of Internal Medicine Henri‐Mondor University Hospital‐UPEC/Assistance Publique‐Hôpitaux de Paris Créteil France
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23
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Njoku F, Zhang X, Shah BN, Machado RF, Han J, Saraf SL, Gordeuk VR. Biomarkers of clinical severity in treated and untreated sickle cell disease: a comparison by genotypes of a single center cohort and African Americans in the NHANES study. Br J Haematol 2021; 194:767-778. [PMID: 34268729 PMCID: PMC8373676 DOI: 10.1111/bjh.17682] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022]
Abstract
Haemolysis and vaso-occlusion underlie multi-organ system complications in sickle cell disease (SCD). We assessed real-world biomarkers in University of Illinois adult SCD patients, categorised as severe (HbSS/Sβ0 -thalassaemia; n = 342) or mild (HbSC/Sβ+ -thalassaemia; n = 100) genotypes and stratified according to treatment. African-American controls from the National Health and Nutrition Examination Survey (NHANES) were matched with each genotype category. Most measures of haemolysis, anaemia, inflammation and function of kidneys, liver and lungs differed markedly in untreated severe genotype patients compared to NHANES controls. These same biomarkers were significantly closer to the NHANES control range in untreated mild versus severe genotype patients, but they were not improved in severe genotype patients receiving treatment with hydroxycarbamide or blood transfusions, except that haemoglobin and HbF were higher with hydroxycarbamide. Systolic blood pressures did not differ among the SCD and NHANES groups, but diastolic pressures were higher in mild genotype patients. Ferritin in severe genotype patients on chronic transfusions was 50-fold higher than NHANES controls. The cross-sectional real-world biomarkers of patients on hydroxycarbamide or transfusions were not markedly improved compared to untreated patients. This may be due partly to poor compliance or more severe disease. Our findings highlight the need for more effective treatments.
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Affiliation(s)
- Franklin Njoku
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Xu Zhang
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Binal N. Shah
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Roberto F. Machado
- Division of Pulmonary, Critical Care, Sleep, and Occupational Medicine, Department of Medicine, Indiana University, Indianapolis, IN
| | - Jin Han
- Department of Pharmacy Practice, College of Pharmacy, University of Illinois at Chicago, Chicago, IL
| | - Santosh L. Saraf
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Victor R. Gordeuk
- Division of Hematology and Oncology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
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24
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American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. Blood Adv 2021; 4:1554-1588. [PMID: 32298430 DOI: 10.1182/bloodadvances.2019001142] [Citation(s) in RCA: 194] [Impact Index Per Article: 64.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 02/03/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Central nervous system (CNS) complications are among the most common, devastating sequelae of sickle cell disease (SCD) occurring throughout the lifespan. OBJECTIVE These evidence-based guidelines of the American Society of Hematology are intended to support the SCD community in decisions about prevention, diagnosis, and treatment of the most common neurological morbidities in SCD. METHODS The Mayo Evidence-Based Practice Research Program supported the guideline development process, including updating or performing systematic evidence reviews. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations. RESULTS The panel placed a higher value on maintaining cognitive function than on being alive with significantly less than baseline cognitive function. The panel developed 19 recommendations with evidence-based strategies to prevent, diagnose, and treat CNS complications of SCD in low-middle- and high-income settings. CONCLUSIONS Three of 19 recommendations immediately impact clinical care. These recommendations include: use of transcranial Doppler ultrasound screening and hydroxyurea for primary stroke prevention in children with hemoglobin SS (HbSS) and hemoglobin Sβ0 (HbSβ0) thalassemia living in low-middle-income settings; surveillance for developmental delay, cognitive impairments, and neurodevelopmental disorders in children; and use of magnetic resonance imaging of the brain without sedation to detect silent cerebral infarcts at least once in early-school-age children and once in adults with HbSS or HbSβ0 thalassemia. Individuals with SCD, their family members, and clinicians should become aware of and implement these recommendations to reduce the burden of CNS complications in children and adults with SCD.
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25
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Halabi CM, Hulbert ML. Sickle cell disease-Under pressure. Pediatr Blood Cancer 2021; 68:e28932. [PMID: 33559325 DOI: 10.1002/pbc.28932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Carmen M Halabi
- Division of Nephrology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Monica L Hulbert
- Division of Hematology/Oncology, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
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26
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Strumph K, Hafeman M, Ranabothu S, Gomes W, Benitez S, Kaskel F, Manwani D, Mahgerefteh J. Nocturnal hypertension associated with stroke and silent cerebral infarcts in children with sickle cell disease. Pediatr Blood Cancer 2021; 68:e28883. [PMID: 33405393 DOI: 10.1002/pbc.28883] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/15/2020] [Accepted: 12/16/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Strokes and silent cerebral infarcts (SCIs) lead to significant morbidity and mortality in children with sickle cell disease (SCD). Higher systolic blood pressures increase risk for stroke and SCIs; however, patients with SCD often have lower clinic blood pressures than the general population. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) allows for more robust examination of blood pressures. This study evaluated associations between abnormal ABPM measurements with stroke and SCIs. PROCEDURE A cross-sectional study was performed. Children with SCD completed 24-hour ABPMs. Children with a documented magnetic resonance imaging (MRI) brain within a year of the ABPM were included in the analysis. Bivariate analyses were performed to identify associations between ABPM parameters with cerebrovascular outcomes. RESULTS Forty-two children with a median age of 13 years (10, 17) were included in the analysis. Seven (17%) had history of stroke and seven (17%) had SCIs. Nocturnal hypertension, elucidated via 24-hour ABPM, was noted in 25% of subjects. The presence of nocturnal hypertension was significantly higher in the SCI/stroke group (55% vs 12%, P = .01). Sensitivity analyses were performed during which stroke patients were removed from analysis. Nocturnal hypertension remained significantly associated with the presence of SCIs (P = .006). CONCLUSIONS This study reveals an association between nocturnal hypertension and a higher prevalence of SCI and stroke in children with SCD. Larger, prospective studies are needed to confirm these findings and evaluate the contributory nature of blood pressure abnormalities to cerebrovascular events in children with SCD.
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Affiliation(s)
- Kaitlin Strumph
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Michael Hafeman
- Department of Anesthesiology, Stony Brook University, Renaissance School of Medicine, Stony Brook, New York
| | - Saritha Ranabothu
- Division of Nephrology, Department of Pediatrics, Arkansas Children's Hospital, Little Rock, Arkansas
| | - William Gomes
- Department of Radiology, Westchester Medical Center, Valhalla, New York
| | - Steven Benitez
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Frederick Kaskel
- Division of Nephrology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Deepa Manwani
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Joseph Mahgerefteh
- Division of Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, Kravis Children's Hospital, New York, New York
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27
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Kupferman JC, Lande MB, Stabouli S, Zafeiriou DI, Pavlakis SG. Hypertension and childhood stroke. Pediatr Nephrol 2021; 36:809-823. [PMID: 32350664 DOI: 10.1007/s00467-020-04550-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 03/18/2020] [Accepted: 03/23/2020] [Indexed: 01/09/2023]
Abstract
Cerebrovascular disease (stroke) is one of the ten leading causes of death in children and adolescents. Multiple etiologies, from arteriopathies to prothrombic states, can cause stroke in youth. In adult stroke, hypertension has been shown to be the single most important modifiable risk factor. Although hypertension has not been strongly identified as a risk factor in childhood stroke to date, there is preliminary evidence that suggests that hypertension may also be associated with stroke in children. In this review, we summarize the literature that may link hypertension to stroke in the young. We have identified a series of barriers and limitations in the fields of pediatric hypertension and pediatric neurology that might explain why hypertension has been overlooked in childhood stroke. We suggest that hypertension may be a relevant risk factor that, alone or in combination with other multiple factors, contributes to the development of stroke in children. Currently, there are no consensus guidelines for the management of post-stroke hypertension in children. Thus, we recommend that blood pressure be assessed carefully in every child presenting with acute stroke in order to better understand the effects of hypertension in the development and the outcome of childhood stroke. We suggest a treatment algorithm to help practitioners manage hypertension after a stroke.
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Affiliation(s)
- Juan C Kupferman
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY, USA.
| | - Marc B Lande
- Department of Pediatrics, University of Rochester, Rochester, NY, USA
| | - Stella Stabouli
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Dimitrios I Zafeiriou
- 1st Department of Pediatrics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Steven G Pavlakis
- Department of Pediatrics, Maimonides Medical Center, Brooklyn, NY, USA
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28
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Alzahrani F, Fallatah AM, Al-Haddad FM, Khayyat ST, AlMehmadi WM, AlQahtani BG, Alamri RS. Risk Factors and Complications Among Pediatric Patients With Sickle Cell Anemia: A Single Tertiary Center Retrospective Study. Cureus 2021; 13:e12440. [PMID: 33552759 PMCID: PMC7851883 DOI: 10.7759/cureus.12440] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and objective Sickle cell anemia (SCA) is one of the common genetic diseases in the Kingdom of Saudi Arabia (KSA). This disease results from a genetic mutation that causes malformation of the red blood cells (RBCs), leading to various systemic complications, including vaso-occlusive crisis (VOC), acute chest syndrome (ACS), osteomyelitis, avascular necrosis (AVN), and stroke, to name a few. The leading cause of mortality in SCA is these systemic complications rather than the disease itself. Understanding the risk factors of these complications can help reduce mortality in these patients and improve their quality of life. In this study, we aimed to determine the risk factors of SCA complications among pediatric patients with SCA at King Abdulaziz University Hospital (KAUH) in Jeddah, KSA. Methods This retrospective study was carried out from January 2012 till June end 2019. It was conducted among pediatric patients with SCA. Patients were screened for eligibility, and we excluded those with thalassemia and those who had a medical history of chronic diseases. Data were collected from patients' electronic medical records. Results The study included 102 pediatric patients with SCA; their mean age was 7.88 ±4.22 years; almost half of them were females (56%) and 44% were males. The dominant body mass index (BMI) classification among them was normal (49%). Urinary tract infection (UTI) was the most common complication with 38 cases followed by VOC with 32 cases. Other complications observed were ACS (25.5%) followed by stroke (15.7%). HbSS was the most prominent genotype among these patients, and it was associated with a higher rate of complications. However, there was no significant relationship between genotype and patients developing complications. Finally, patients with high white blood cell (WBC) counts, elevated systolic blood pressure (SBP), and hypoxia developed more complications, and there was a significant relationship between these conditions and the development of complications (p<0.05). Conclusion Based on our findings, patients with high WBC count, elevated SBP, and hypoxia are at greater risk of developing complications. Accordingly, healthcare providers should consider putting in place all measures required to provide a good quality of life for these patients, including raising awareness about the risk factors that lead to these complications, appropriate immunizations, and precautionary measures to promote these patients' welfare.
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Affiliation(s)
| | - Anas M Fallatah
- Medicine, College of Medicine, King Abdulaziz University, Jeddah, SAU
| | - Fatimah M Al-Haddad
- Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Shahad T Khayyat
- Medicine, College of Medicine, King Abdulaziz University, Jeddah, SAU
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29
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End points for sickle cell disease clinical trials: renal and cardiopulmonary, cure, and low-resource settings. Blood Adv 2020; 3:4002-4020. [PMID: 31809537 DOI: 10.1182/bloodadvances.2019000883] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/07/2019] [Indexed: 01/19/2023] Open
Abstract
To address the global burden of sickle cell disease and the need for novel therapies, the American Society of Hematology partnered with the US Food and Drug Administration to engage the work of 7 panels of clinicians, investigators, and patients to develop consensus recommendations for clinical trial end points. The panels conducted their work through literature reviews, assessment of available evidence, and expert judgment focusing on end points related to patient-reported outcome, pain (non-patient-reported outcomes), the brain, end-organ considerations, biomarkers, measurement of cure, and low-resource settings. This article presents the findings and recommendations of the end-organ considerations, measurement of cure, and low-resource settings panels as well as relevant findings and recommendations from the biomarkers panel.
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30
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Stabouli S, Antza C, Papadopoulou E, Teli A, Kotsis V, Economou M. Unmasking hypertension in children and adolescents with sickle/beta-thalassemia. J Clin Hypertens (Greenwich) 2020; 22:1444-1449. [PMID: 32762124 DOI: 10.1111/jch.13957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 01/06/2023]
Abstract
Sickle cell disease (SCD) is associated with increased risk of cardiovascular disease, although blood pressure (BP) levels have been reported to be lower in SCD patients compared to general population. Aims of the present study were to investigate the prevalence of BP phenotypes and levels of arterial stiffness in pediatric patients with SCD and to assess the differences with children at risk for hypertension. We included in the study 16 pediatric SCD (HbS/β-thalassemia, S/β-thal) patients and 16 consecutive children at risk for hypertension referred to our hypertension clinic that served as high-risk controls. All patients underwent ambulatory BP monitoring and measurement of carotid-femoral pulse wave velocity (PWV). S/β-thal patients had lower office systolic BP than the high-risk control group (115.43 ± 10.03 vs 123.37 ± 11.92, P = .05) but presented similar levels of day and night ambulatory BP. Office hypertension was found in 12.5% of the S/β-thal patients and in 43.8% of the high-risk controls (P = .06), while 18.8% of the S/β-thal patients and 25% of the high-risk controls presented hypertension by ambulatory BP levels (P = .21). All of the S/β-thal patients with ambulatory hypertension had night hypertension (one combined night and day hypertension) with office normotension (masked hypertension). S/β-thal patients and high-risk controls presented equal prevalence of masked hypertension (18.8%). Children and adolescents with S/β-thal present similar prevalence of BP phenotypes and levels of PWV with children at risk for hypertension. A significant number of children and adolescents with S/β-thal may have masked nighttime hypertension despite normal office BP levels.
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Affiliation(s)
- Stella Stabouli
- 1st Pediatric Department, Aristotle University Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece
| | - Christina Antza
- Hypertension-24h ABPM ESH Center of Excellence, 3rd Department of Medicine, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Eleni Papadopoulou
- 1st Pediatric Department, Aristotle University Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece
| | - Aikaterini Teli
- 1st Pediatric Department, Aristotle University Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece
| | - Vasilios Kotsis
- Hypertension-24h ABPM ESH Center of Excellence, 3rd Department of Medicine, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Marina Economou
- 1st Pediatric Department, Aristotle University Thessaloniki, Hippocratio Hospital, Thessaloniki, Greece
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31
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Fiocchi J, Urits I, Orhurhu V, Orhurhu MS, Giacomazzi S, Hoyt B, Kaye AD, Kaye RJ, Viswanath O. A Comprehensive Review of the Treatment and Management of Pain in Sickle Cell Disease. Curr Pain Headache Rep 2020; 24:17. [PMID: 32200490 DOI: 10.1007/s11916-020-00854-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW Sickle cell disease (SCD) is a hematological disorder which leads to serious complications in multiple organ systems. While significant research has addressed many of the effects of acute pain episodes and end-organ damage connected to this disease, little has approached the chronic pain state associated with this condition. RECENT FINDINGS Associated chronic pain represents a significant detractor from the quality of life experienced by these patients, affecting over half of those with SCD on more days than not. Current treatment typically is centered upon preventing and responding to acute vasoocclusive crises, presumably because this is the most common reason for hospitalization in these patients. The lack of management of chronic pain symptoms leaves many with SCD in a state of suffering. In this review, the treatment methodologies of SCD patients are examined including alternative treatments, both pharmaceutical and non-pharmaceutical, as well as procedural approaches specifically aimed at reducing chronic pain in these patients.
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Affiliation(s)
- Jacob Fiocchi
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA.
| | - Vwaire Orhurhu
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Critical Care, and Pain Medicine, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Mariam Salisu Orhurhu
- Department of Anesthesia, Critical Care, and Pain Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Stephen Giacomazzi
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Briggs Hoyt
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Rachel J Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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32
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Caughey MC, Novelli EM. Editorial commentary: Sickle cell disease: Diagnosing the heart of the matter. Trends Cardiovasc Med 2020; 31:194-195. [PMID: 32192822 DOI: 10.1016/j.tcm.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 02/22/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Melissa C Caughey
- Joint Department of Biomedical Engineering, University of North Carolina and North Carolina State University, Chapel Hill, NC, USA.
| | - Enrico M Novelli
- Heart, Lung, Blood, and Vascular Medicine Institute and Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA
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33
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Sachdev V, Rosing DR, Thein SL. Cardiovascular complications of sickle cell disease. Trends Cardiovasc Med 2020; 31:187-193. [PMID: 32139143 DOI: 10.1016/j.tcm.2020.02.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/26/2020] [Accepted: 02/07/2020] [Indexed: 12/12/2022]
Abstract
Sickle cell disease (SCD) is the most common inherited blood disorder in the United States, and a global health problem. Pathological features of the abnormal hemoglobin (HbS) result in 2 hallmarks of the disease - recurrent episodes of acute microvascular occlusion and chronic hemolytic anemia - that inflict continuous and insidious damage to multiple organs. With improved childhood survival, SCD in adults has evolved into a chronic degenerative disease with underlying damage to multiple organs including the heart and lungs. Cardiopulmonary complications, including cardiomyopathy, diastolic dysfunction, pulmonary hypertension (PH), and sudden cardiac death are the most common causes of morbidity and mortality. Awareness of the sickle-related cardiovascular phenotypes is important for screening, early diagnosis, and intervention of cardiac complications in this disorder.
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Affiliation(s)
- Vandana Sachdev
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Douglas R Rosing
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - Swee Lay Thein
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Al-Musawa FE, Al-Saqladi AWM. Prevalence and correlates of microalbuminuria in Yemeni children with sickle cell disease. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 30:832-842. [PMID: 31464240 DOI: 10.4103/1319-2442.265459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Microalbuminuria (MA) has been recognized as a sensitive marker of early glomerular injury and a predictor of kidney dysfunction in patients with sickle cell disease (SCD). Limited data are available about MA in SCD children in the Arab countries and none from Yemen. The aim of this study is to determine the prevalence and correlates of MA among 101 children aged 1-16 years, with SCD at their steady state. Children were recruited during their routine health-care visits to the pediatric outpatient clinic in Al-Sadaqa general teaching hospital, Aden, Yemen, between September 2014 and February 2015. A random spot urine sample for each child was screened for MA using Micral-Test strips method. Data on clinical history, anthropometry, blood pressure (BP), and laboratory investigations were obtained. The overall prevalence of MA in this sample was 30.7%, with male predominance (80.6%) (P <0.05). The mean age of children with MA was 7.5 ± 3.2 years, and 10% of them were under five years of age. MA was correlated to both hemoglobin and hematocrit levels, which found to have protective effect against MA (Odds ratio = 0.17 and 0.59, respectively, P <0.05). No correlations were found between MA with age, height, weight, body mass index, recurrent clinical events (painful crises, blood transfusions, and hospitalizations), or fetal hemoglobin levels. BP measurements for all individuals were within the normal ranges, but systolic and diastolic BP were significantly higher in those with MA than without. This study demonstrated a high prevalence of MA in Yemeni children with SCD, and affecting young children as early as 2.5 years of age. Screening for MA as one of the early renal injury markers in children with SCD may help in the prevention of permanent loss of renal function and subsequent renal insufficiency in adulthood.
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Affiliation(s)
- Fatima Essa Al-Musawa
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
| | - Abdul-Wahab M Al-Saqladi
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Aden, Aden, Yemen
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Ito MT, da Silva Costa SM, Baptista LC, Carvalho-Siqueira GQ, Albuquerque DM, Rios VM, Ospina-Prieto S, Saez RC, Vieira KP, Cendes F, Ozelo MC, Saad STO, Costa FF, Melo MB. Angiogenesis-Related Genes in Endothelial Progenitor Cells May Be Involved in Sickle Cell Stroke. J Am Heart Assoc 2020; 9:e014143. [PMID: 32009522 PMCID: PMC7033889 DOI: 10.1161/jaha.119.014143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The clinical aspects of sickle cell anemia (SCA) are heterogeneous, and different patients may present significantly different clinical evolutions. Almost all organs can be affected, particularly the central nervous system. Transient ischemic events, infarcts, and cerebral hemorrhage can be observed and affect ≈25% of the patients with SCA. Differences in the expression of molecules produced by endothelial cells may be associated with the clinical heterogeneity of patients affected by vascular diseases. In this study, we investigated the differential expression of genes involved in endothelial cell biology in SCA patients with and without stroke. Methods and Results Endothelial progenitor cells from 4 SCA patients with stroke and 6 SCA patients without stroke were evaluated through the polymerase chain reaction array technique. The analysis of gene expression profiling identified 29 differentially expressed genes. Eleven of these genes were upregulated, and most were associated with angiogenesis (55%), inflammatory response (18%), and coagulation (18%) pathways. Downregulated expression was observed in 18 genes, with the majority associated with angiogenesis (28%), apoptosis (28%), and cell adhesion (22%) pathways. Remarkable overexpression of the MMP1 (matrix metalloproteinase 1) gene in the endothelial progenitor cells of all SCA patients with stroke (fold change: 204.64; P=0.0004) was observed. Conclusions Our results strongly suggest that angiogenesis is an important process in sickle cell stroke, and differences in the gene expression profile of endothelial cell biology, especially MMP1, may be related to stroke in SCA patients.
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Affiliation(s)
- Mirta T Ito
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Sueli M da Silva Costa
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Letícia C Baptista
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
| | | | | | - Vinicius M Rios
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
| | | | - Roberta C Saez
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Karla P Vieira
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Fernando Cendes
- Neuroimaging Laboratory Department of Neurology University of Campinas, UNICAMP Campinas São Paulo Brazil
| | - Margareth C Ozelo
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Sara Teresinha O Saad
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Fernando F Costa
- Hematology and Hemotherapy Center University of Campinas-UNICAMP Campinas São Paulo Brazil
| | - Mônica B Melo
- Center for Molecular Biology and Genetic Engineering University of Campinas-UNICAMP Campinas São Paulo Brazil
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Ochocinski D, Dalal M, Black LV, Carr S, Lew J, Sullivan K, Kissoon N. Life-Threatening Infectious Complications in Sickle Cell Disease: A Concise Narrative Review. Front Pediatr 2020; 8:38. [PMID: 32154192 PMCID: PMC7044152 DOI: 10.3389/fped.2020.00038] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 01/27/2020] [Indexed: 12/19/2022] Open
Abstract
Sickle cell disease (SCD) results in chronic hemolytic anemia, recurrent vascular occlusion, insidious vital organ deterioration, early mortality, and diminished quality of life. Life-threatening acute physiologic crises may occur on a background of progressive diminishing vital organ function. Sickle hemoglobin polymerizes in the deoxygenated state, resulting in erythrocyte membrane deformation, vascular occlusion, and hemolysis. Vascular occlusion and increased blood viscosity results in functional asplenia and immune deficiency in early childhood, resulting in life-long increased susceptibility to serious bacterial infections. Infection remains a main cause of overall mortality in patients with SCD in low- and middle-income countries due to increased exposure to pathogens, increased co-morbidities such as malnutrition, lower vaccination rates, and diminished access to definitive care, including antibiotics and blood. Thus, the greatest gains in preventing infection-associated mortality can be achieved by addressing these factors for SCD patients in austere environments. In contrast, in high-income countries, perinatal diagnosis of SCD, antimicrobial prophylaxis, vaccination, aggressive use of antibiotics for febrile episodes, and the availability of contemporary critical care resources have resulted in a significant reduction in deaths from infection; however, chronic organ injury is problematic. All clinicians, regardless of their discipline, who assume the care of SCD patients must understand the importance of infectious disease as a contributor to death and disability. In this concise narrative review, we summarize the data that describes the importance of infectious diseases as a contributor to death and disability in SCD and discuss pathophysiology, prevalent organisms, prevention, management of acute episodes of critical illness, and ongoing care.
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Affiliation(s)
- Dominik Ochocinski
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States
| | - Mansi Dalal
- Division of Pediatric Hematology/Oncology, University of Florida, Gainesville, FL, United States
| | - L Vandy Black
- Division of Pediatric Hematology/Oncology, University of Florida, Gainesville, FL, United States
| | - Silvana Carr
- Division of Pediatric Infectious Disease, University of Florida, Gainesville, FL, United States
| | - Judy Lew
- Division of Pediatric Infectious Disease, University of Florida, Gainesville, FL, United States
| | - Kevin Sullivan
- Department of Anesthesiology, University of Florida, Gainesville, FL, United States.,Congenital Heart Center, University of Florida, Gainesville, FL, United States
| | - Niranjan Kissoon
- Department of Pediatrics, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
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Krishnamurti L. Hematopoietic Cell Transplantation for Sickle Cell Disease. Front Pediatr 2020; 8:551170. [PMID: 33469520 PMCID: PMC7813811 DOI: 10.3389/fped.2020.551170] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022] Open
Abstract
Sickle cell disease (SCD) is a severe autosomal recessively inherited disorder of the red blood cell characterized by erythrocyte deformation caused by the polymerization of the abnormal hemoglobin, which leads to erythrocyte deformation and triggers downstream pathological changes. These include abnormal rheology, vaso-occlusion, ischemic tissue damage, and hemolysis-associated endothelial dysfunction. These acute and chronic physiologic disturbances contribute to morbidity, organ dysfunction, and diminished survival. Hematopoietic cell transplantation (HCT) from HLA-matched or unrelated donors or haploidentical related donors or genetically modified autologous hematopoietic progenitor cells is performed with the intent of cure or long-term amelioration of disease manifestations. Excellent outcomes have been observed following HLA-identical matched related donor HCT. The majority of SCD patients do not have an available HLA-identical sibling donor. Increasingly, however, they have the option of undergoing HCT from unrelated HLA matched or related haploidentical donors. The preliminary results of transplantation of autologous hematopoietic progenitor cells genetically modified by adding a non-sickling gene or by genomic editing to increase expression of fetal hemoglobin are encouraging. These approaches are being evaluated in early-phase clinical trials. In performing HCT in patients with SCD, careful consideration must be given to patient and donor selection, conditioning and graft-vs.-host disease regimen, and pre-HCT evaluation and management during and after HCT. Sociodemographic factors may also impact awareness of and access to HCT. Further, there is a substantial decisional dilemma in HCT with complex tradeoffs between the possibility of amelioration of disease manifestations and early or late complications of HCT. The performance of HCT for SCD requires careful multidisciplinary collaboration and shared decision making between the physician and informed patients and caregivers.
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Affiliation(s)
- Lakshmanan Krishnamurti
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, United States
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38
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Stenger EO, Shenoy S, Krishnamurti L. How I treat sickle cell disease with hematopoietic cell transplantation. Blood 2019; 134:2249-2260. [PMID: 31697818 PMCID: PMC6923666 DOI: 10.1182/blood.2019000821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 10/28/2019] [Indexed: 12/14/2022] Open
Abstract
Sickle cell disease (SCD) leads to significant morbidity and early mortality, and hematopoietic cell transplantation (HCT) is the only widely available cure, with impacts seen on SCD-related organ dysfunction. Outcomes are excellent following matched-related donor (MRD) HCT, leading to significantly expanded application of this treatment over the past decade. The majority of SCD patients lack an MRD, but outcomes following alternative donor HCT continue to improve on clinical trials. Within this framework, we aim to provide our perspective on how to apply research findings to clinical practice, for an individual patient. We also emphasize that the preparation of SCD recipients for HCT and supporting them through HCT have special nuances that require awareness and close attention. Through the use of clinical vignettes, we provide our perpsective on the complex decision-making process in HCT for SCD as well as recommendations for the evaluation and support of these patients through HCT.
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Affiliation(s)
- Elizabeth O Stenger
- Division of Blood and Marrow Transplantation and Cellular Therapies, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Shalini Shenoy
- Division of Hematology/Oncology, Children's Hospital St. Louis, St. Louis, MO; and
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Liem RI, Lanzkron S, D Coates T, DeCastro L, Desai AA, Ataga KI, Cohen RT, Haynes J, Osunkwo I, Lebensburger JD, Lash JP, Wun T, Verhovsek M, Ontala E, Blaylark R, Alahdab F, Katabi A, Mustafa RA. American Society of Hematology 2019 guidelines for sickle cell disease: cardiopulmonary and kidney disease. Blood Adv 2019; 3:3867-3897. [PMID: 31794601 PMCID: PMC6963257 DOI: 10.1182/bloodadvances.2019000916] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 11/01/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Prevention and management of end-organ disease represent major challenges facing providers of children and adults with sickle cell disease (SCD). Uncertainty and variability in the screening, diagnosis, and management of cardiopulmonary and renal complications in SCD lead to varying outcomes for affected individuals. OBJECTIVE These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about screening, diagnosis, and management of cardiopulmonary and renal complications of SCD. METHODS ASH formed a multidisciplinary guideline panel that included 2 patient representatives and was balanced to minimize potential bias from conflicts of interest. The Mayo Evidence-Based Practice Research Program supported the guideline development process, including performing systematic evidence reviews up to September 2017. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS The panel agreed on 10 recommendations for screening, diagnosis, and management of cardiopulmonary and renal complications of SCD. Recommendations related to anticoagulation duration for adults with SCD and venous thromboembolism were also developed. CONCLUSIONS Most recommendations were conditional due to a paucity of direct, high-quality evidence for outcomes of interest. Future research was identified, including the need for prospective studies to better understand the natural history of cardiopulmonary and renal disease, their relationship to patient-important outcomes, and optimal management.
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Affiliation(s)
- Robert I Liem
- Division of Hematology, Oncology and Stem Cell Transplant, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Sophie Lanzkron
- Division of Adult Hematology, School of Medicine, Johns Hopkins University, Baltimore, MD
| | - Thomas D Coates
- Division of Hematology, Oncology and Blood and Marrow Transplantation, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Laura DeCastro
- Division of Hematology/Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ankit A Desai
- Krannert Institute of Cardiology, School of Medicine, Indiana University, Indianapolis, IN
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
| | - Robyn T Cohen
- Division of Pediatric Pulmonary and Allergy, Boston Medical Center, School of Medicine, Boston University, Boston, MA
| | - Johnson Haynes
- Division of Pulmonary Disease, College of Medicine, University of South Alabama, Mobile, AL
| | - Ifeyinwa Osunkwo
- Division of Hematology, The Levine Cancer Institute, Atrium Health, Charlotte, NC
| | - Jeffrey D Lebensburger
- Division of Pediatric Hematology/Oncology, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - James P Lash
- Division of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Theodore Wun
- Division of Hematology and Oncology, School of Medicine, University of California Davis, Sacramento, CA
| | - Madeleine Verhovsek
- Division of Hematology and Thromboembolism, McMaster University, Hamilton, ON, Canada
| | | | | | - Fares Alahdab
- Division of General Internal Medicine, Mayo Medical School, Rochester, MN; and
| | - Abdulrahman Katabi
- Division of General Internal Medicine, Mayo Medical School, Rochester, MN; and
| | - Reem A Mustafa
- Division of Nephrology and Hypertension, School of Medicine, University of Kansas, Kansas City, KS
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Cahill LS, Pilmeyer J, Yu LX, Steinman J, Hare GMT, Kassner A, Macgowan CK, Sled JG. Ultrasound Detection of Abnormal Cerebrovascular Morphology in a Mouse Model of Sickle Cell Disease Based on Wave Reflection. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:3269-3278. [PMID: 31563480 DOI: 10.1016/j.ultrasmedbio.2019.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 08/09/2019] [Accepted: 08/23/2019] [Indexed: 06/10/2023]
Abstract
Sickle cell disease (SCD) is associated with a high risk of stroke, and affected individuals often have focal brain lesions termed silent cerebral infarcts. The mechanisms leading to these types of injuries are at present poorly understood. Our group has recently demonstrated a non-invasive measurement of cerebrovascular impedance and wave reflection in mice using high-frequency ultrasound in the common carotid artery. To better understand the pathophysiology in SCD, we used this approach in combination with micro-computed tomography to investigate changes in cerebrovascular morphology in the Townes mouse model of SCD. Relative to controls, the SCD mice demonstrated the following: (i) increased carotid artery diameter, blood flow and vessel wall thickness; (ii) elevated pulse wave velocity; (iii) increased reflection coefficient; and (iv) an increase in the total number of vessel segments in the brain. This study highlights the potential for wave reflection to aid the non-invasive clinical assessment of vascular pathology in SCD.
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Affiliation(s)
- Lindsay S Cahill
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada; Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
| | - Jesper Pilmeyer
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lisa X Yu
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada; Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joe Steinman
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - Gregory M T Hare
- Keenan Research Centre for Biomedical Science and Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Kassner
- Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Christopher K Macgowan
- Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
| | - John G Sled
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada; Translational Medicine, Hospital for Sick Children, Toronto, Ontario, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario, Canada
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Inusa BPD, Colombatti R, Rees DC, Heeney MM, Hoppe CC, Ogutu B, Hassab HM, Zhou C, Yao S, Brown PB, Heath LE, Jakubowski JA, Abboud MR. Geographic Differences in Phenotype and Treatment of Children with Sickle Cell Anemia from the Multinational DOVE Study. J Clin Med 2019; 8:jcm8112009. [PMID: 31744266 PMCID: PMC6912763 DOI: 10.3390/jcm8112009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 11/30/2022] Open
Abstract
Background: DOVE (Determining Effects of Platelet Inhibition on Vaso-Occlusive Events) was a Phase 3, randomized, double-blind, placebo-controlled study conducted in children with sickle cell anemia at 51 sites in 13 countries across four continents. Procedure: Data from DOVE were assessed for regional differences in subject phenotype and treatment. Demographics, baseline clinical and laboratory data, hydroxyurea (HU) use, vaso-occlusive crisis (VOCs; composite endpoint of painful crisis or acute chest syndrome (ACS)), serious adverse events (SAEs), hospitalization, and treatments were compared across the Americas, Europe, North Africa/Middle East, and Sub-Saharan Africa (SSA). Results: Race, body mass index, and blood pressures differed by region. Pre-enrollment VOCs were highest in the Americas. For subjects not on HU, baseline hemoglobin was lowest in SSA; reticulocyte count was lowest in the Americas. Within SSA, Kenya subjects presented higher baseline hemolysis. Painful crisis was the most common SAE, followed by ACS in the Americas and infections in other regions. VOC rate and percentage of VOC hospitalizations were highest in Europe. Regardless of region, most VOCs were treated with analgesics; approximately half were treated with intravenous fluids. The proportion of VOC-related transfusions was greatest in Europe. Lengths of hospital stay were similar across regions. Conclusions: Overall differences in SAEs and hospitalization for VOCs may be due to cultural diversities, resource utilization, disease severity, or a combination of factors. These data are of importance for the planning of future trials in SCA in a multinational setting.
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Affiliation(s)
- Baba Psalm Duniya Inusa
- Evelina Children’s Hospital, and Guy’s and St. Thomas’ Hospital, London SE1 7EH, UK
- Women and Children’s Health, Faculty of Life Sciences & Medicine, King’s College, London SE1 7EH, UK
- Correspondence: ; Tel.: +44-791-959-7783; Fax: +44-207-188-4612
| | - Raffaella Colombatti
- Clinic of Pediatric Hematology-Oncology, Azienda Ospedaliera-University of Padua, Padua 35129, Italy;
| | - David C. Rees
- Department of Paediatric Haematology, King’s College London, King’s College Hospital, Denmark Hill, London SE5 8RZ, UK;
| | - Matthew M. Heeney
- Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Boston, MA 02115, USA;
| | - Carolyn C. Hoppe
- UCSF Benioff Children’s Hospital Oakland, Oakland, CA 94609, USA;
| | - Bernhards Ogutu
- U.S. Army Medical Research Unit-Kenya, Centre for Clinical Research, Kenya Medical Research Institute, Kisumu 00200, Kenya;
| | - Hoda M. Hassab
- Pediatric Department and Clinical Research Center, Faculty of Medicine, Alexandria University, Alexandria 21500, Egypt;
| | - Chunmei Zhou
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (C.Z.); (S.Y.); (P.B.B.); (L.E.H.); (J.A.J.)
| | - Suqin Yao
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (C.Z.); (S.Y.); (P.B.B.); (L.E.H.); (J.A.J.)
| | - Patricia B. Brown
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (C.Z.); (S.Y.); (P.B.B.); (L.E.H.); (J.A.J.)
| | - Lori E. Heath
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (C.Z.); (S.Y.); (P.B.B.); (L.E.H.); (J.A.J.)
| | - Joseph A. Jakubowski
- Eli Lilly and Company, Indianapolis, IN 46285, USA; (C.Z.); (S.Y.); (P.B.B.); (L.E.H.); (J.A.J.)
| | - Miguel R. Abboud
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut 11-0236, Lebanon;
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Laurentino MR, Parente Filho SLA, Parente LLC, da Silva Júnior GB, Daher EDF, Lemes RPG. Non-invasive urinary biomarkers of renal function in sickle cell disease: an overview. Ann Hematol 2019; 98:2653-2660. [PMID: 31641850 DOI: 10.1007/s00277-019-03813-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 09/26/2019] [Indexed: 12/27/2022]
Abstract
Sickle cell disease (SCD) is a hereditary condition characterized by homozygosis of the hemoglobin S (HbS) gene. Marked morbimortality is observed due to chronic hemolysis, endothelial injury, and episodes of vaso-occlusion, which leads to multi-organ damage. Renal impairment is common and may have different presentations, such as deficiency in urinary acidification or concentration, glomerulopathies, proteinuria, and hematuria, frequently resulting in end-stage renal disease (ESRD). Novel biomarkers of renal function, such as kidney injury molecule 1 (KIM-1), and neutrophil gelatinase-associated lipocalin (NGAL) and monocyte chemoattractant protein 1 (MCP-1) are being studied in order to enable early diagnosis of kidney damage in SCD.
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Affiliation(s)
- Marília Rocha Laurentino
- Post-Graduation Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Ceara, Capitão Francisco Pedro, Street, n.1210 - Rodolfo Teófilo, Fortaleza, Ceara, CEP 60430-370, Brazil.
| | - Sérgio Luiz Arruda Parente Filho
- Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | | | - Geraldo Bezerra da Silva Júnior
- Public Health Post-Graduation Program, School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceara, Brazil
| | - Elizabeth De Francesco Daher
- Medical Sciences Post-Graduation Program, Department of Internal Medicine, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Romélia Pinheiro Gonçalves Lemes
- Post-Graduation Program in Pharmaceutical Sciences, School of Pharmacy, Federal University of Ceara, Capitão Francisco Pedro, Street, n.1210 - Rodolfo Teófilo, Fortaleza, Ceara, CEP 60430-370, Brazil
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Stotesbury H, Kawadler JM, Hales PW, Saunders DE, Clark CA, Kirkham FJ. Vascular Instability and Neurological Morbidity in Sickle Cell Disease: An Integrative Framework. Front Neurol 2019; 10:871. [PMID: 31474929 PMCID: PMC6705232 DOI: 10.3389/fneur.2019.00871] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/26/2019] [Indexed: 12/20/2022] Open
Abstract
It is well-established that patients with sickle cell disease (SCD) are at substantial risk of neurological complications, including overt and silent stroke, microstructural injury, and cognitive difficulties. Yet the underlying mechanisms remain poorly understood, partly because findings have largely been considered in isolation. Here, we review mechanistic pathways for which there is accumulating evidence and propose an integrative systems-biology framework for understanding neurological risk. Drawing upon work from other vascular beds in SCD, as well as the wider stroke literature, we propose that macro-circulatory hyper-perfusion, regions of relative micro-circulatory hypo-perfusion, and an exhaustion of cerebral reserve mechanisms, together lead to a state of cerebral vascular instability. We suggest that in this state, tissue oxygen supply is fragile and easily perturbed by changes in clinical condition, with the potential for stroke and/or microstructural injury if metabolic demand exceeds tissue oxygenation. This framework brings together recent developments in the field, highlights outstanding questions, and offers a first step toward a linking pathophysiological explanation of neurological risk that may help inform future screening and treatment strategies.
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Affiliation(s)
- Hanne Stotesbury
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Jamie M Kawadler
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Patrick W Hales
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Dawn E Saunders
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom.,Department of Radiology, Great Ormond Hospital, London, United Kingdom
| | - Christopher A Clark
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom
| | - Fenella J Kirkham
- Developmental Neurosciences, UCL Great Ormond Institute of Child Health, London, United Kingdom.,Clinical and Experimental Sciences, University of Southampton, Southampton, United Kingdom.,Department of Child Health, University Hospital Southampton, Southampton, United Kingdom.,Department of Paediatric Neurology, Kings College Hospital NHS Foundation Trust, London, United Kingdom
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Hammoudi N, Lionnet F, Redheuil A, Montalescot G. Cardiovascular manifestations of sickle cell disease. Eur Heart J 2019; 41:1365-1373. [DOI: 10.1093/eurheartj/ehz217] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023] Open
Abstract
Abstract
Sickle cell disease (SCD) is the most frequent genetic haemoglobinopathy worldwide. Early childhood mortality has dramatically decreased in high-income countries, and most patients now survive beyond the 5th decade. However, in the aging SCD population, the morbidity related to chronic organ damage, especially kidney and heart, has become a major concern. While pulmonary hypertension has attracted most attention, it appears that this condition is frequently linked to left heart failure (HF). Accordingly, SCD-associated cardiomyopathy is emerging as a major cause of reduced quality of life and early mortality in these patients. The diagnosis of this particular phenotype of high-output HF is challenging. Exercise intolerance and dyspnoea in SCD patients are linked to multiple causes including chronic anaemia. Moreover, echocardiographic features are unusual and can be misinterpreted. The classical diagnosis algorithm for HF is generally not suitable in SCD patients, and HF is poorly recognized and mostly diagnosed at a late congestive stage in routine practice. Such patients need to be identified at an earlier stage of myocardial dysfunction via improved phenotyping. This constitutes the first step towards further investigations in SCD needed to improve the prognosis and the quality of life. This article provides an updated review of the recent advances in the pathophysiology and diagnosis, and in addition, perspectives of new therapeutic approaches in SCD-related cardiac manifestations.
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Affiliation(s)
- Nadjib Hammoudi
- Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group and Department of Cardiology, Institute of Cardiology (AP-HP), Hôpital Pitié- Salpêtrière, Boulevard de l'hôpital, Paris F-75013, France
| | - François Lionnet
- Sorbonne Université, Department of Internal Medicine, centre de référence de la drépanocytose (AP-HP), Centre Hospitalier Universitaire Tenon, rue de la Chine, 75020 Paris, France
| | - Alban Redheuil
- Department of Cardiovascular Imaging, Interventional and Thoracic Radiology (DICVRIT), Hôpital Pitié- Salpêtrière, Boulevard de l'hôpital, Sorbonne Université, Inserm, CNRS 7371, Laboratoire d'Imagerie Biomédicale, Institute of Cardiometabolism and Nutrition (ICAN), Institute of Cardiology (AP-HP), Paris F-75013, France
| | - Gilles Montalescot
- Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group and Department of Cardiology, Institute of Cardiology (AP-HP), Hôpital Pitié- Salpêtrière, Boulevard de l'hôpital, Paris F-75013, France
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45
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Nugent WH, Jubin R, Buontempo PJ, Kazo F, Song BK. Microvascular and systemic responses to novel PEGylated carboxyhaemoglobin-based oxygen carrier in a rat model of vaso-occlusive crisis. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:95-103. [DOI: 10.1080/21691401.2018.1543197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Ronald Jubin
- Prolong Pharmaceuticals, South Plainfield, NJ, USA
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ElAlfy MS, Ebeid FSE, Kamal TM, Eissa DS, Ismail EAR, Mohamed SH. Angiotensinogen M235T Gene Polymorphism is a Genetic Determinant of Cerebrovascular and Cardiopulmonary Morbidity in Adolescents with Sickle Cell Disease. J Stroke Cerebrovasc Dis 2019; 28:441-449. [PMID: 30409744 DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/09/2018] [Accepted: 10/13/2018] [Indexed: 01/19/2023] Open
Affiliation(s)
- Mohsen Saleh ElAlfy
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | | | - Tarek Mostafa Kamal
- Medical Genetics Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
| | - Deena Samir Eissa
- Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
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47
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Babiker AO, Kaddam LA. Risk factors of metabolic syndrome among adult Sudanese sickle cell anemia patients. BMC HEMATOLOGY 2018; 18:38. [PMID: 30603087 PMCID: PMC6307197 DOI: 10.1186/s12878-018-0110-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/25/2018] [Indexed: 11/12/2022]
Abstract
BACKGROUND Sickle cell disease is a hereditary disorder characterized by haematological anaemia. Several studies assumed that adult sickle patients might develop metabolic syndrome features as hyperglycaemia, hypertension and dyslipidaemia. The aim of this study was to evaluate the metabolic syndrome risk factors among adult Sudanese with sickle cell anemia in the steady state. METHODS A prospective cross sectional study design was conducted among thirty adult patients with sickle cell anemia Hb SS (mean age 23 ± 6.1 years) and thirty healthy individuals matched for age and gender. Waist and hip circumferences were measured by simple tape. Venous blood sample were analysed to detect blood glucose level, uric acid, total cholesterol, triglycerides, low and high-density lipoprotein after 8 h overnight fasting by spectrophotometer. Blood pressure was measured by sphygmomanometer. National Cholesterol Education Program-Adult Treatment Panel III was utilised to define metabolic syndrome. Statistical analysis was performed SPSS software version 23. Continuous data were expressed using mean ± SD. P-value of < 0.05 (two-tailed) was used to establish statistical significance. Unpaired independent T- test was used. RESULTS No significant difference in mean systolic blood pressure in patients group compared to control (P value = 0.3). Mean value of diastolic blood pressure was significantly low in patients group compared to control (65.4 ± 10. 4 VS72.33 ± 8.27 mmHg, P value< 0.001). Fasting triglycerides level was comparable between patients group and control (P value = 0.56). While high-density lipoprotein was significantly lower in sicklers compared to control (30.2 ± 8.2 mg/dL vs 44.71 ± 1.85 mg/dL, P value< 0.001). Fasting blood glucose was significantly low in sickle compared to control (92.6 ± 13 mg/dL vs 106.83 ± 25.11 mg/dL P value< 0.001). Uric acid level was not statistically differed in patients group compared to control (p value = 0.5). CONCLUSION There was significant decrease in fasting High-density lipoprotein, diastolic blood pressure, mean arterial pressure and fasting blood glucose among SCA patients compared to control. There was no significant difference in waist circumference, systolic blood pressure, fasting triglycerides and uric acid levels between patients and control groups.
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Affiliation(s)
- Awab Omer Babiker
- Department of Physiology, Faculty of Medicine, Alneelain University, P.O. Box: 11121, 12702 Khartoum, Sudan
| | - Lamis AbdelGadir Kaddam
- Department of Physiology, Faculty of Medicine, Alneelain University, P.O. Box: 11121, 12702 Khartoum, Sudan
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Makani J, Tluway F, Makubi A, Soka D, Nkya S, Sangeda R, Mgaya J, Rwezaula S, Kirkham FJ, Kindole C, Osati E, Meda E, Snow RW, Newton CR, Roberts D, Aboud M, Thein SL, Cox SE, Luzzatto L, Mmbando BP. A ten year review of the sickle cell program in Muhimbili National Hospital, Tanzania. BMC HEMATOLOGY 2018; 18:33. [PMID: 30459954 PMCID: PMC6236876 DOI: 10.1186/s12878-018-0125-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 10/16/2018] [Indexed: 11/10/2022]
Abstract
Background Africa has the highest burden of Sickle cell disease (SCD) but there are few large, systematic studies providing reliable descriptions of the disease spectrum. Tanzania, with 11,000 SCD births annually, established the Muhimbili Sickle Cell program aiming to improve understanding of SCD in Africa. We report the profile of SCD seen in the first 10 years at Muhimbili National Hospital (MNH). Methods Individuals seen at MNH known or suspected to have SCD were enrolled at clinic and laboratory testing for SCD, haematological and biochemical analyses done. Ethnicity was self-reported. Clinical and laboratory features of SCD were documented. Comparison was made with non-SCD population as well as within 3 different age groups (< 5, 5–17 and ≥ 18 years) within the SCD population. Results From 2004 to 2013, 6397 individuals, 3751 (58.6%) SCD patients, were enrolled, the majority (47.4%) in age group 5–17 years. There was variation in the geographical distribution of SCD. Individuals with SCD compared to non-SCD, had significantly lower blood pressure and peripheral oxygen saturation (SpO2). SCD patients had higher prevalence of severe anemia, jaundice and desaturation (SpO2 < 95%) as well as higher levels of reticulocytes, white blood cells, platelets and fetal hemoglobin. The main causes of hospitalization for SCD within a 12-month period preceding enrolment were pain (adults), and fever and severe anemia (children). When clinical and laboratory features were compared in SCD within 3 age groups, there was a progressive decrease in the prevalence of splenic enlargement and an increase in prevalence of jaundice. Furthermore, there were significant differences with monotonic trends across age groups in SpO2, hematological and biochemical parameters. Conclusion This report confirms that the wide spectrum of clinical expression of SCD observed elsewhere is also present in Tanzania, with non-uniform geographical distribution across the country. Age-specific analysis is consistent with different disease-patterns across the lifespan.
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Affiliation(s)
- Julie Makani
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,2University of Oxford, Oxford, UK.,3Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Furahini Tluway
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Abel Makubi
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Deogratius Soka
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Siana Nkya
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,4Dar-es-Salaam University College of Education, Dar-es-Salaam, Tanzania
| | - Raphael Sangeda
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Josephine Mgaya
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Stella Rwezaula
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,3Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | | | - Christina Kindole
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,3Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Elisha Osati
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,3Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Elineema Meda
- 3Muhimbili National Hospital, Dar-es-Salaam, Tanzania
| | - Robert W Snow
- 2University of Oxford, Oxford, UK.,6Centre for Geographic Medicine Research, Kenya Medical Research Institute, Kilifi, Kenya
| | - Charles R Newton
- 2University of Oxford, Oxford, UK.,6Centre for Geographic Medicine Research, Kenya Medical Research Institute, Kilifi, Kenya
| | | | - Muhsin Aboud
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | | | - Sharon E Cox
- 8London School of Hygiene & Tropical Medicine, London, UK
| | - Lucio Luzzatto
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania
| | - Bruno P Mmbando
- 1Muhimbili University of Health and Allied Sciences, Dar-es-Salaam, Tanzania.,National Institute for Medical Research Tanga Centre, Tanga, Tanzania
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49
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How I treat the older adult with sickle cell disease. Blood 2018; 132:1750-1760. [PMID: 30206116 DOI: 10.1182/blood-2018-03-818161] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/21/2018] [Indexed: 12/31/2022] Open
Abstract
With increasing survival, cumulative complications of sickle cell disease (SCD), which develop insidiously over time, are becoming more apparent and common in older patients, particularly those in their fifth decade and beyond. The older patient is also more likely to develop other age-related nonsickle conditions that interact and add to the disease morbidity. A common misconception is that any symptom in a SCD patient is attributable to their SCD and this may lead to delays in diagnosis and appropriate intervention. We recommend regular comprehensive reviews and monitoring for early signs of organ damage and a low threshold for the use of hydroxyurea and blood transfusions as preventative measures for end-organ disease. Treatable comorbidities and acute deterioration should be managed aggressively. Although the primary goal in management of the older adult with SCD is improving anemia and minimizing organ damage, the time has come for us to be more proactive in considering curative therapies previously offered to the younger patient. Curative or experimental interventions should be discussed early, before complications render the patients ineligible for these treatments.
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50
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Hulbert ML, Shenoy S. Hematopoietic stem cell transplantation for sickle cell disease: Progress and challenges. Pediatr Blood Cancer 2018; 65:e27263. [PMID: 29797658 DOI: 10.1002/pbc.27263] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/04/2018] [Accepted: 05/07/2018] [Indexed: 02/06/2023]
Abstract
Sickle cell disease (SCD) presents challenges to hematopoietic stem cell transplantation (HSCT), including donor availability and morbidity with age/disease severity. However, severe SCD causes irreversible organ damage that HSCT can mitigate. This benefit must be balanced against preparative regimen toxicity, graft-versus-host disease, and mortality risk. We review efforts to balance HSCT complications with the promise of cure, and knowledge gaps that warrant further investigation. We highlight the burden of SCD, HSCT risks and benefits, and SCD families' approach to this balance. We emphasize the necessity for information exchange to ensure a joint decision-making process between providers and patients.
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Affiliation(s)
- Monica L Hulbert
- Division of Pediatric Hematology/Oncology, Washington University in St. Louis, St. Louis, Missouri
| | - Shalini Shenoy
- Division of Pediatric Hematology/Oncology, Washington University in St. Louis, St. Louis, Missouri
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