1
|
Ramadas N, Lowder K, Dutton J, Trebak F, Faes C, Griffin JH, Pawlinski R, Mosnier LO, Sparkenbaugh E. Biased agonism of protease-activated receptor-1 regulates thromboinflammation in murine sickle cell disease. Blood Adv 2024; 8:3272-3283. [PMID: 38640339 PMCID: PMC11226968 DOI: 10.1182/bloodadvances.2023011907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024] Open
Abstract
ABSTRACT Sickle cell disease (SCD) is a hereditary hemoglobinopathy marked by hemolytic anemia and vaso-occlusive events (VOEs). Chronic endothelial activation, inflammation, and coagulation activation contribute to vascular congestion, VOEs, and end-organ damage. Coagulation proteases such as thrombin and activated protein C (APC) modulate inflammation and endothelial dysfunction by activating protease-activated receptor 1 (PAR1), a G-protein-coupled receptor. Thrombin cleaves PAR1 at Arg41, while APC cleaves PAR1 at Arg46, initiating either proinflammatory or cytoprotective signaling, respectively, a signaling conundrum known as biased agonism. Our prior research established the role of thrombin and PAR1 in vascular stasis in an SCD mouse model. However, the role of APC and APC-biased PAR1 signaling in thrombin generation, inflammation, and endothelial activation in SCD remains unexplored. Inhibition of APC in SCD mice increased thrombin generation, inflammation, and endothelial activation during both steady state and tumor necrosis factor α challenge. To dissect the individual contributions of thrombin-PAR1 and APC-PAR1 signaling, we used transgenic mice with point mutations at 2 PAR1 cleavage sites, ArgR41Gln (R41Q) imparting insensitivity to thrombin and Arg46Gln (R46Q) imparting insensitivity to APC. Sickle bone marrow chimeras expressing PAR1-R41Q exhibited reduced thrombo-inflammatory responses compared with wild type PAR1 or PAR1-R46Q mice. These findings highlight the potential benefit of reducing thrombin-dependent PAR1 activation while preserving APC-PAR1 signaling in SCD thromboinflammation. These results also suggest that pharmacological strategies promoting biased PAR1 signaling could effectively mitigate vascular complications associated with SCD.
Collapse
Affiliation(s)
- Nirupama Ramadas
- Division of Hematology, Department of Medicine, Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kailyn Lowder
- Division of Hematology, Department of Medicine, Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Joshua Dutton
- Division of Hematology, Department of Medicine, Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Fatima Trebak
- Division of Hematology, Department of Medicine, Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Camille Faes
- Division of Hematology, Department of Medicine, Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John H. Griffin
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA
| | - Rafal Pawlinski
- Division of Hematology, Department of Medicine, Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laurent O. Mosnier
- Department of Molecular Medicine, The Scripps Research Institute, La Jolla, CA
| | - Erica Sparkenbaugh
- Division of Hematology, Department of Medicine, Blood Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|
2
|
Agarwal S, Foster KL, Anum SJ, Shapiro MC, Han H, Scheurer ME, Airewele G, Sartain SE. Hospital acquired venous thromboembolism in children with sickle cell disease. Pediatr Hematol Oncol 2024:1-11. [PMID: 38836515 DOI: 10.1080/08880018.2024.2362147] [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: 10/06/2023] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
Sickle cell disease (SCD) is well recognized as a hypercoagulablestate, however, it remains unclear whether a subgroup of children with SCD at higher risk of venous thromboembolic event (VTE) during hospitalization may benefit from thromboprophylaxis. Our objectives were to describe the clinical characteristics, outcomes and recurrence of hospital acquired VTE in patients with SCD younger than 21 years. This was a single center retrospective study. Data regarding demographics, reason for admission, location of VTE, risk factors like central venous catheter (CVC), intensive care unit (ICU) admission among others were extracted from electronic medical records over a 10-year study period (2011-2021). Recurrence of VTE at 1 and 5 years was assessed. Descriptive statistics were used as indicated. We identified a total of 20 VTE events over the 10-year study period. Six of these events occurred in those younger than 12 years of age. Fourteen (70%) VTE events occurred in the HbSS or HbSβThal0 genotypes compared to 6 (30%) in HbSC. Most common VTE was isolated pulmonary embolism (PE) (n = 10, 50%). VTE were most often associated with acute chest syndrome (ACS) (n = 14, 70%), ICU admissions (n = 10, 50%) and CVC (n = 5/9, 55%). One patient died from the VTE event. One patient with additional underlying risk factors had a recurrent VTE at 13 months. Our study suggests that ICU admission, ACS and presence of CVC increases the risk of VTE in children and young adults with SCD, but larger studies are indicated to validate our findings.
Collapse
Affiliation(s)
- Shreya Agarwal
- Department of Pediatrics, Division of Hematology, University of California, San Francisco, California, USA
| | - Kayla L Foster
- Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Houston, Texas, USA
| | - Shaniqua J Anum
- Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Houston, Texas, USA
| | - Mary C Shapiro
- Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Houston, Texas, USA
| | - HyoJeong Han
- Department of Pediatrics, Division of Hematology-Oncology, Children's National Medical Center, Washington, District Columbia, USA
| | - Michael E Scheurer
- Texas Children's Cancer and Hematology Center, Houston, Texas, USA
- Center for Epidemiology and Population Health, Baylor College of Medicine, Houston, Texas, USA
| | - Gladstone Airewele
- Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Houston, Texas, USA
| | - Sarah E Sartain
- Department of Pediatrics, Division of Hematology-Oncology, Baylor College of Medicine, Houston, Texas, USA
- Texas Children's Cancer and Hematology Center, Houston, Texas, USA
| |
Collapse
|
3
|
Bathla T, Lotfollahzadeh S, Quisel M, Mehta M, Malikova M, Chitalia VC. End Organ Affection in Sickle Cell Disease. Cells 2024; 13:934. [PMID: 38891066 PMCID: PMC11174153 DOI: 10.3390/cells13110934] [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: 01/23/2024] [Revised: 05/21/2024] [Accepted: 05/24/2024] [Indexed: 06/20/2024] Open
Abstract
Sickle cell disease is an orphan disease affecting ethnic minorities and characterized by profound systemic manifestations. Although around 100,000 individuals with SCD are living in the US, the exact number of individuals is unknown, and it is considered an orphan disease. This single-gene disorder leads to red blood cell sickling and the deoxygenation of hemoglobin, resulting in hemolysis. SCD is associated with acute complications such as vaso-occlusive crisis, infections, and chronic target organ complications such as pulmonary disease and renal failure. While genetic therapy holds promise to alter the fundamental disease process, the major challenge in the field remains the target end organ damage and ways to mitigate or reverse it. Here, we provide an overview of the clinical manifestations and pathogenesis with a focus on end-organ damage and current therapeutic options, including recent FDA-approved stem cell and gene editing therapies.
Collapse
Affiliation(s)
- Tanvi Bathla
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (T.B.); (S.L.); (M.Q.)
| | - Saran Lotfollahzadeh
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (T.B.); (S.L.); (M.Q.)
| | - Matthew Quisel
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (T.B.); (S.L.); (M.Q.)
| | - Mansi Mehta
- Saint Vincent’s Medical Hospital, Worcester, MA 01608, USA;
| | - Marina Malikova
- Department of Surgery, Boston University School of Medicine, Boston, MA 02118, USA;
| | - Vipul C. Chitalia
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA; (T.B.); (S.L.); (M.Q.)
- Veterans Affairs Boston Healthcare System, Boston, MA 02118, USA
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
- Center of Cross-Organ Vascular Pathology, Department of Medicine, Boston University Medical Center, Evans Biomedical Research Center, X-530, Boston, MA 02118, USA
| |
Collapse
|
4
|
Agarwal S, Stanek JR, Vesely SK, Creary SE, Cronin RM, Roe AH, O’Brien SH. Pregnancy-related thromboembolism in women with sickle cell disease: An analysis of National Medicaid Data. Am J Hematol 2023; 98:1677-1684. [PMID: 37551881 PMCID: PMC10592294 DOI: 10.1002/ajh.27045] [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: 04/19/2023] [Revised: 07/05/2023] [Accepted: 07/16/2023] [Indexed: 08/09/2023]
Abstract
Pregnancy and sickle cell disease (SCD) both individually carry a risk of thromboembolism (TE). Pregnancy in people with SCD may further enhance the prothrombotic effect of the underlying disease. The objectives of this study were to determine the rate and risk factors for arterial and venous thrombosis in pregnant people with SCD. Administrative claims data from the United States Centers for Medicare and Medicaid Service Analytic eXtract from 2006 to 2018 were used. The study population included people with SCD from the start of their first identified pregnancy until 1 year postpartum and a control cohort of pregnant people without SCD of similar age and race. Outcomes of interest were identified with ICD-9 or 10 codes. Logistic regression analyses were used to analyze risk factors. We identified infant deliveries in 6388 unique people with SCD and 17 110 controls. A total of 720 venous thromboembolism (11.3%) and 335 arterial TE (5.2%) were observed in people with SCD compared to 202 (1.2%) and 95 (0.6%) in controls. People with SCD had an 8-11 times higher odds of TE compared to controls (p < .001). Within the SCD cohort, age, hemoglobin SS (HbSS) genotype, hypertension, and history of thrombosis were identified as independent risk factors for pregnancy-related TE. Pregnancy-specific factors (pre-eclampsia, eclampsia, multigestational pregnancy) were not associated with TE. In conclusion, the risk of pregnancy-related TE is considerably higher in people with SCD compared with controls without SCD. Hence, people with SCD, particularly those with multiple risk factors may be candidates for thromboprophylaxis during pregnancy and the postpartum period.
Collapse
Affiliation(s)
- Shreya Agarwal
- Division of Hematology/Oncology/BMT, Nationwide Children’s Hospital, Columbus, OH
| | - Joseph R Stanek
- Division of Hematology/Oncology/BMT, Nationwide Children’s Hospital, Columbus, OH
- Biostatistics Resource at Nationwide Children’s Hospital, Columbus, OH
| | - Sara K. Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma, Oklahoma City, OK
| | - Susan E. Creary
- Division of Hematology/Oncology/BMT, Nationwide Children’s Hospital, Columbus, OH
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| | - Robert M Cronin
- Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH
| | - Andrea H. Roe
- Department of Obstetrics and Gynecology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Sarah H. O’Brien
- Division of Hematology/Oncology/BMT, Nationwide Children’s Hospital, Columbus, OH
- Center for Child Health Equity and Outcomes Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH
| |
Collapse
|
5
|
Ramadas N, Sparkenbaugh EM. The APC-EPCR-PAR1 axis in sickle cell disease. Front Med (Lausanne) 2023; 10:1141020. [PMID: 37497271 PMCID: PMC10366386 DOI: 10.3389/fmed.2023.1141020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Sickle Cell Disease (SCD) is a group of inherited hemoglobinopathies. Sickle cell anemia (SCA) is caused by a homozygous mutation in the β-globin generating sickle hemoglobin (HbS). Deoxygenation leads to pathologic polymerization of HbS and sickling of erythrocytes. The two predominant pathologies of SCD are hemolytic anemia and vaso-occlusive episodes (VOE), along with sequelae of complications including acute chest syndrome, hepatopathy, nephropathy, pulmonary hypertension, venous thromboembolism, and stroke. SCD is associated with endothelial activation due to the release of danger-associated molecular patterns (DAMPs) such as heme, recurrent ischemia-reperfusion injury, and chronic thrombin generation and inflammation. Endothelial cell activation is mediated, in part, by thrombin-dependent activation of protease-activated receptor 1 (PAR1), a G protein coupled receptor that plays a role in platelet activation, endothelial permeability, inflammation, and cytotoxicity. PAR1 can also be activated by activated protein C (APC), which promotes endothelial barrier protection and cytoprotective signaling. Notably, the APC system is dysregulated in SCD. This mini-review will discuss activation of PAR1 by APC and thrombin, the APC-EPCR-PAR1 axis, and their potential roles in SCD.
Collapse
Affiliation(s)
- Nirupama Ramadas
- Department of Medicine, Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Erica M. Sparkenbaugh
- Department of Medicine, Blood Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
6
|
Fordjour FA, Kwarteng A, Paintsil V, Amanor E, Ackah EB, Amuzu EX, Sackey DS, Akoto AOY. Hemolysis scavenger proteins and renal function marker in children with sickle cell disease at steady state: A cross-sectional study. Health Sci Rep 2023; 6:e1177. [PMID: 37008811 PMCID: PMC10062495 DOI: 10.1002/hsr2.1177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 03/08/2023] [Accepted: 03/13/2023] [Indexed: 04/04/2023] Open
Abstract
Background and Aims Hemolysis is a fundamental feature of sickle cell disease (SCD) contributing to the vaso-occlusive crisis of patients. The objectives of the study were to assess the link between hemolysis proteins and hematological parameters, and to validate cystatin C (CYS C) as a potent renal marker in diagnoising SCD. Method Here, a cross-sectional study carried out at the pediatric SCD clinic of the Komfo Anokye Teaching Hospital comprised 90 SCD children (HbSC, HbSF, and HbSS). ANOVA, t-test, and Spearman's rank correlation analysis were done. Elevated proteins levels were compared to standard values; alpha-1 microglobulin (A1M) (1.8-65 µg/L), CYS C (0.1-4.5 µmol/L), and haemopexin (HPX) (500-1500 µg/mL). Results The mean (standard deviation) age of participants was 9.830 (±0.3217) years, and 46% of them were males. From simple descriptive analysis, we observed that all but one patient had their HPX level below the reference range (<500 µg/mL). Here, A1M levels were shown to be within the appropriate reference range for all the patients except few patients. CYS C levels were also all within the required reference values. A Spearman's rank correlation test between full blood count and HPX generally suggested a weak but positive correlation; RBC (coef. = 0.2448; p = 0.0248), HGB (coef. = 0.2310; p = 0.030), hematocrit (coef. = 0.2509; p = 0.020), and platelet (coef. = 0.1545; p = 0.160). Mean corpuscular volume (coef. = -0.5645; p = 0.610) had a stronger but negative correlation with HPX. This study depicts a positive and stronger association between CYS C and HPX levels (coef. = 0.9996; p < 0.0001), validating the use of CYS C as a useful marker of renal function in persons with SCDs. Conclusion In the present study, we show that A1M levels were normal for most of the patients, hence CYS C levels are not alarming in this study. Further, there exists a correlation between hemolysis scavenger proteins and hematological parameters.
Collapse
Affiliation(s)
- Fatima A. Fordjour
- Department of MicrobiologyUniversity for Development StudiesTamaleGhana
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Alexander Kwarteng
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
- Kumasi Centre for Collaborative Research in Tropical MedicineKumasiGhana
| | - Vivian Paintsil
- Child Health DirectorateKomfo Anokye Teaching HospitalKumasiGhana
- College of Health SciencesKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ernest Amanor
- Department of Biochemistry and Biotechnology, College of ScienceKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Ezekiel B. Ackah
- School of Public HealthKwame Nkrumah University of Science and TechnologyKumasiGhana
| | - Evans X. Amuzu
- Child Health DirectorateKomfo Anokye Teaching HospitalKumasiGhana
| | | | | |
Collapse
|
7
|
Ebouat KMEV, Konate Z, Coulibaly ZM, Djodjo M, Botti K, Yapo-Etté H. A case of autopsy discovery of acute chest syndrome triggered by pulmonary embolism in a sickle cell patient. Forensic Sci Med Pathol 2022; 18:251-255. [PMID: 35503496 DOI: 10.1007/s12024-022-00480-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 12/14/2022]
Abstract
This is a case report about a 7-year-old male child with sickle cell anemia (S/β+) who died unexpectedly during hospitalization, justifying the performance of a forensic autopsy completed by histological examination of organ fragments and toxicological analyses of biological fluids. The diagnosis retained was pulmonary thromboembolism as the cause of death occurring in the context of an acute chest syndrome (ACS). The mechanism of occurrence of this pulmonary embolism was vascular stasis caused by sickle cell disease. The search for etiologies of ACS complicating sickle cell disease should not exclude pulmonary embolism with red cell dense fibrin clot..
Collapse
Affiliation(s)
- Kouadio Marc-Eric Victor Ebouat
- Department of Public Health and Related Specialties - Faculty of Health - University Alassane Ouattara of Bouaké, 01 BP v 18, Bouaké, Côte d'Ivoire.
| | - Zana Konate
- Department of Public Health and Related Specialties - Faculty of Health - University Alassane Ouattara of Bouaké, 01 BP v 18, Bouaké, Côte d'Ivoire
| | - Zié Moussa Coulibaly
- Faculty of Health - University Alassane Ouattara of Bouake, 01 BP V3, Abidjan, Côte d'Ivoire
| | - Mathurin Djodjo
- Department of Public Health - Faculty of Health, University Félix Houphouët-Boigny of Abidjan, 11 BP 268, Abidjan, Côte d'Ivoire
| | - Koffi Botti
- Department of Public Health - Faculty of Health, University Félix Houphouët-Boigny of Abidjan, 11 BP 268, Abidjan, Côte d'Ivoire
| | - Hélène Yapo-Etté
- Department of Public Health - Faculty of Health, University Félix Houphouët-Boigny of Abidjan, 11 BP 268, Abidjan, Côte d'Ivoire
| |
Collapse
|
8
|
Ilonze C, Anderson M, Stubblefield A, Journeycake J, Sinha AA. Use of infusion ports in patients with sickle cell disease: Indications and complications. Pediatr Blood Cancer 2022; 69:e29445. [PMID: 34786823 DOI: 10.1002/pbc.29445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/27/2021] [Accepted: 10/15/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Peripheral venous access in patients with sickle cell disease (SCD) can become difficult over time due to frequent access and scarring. Infusion ports provide reliable central venous access. Deep venous thrombosis (DVT) and infections are complications associated with SCD and infusion ports. METHODS We performed a 17.5-year single-institution retrospective chart review (January 2000 to July 2018) with literature review regarding use of infusion ports in patients with SCD. RESULTS We identified 32 patients with infusion ports placed for a total of 63 devices (48 for chronic transfusion [CT] and 15 for poor venous access [PVA], not on CT) for a total of 99,272 catheter days. The mean age at first insertion was 8 years (range 1-20 years). Complications included malfunction, infection, thrombosis, difficult access, and pain over infusion port site. The rate of infection was 0.2 per 1000 catheter days. Thrombosis was identified in three devices (5%) in three patients (9%), with a rate of 0.03 per 1000 catheter days. There was no difference in complications by site in either the left or right subclavian vein (p = 1). The rate of premature removal was 0.36 per 1000 catheter days, which was higher among patients with infusion ports solely for PVA (0.87 per 1000 catheter days) compared with those placed for CT (0.29 per 1000 catheter days). CONCLUSION Infusion ports in patients with SCD was associated with low rates of thrombosis, infection, and malfunction, and may be considered as an alternative to frequent intravenous access, especially in patients requiring CT.
Collapse
Affiliation(s)
- Chibuzo Ilonze
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael Anderson
- Department of Epidemiology & Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Alex Stubblefield
- Department of Epidemiology & Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Economics, Michigan State University, East Lansing, Michigan, USA
| | - Janna Journeycake
- Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Arpan A Sinha
- Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| |
Collapse
|
9
|
Elsherif L, Scott LC, Wichlan D, Jones SK, Mathias JG, Shen JH, Smeltzer MP, Ataga KI. Hydroxyurea therapy decreases coagulation and endothelial activation in sickle cell disease: a Longitudinal Study. Br J Haematol 2021; 194:e71-e73. [PMID: 34231209 DOI: 10.1111/bjh.17650] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/18/2021] [Accepted: 05/27/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Laila Elsherif
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Lara C Scott
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - David Wichlan
- Division of Hematology, University of North Carolina, Chapel Hill, NC, USA
| | - Susan K Jones
- Division of Hematology, University of North Carolina, Chapel Hill, NC, USA.,Division of Hematologic Malignancies and Cellular Therapy, Duke University School of Medicine, Durham, NC, USA
| | - Joacy G Mathias
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Jessica H Shen
- Division of Hematology, University of North Carolina, Chapel Hill, NC, USA.,School of Dentistry, Temple University, Philadelphia, PA, USA
| | - Matthew P Smeltzer
- Division of Epidemiology, Biostatistics and Environmental Health, The University of Memphis, Memphis, TN, USA
| | - Kenneth I Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
10
|
Merashli M, Arcaro A, Graf M, Caruso M, Ames PRJ, Gentile F. Antiphospholipid Antibodies in Sickle Cell Disease: A Systematic Review and Exploratory Meta-Analysis. Clin Appl Thromb Hemost 2021; 27:10760296211002914. [PMID: 33784835 PMCID: PMC8020102 DOI: 10.1177/10760296211002914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
The relationship between antiphospholipid antibodies (aPL) and sickle cell
disease (SCD) has never been systematically addressed. Our aim was to evaluate
potential links between SCD and aPL in all age groups. EMBASE/PubMed was
screened from inception to May 2020 and Peto odds ratios for rare events were
calculated. The pooled prevalence (PP) of IgG anticardiolipin antibodies (aCL)
was higher in individuals with SCD than in controls (27.9% vs 8.7%,
P < 0.0001), that of IgM aCL was similar in the two
groups (2.9% vs 2.7%); only individuals with SCD were positive for lupus
anticoagulant (LA) (7.7% vs 0%, P < 0.0001). The PP of leg
ulcers was similar between aPL positive and negative individuals (44% vs 53%)
and between patients in acute crisis and stable patients (5.6% vs 7.3%).
Reporting of aPL as a binary outcome and not as a titer precluded further
interpretation. The results indicate that a prospective case-control study with
serial measurements of a panel of aPL in SCD patients might be warranted, in
order to understand further the possible pathogenic role of aPL in SCD.
Collapse
Affiliation(s)
- Mira Merashli
- Department of Internal Medicine, Division of Rheumatology, 11238American University of Beirut, Beirut, Lebanon
| | - Alessia Arcaro
- Department of Medicine & Health Sciences, 11238University of Molise, Campobasso, Italy
| | - Maria Graf
- Immunohaematology and Transfusion Medicine Unit, 165474Federico II University Hospital, Naples, Italy
| | - Matilde Caruso
- Transfusion Medicine Unit, 18523Cardarelli Hospital, Campobasso, Italy
| | - Paul R J Ames
- Immune Response & Vascular Disease Unit, 50106Nova University, Lisbon, Portugal.,Dumfries and Galloway Royal Infirmary, Dumfries, United Kingdom
| | - Fabrizio Gentile
- Department of Medicine & Health Sciences, 11238University of Molise, Campobasso, Italy
| |
Collapse
|
11
|
Gbotosho OT, Taylor M, Malik P. Cardiac pathophysiology in sickle cell disease. J Thromb Thrombolysis 2021; 52:248-259. [PMID: 33677791 DOI: 10.1007/s11239-021-02414-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Oluwabukola Temitope Gbotosho
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA
| | - Michael Taylor
- Division of Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA
| | - Punam Malik
- Division of Experimental Hematology and Cancer Biology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, OH, USA. .,Division of Hematology, Cancer and Blood Diseases Institute, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, 45229, USA.
| |
Collapse
|
12
|
Hopp MT, Imhof D. Linking Labile Heme with Thrombosis. J Clin Med 2021; 10:427. [PMID: 33499296 PMCID: PMC7865584 DOI: 10.3390/jcm10030427] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/14/2022] Open
Abstract
Thrombosis is one of the leading causes of death worldwide. As such, it also occurs as one of the major complications in hemolytic diseases, like hemolytic uremic syndrome, hemorrhage and sickle cell disease. Under these conditions, red blood cell lysis finally leads to the release of large amounts of labile heme into the vascular compartment. This, in turn, can trigger oxidative stress and proinflammatory reactions. Moreover, the heme-induced activation of the blood coagulation system was suggested as a mechanism for the initiation of thrombotic events under hemolytic conditions. Studies of heme infusion and subsequent thrombotic reactions support this assumption. Furthermore, several direct effects of heme on different cellular and protein components of the blood coagulation system were reported. However, these effects are controversially discussed or not yet fully understood. This review summarizes the existing reports on heme and its interference in coagulation processes, emphasizing the relevance of considering heme in the context of the treatment of thrombosis in patients with hemolytic disorders.
Collapse
Affiliation(s)
| | - Diana Imhof
- Pharmaceutical Biochemistry and Bioanalytics, University of Bonn, An der Immenburg 4, 53121 Bonn, Germany;
| |
Collapse
|
13
|
Hopp MT, Alhanafi N, Paul George AA, Hamedani NS, Biswas A, Oldenburg J, Pötzsch B, Imhof D. Molecular Insights and Functional Consequences of the Interaction of Heme with Activated Protein C. Antioxid Redox Signal 2021; 34:32-48. [PMID: 32705892 DOI: 10.1089/ars.2019.7992] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Aims: In hemolysis, which is accompanied by increased levels of labile redox-active heme and is often associated with hemostatic abnormalities, a decreased activity of activated protein C (APC) is routinely detected. APC is a versatile enzyme that exerts its anticoagulant function through inactivation of clotting factors Va and VIIIa. APC has not been demonstrated to be affected by heme as described for other clotting factors and, thus, is a subject of investigation. Results: We report the interaction of heme with APC and its impact on the protein function by employing spectroscopic and physiologically relevant methods. Binding of heme to APC results in inhibition of its amidolytic and anticoagulant activity, increase of the peroxidase-like activity of heme, and protection of human umbilical vein endothelial cells from heme-induced hyperpermeability. To define the sites that are responsible for heme binding, we mapped the surface of APC for potential heme-binding motifs. T285GWGYHSSR293 and W387IHGHIRDK395, both located on the basic exosite, turned out as potential heme-binding sites. Molecular docking employing a homology model of full-length APC indicated Tyr289 and His391 as the Fe(III)-coordinating amino acids. Innovation: The results strongly suggest that hemolysis-derived heme may directly influence the protein C pathway through binding to APC, conceivably explaining the decreased activity of APC under hemolytic conditions. Further, these results extend our understanding of heme as a multifaceted effector molecule within coagulation and may allow for an improved understanding of disease development in hemostasis under hemolytic conditions. Conclusion: Our study identifies APC as a heme-binding protein and provides insights into the functional consequences.
Collapse
Affiliation(s)
- Marie-Thérèse Hopp
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, Bonn, Germany
| | - Nour Alhanafi
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, Bonn, Germany
| | - Ajay Abisheck Paul George
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, Bonn, Germany
| | - Nasim Shahidi Hamedani
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Arijit Biswas
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Johannes Oldenburg
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Bernd Pötzsch
- Institute of Experimental Hematology and Transfusion Medicine, University Hospital Bonn, Bonn, Germany
| | - Diana Imhof
- Pharmaceutical Biochemistry and Bioanalytics, Pharmaceutical Institute, University of Bonn, Bonn, Germany
| |
Collapse
|
14
|
Thrombin generation in children with sickle cell Anemia is Higher in the presence of platelets ⋆ and ⋆. Transfus Apher Sci 2020; 59:102852. [PMID: 32576489 DOI: 10.1016/j.transci.2020.102852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 03/31/2020] [Accepted: 06/03/2020] [Indexed: 11/19/2022]
Abstract
Cellular and plasma interactions underlie hypercoagulability in sickle cell anemia (SCA). In healthy adults, thrombin generation (TG), a biomarker of hypercoagulability, is similar in plasma with and without platelets. Studies investigating TG in SCA using platelet-poor plasma (PPP) show conflicting results. There are no studies in SCA simultaneously comparing TG using platelet rich plasma (PRP) and PPP. This prospective study compares TG in children with SCA, at steady state, in PPP versus PRP and investigates the association of predefined clinical variables with the difference between PRP and PPP. Our secondary aim was to investigate derangements in the protein C and S pathway measuring TG with and without thrombomodulin (TM). In forty-three paired samples from SCA patients, aged 2-15 years, TG in the presence of platelets was 5.9 % higher [1239 nmol/(min*L) (SD: 224.1) vs. 1151 nmol/(min*L) (SD 223.3); p = 0.026]. The difference was highest in the 6-10 year age group (9.5 %; SD 14.1) followed by the 2-5 year age group (5.4 %; SD 21.4). In a multiple linear regression model, age, gender, current use of hydroxyurea, degree of hemolysis and severity of pain crises were not predictive of the difference between PRP and PPP. In PPP, TG reduction after TM addition was 7.4 % (SD 16.8), signifying activated protein C resistance. In conclusion, TG in children with SCA aged 2-10 years is higher in the presence of platelets. TG using PRP along with TM addition may be a useful biomarker of hypercoagulability in this population.
Collapse
|
15
|
Antwi-Baffour S, Kyeremeh R, Annison L. Severity of Anaemia Has Corresponding Effects on Coagulation Parameters of Sickle Cell Disease Patients. Diseases 2019; 7:E59. [PMID: 31861183 PMCID: PMC6956179 DOI: 10.3390/diseases7040059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/18/2019] [Accepted: 10/18/2019] [Indexed: 12/25/2022] Open
Abstract
Sickle cell disease (SCD) is an inherited condition characterized by chronic haemolytic anaemia. SCD is associated with moderate to severe anaemia, hypercoagulable state and inconsistent platelet count and function. However, studies have yielded conflicting results with regards to the effect of anaemia on coagulation in SCD. The purpose of this study was to determine the effect of anaemia severity on selected coagulation parameters of SCD patients. Four millilitres of venous blood samples were taken from the participants (SCD and non-SCD patients) and used for analysis of full blood count and coagulation parameters. Data was analysed using SPSS version-16. From the results, it was seen that individuals with SCD had a prolonged mean PT, APTT and high platelet count compared to the controls. There was also significant difference in the mean PT (p = 0.039), APTT (p = 0.041) and platelet count (p = 0.010) in HbSS participants with severe anaemia. Mean APTT also showed significant difference (p = 0.044) with severe anaemia in HbSC participants. It can be concluded that SCD patients have prolonged PT, APTT and increased platelet count which might predispose them to bleeding episodes and thrombocytosis. Significant difference was also seen between severity of anaemia and mean PT, APTT and platelet count in HbSS individuals.
Collapse
Affiliation(s)
- Samuel Antwi-Baffour
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, University of Ghana, P.O. Box KB 143 Accra, Ghana;
| | - Ransford Kyeremeh
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, College of Health Sciences, University of Ghana, P.O. Box KB 143 Accra, Ghana;
| | - Lawrence Annison
- Department of Medical Laboratory Sciences, School of Allied Health Sciences, Narh-Bita College, P.O. Box Co1061 Tema, Ghana;
| |
Collapse
|
16
|
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To determine the impact of sickle cell anemia on perioperative outcomes and resource utilization in elective spinal fusion surgery. SUMMARY OF BACKGROUND DATA Sickle cell anemia has been identified as an important surgical risk factor in otolaryngology, cardiothoracic surgery, general surgery, and total joint arthroplasty. However, the impact of sickle cell anemia on elective spine surgery is unknown. METHODS Hospitalizations for elective spinal fusion surgery between the years of 2001-2014 from the US National Inpatient Sample were identified using ICD-9-CM codes and patients were grouped into those with and without sickle cell anemia. The main outcome measures were in-hospital neurological, respiratory, cardiac, gastrointestinal, renal and urinary, pulmonary embolism, and wound-related complications and mortality. Length of stay and inpatient costs were also collected. Multivariable logistic regressions were conducted to compare the in-hospital outcomes of patients undergoing elective spinal fusion with or without sickle cell anemia. RESULTS From a total of 4,542,719 patients undergoing elective spinal fusions from 2001 to 2014, 456 sickle cell disease patients were identified. Sickle cell anemia is a significant independent predictor for pulmonary embolism [odds ratio (OR)=7.37; confidence interval (CI), 4.27-12.71; P<0.001], respiratory complications (OR=2.36; CI, 1.63-3.42; P<0.001), wound complications (OR=3.84; CI, 2.72-5.44; P<0.001), and overall inpatient complications (OR=2.58; CI, 2.05-3.25; P<0.001). Sickle cell anemia patients also have significantly longer length of stay (7.0 vs. 3.8 d; P<0.001) and higher inpatient costs ($20,794 vs. $17,608 P<0.05). CONCLUSIONS Sickle cell anemia is associated with increased risk of perioperative complications and greater health care resource utilization. Sickle cell anemia patients undergoing spinal fusion surgeries should be counseled on these increased risks. Moreover, current strategies for perioperative management of sickle cell anemia patients undergoing spinal fusion surgery need to be improved.
Collapse
|
17
|
Christen JR, Bertolino J, Jean E, Camoin L, Ebbo M, Harlé JR, Schleinitz N, Sarlon G, Bernit E. Use of Direct Oral Anticoagulants in Patients with Sickle Cell Disease and Venous Thromboembolism: A Prospective Cohort Study of 12 Patients. Hemoglobin 2019; 43:296-299. [PMID: 31724442 DOI: 10.1080/03630269.2019.1689997] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Patients with sickle cell disease have an increased risk of venous thromboembolism (VTE) and with a mortality 2-fold higher. The anticoagulation of VTE in a young population is an important question. Indeed, hemorrhagic complications of anticoagulation may occur more frequently than in the general population. The use of a direct oral anticoagulant (DOAC) is not recommended for VTE in patients with sickle cell disease because those patients were not included in the clinical studies. We aimed to study the safety of using DOACs in a prospective cohort of patients with sickle cell disease and VTE. We prospectively followed the cohort of all sickle cell disease patients undergoing recent DOAC treatment for VTE at a sickle cell disease reference center. Twelve patients received rivaroxaban for VTE (eight women and four men). The median age was 27 years (20-45). The sickle cell disease variants included homozygous Hb SS (HBB: c.20A>T) in eight patients, Hb S-β+-thalassemia (Hb S-β+-thal) in two, Hb S-β0-thal in one and Hb S-Hb C (HBB: c.19G>A) in one. The cumulative duration of follow-up was 3134 days under rivaroxaban treatment. There were two thrombotic events, including a patient with a double positivity of antiphospholipid antibodies. No major bleeding was observed, and 6/12 patients presented minor bleeding (epistaxis: n = 4; anal fissure bleeding: n = 1; menorrhagia n = 4). Of these, 3/6 required their treatment to be switched to apixaban, which stopped the bleeding. Direct oral anticoagulants may be an alternative treatment for VTE in patients with sickle cell disease, except for an associated antiphospholipid syndrome.
Collapse
Affiliation(s)
| | - Julien Bertolino
- Department of Internal Medicine, La Timone Hospital, Marseille, France
| | - Estelle Jean
- Department of Internal Medicine, La Timone Hospital, Marseille, France
| | - Laurence Camoin
- Department of Hematology, La Timone Hospital, Marseille, France
| | - Mikael Ebbo
- Department of Internal Medicine, La Timone Hospital, Marseille, France
| | - Jean-Robert Harlé
- Department of Internal Medicine, La Timone Hospital, Marseille, France
| | | | - Gabrielle Sarlon
- Department of Vascular Surgery, La Timone Hospital, Marseille, France
| | - Emmanuelle Bernit
- Department of Internal Medicine, La Timone Hospital, Marseille, France
| |
Collapse
|
18
|
Rozen L, Noubouossie DF, Dedeken L, Lê PQ, Ferster A, Demulder A. Is There Any Improvement of the Coagulation Imbalance in Sickle Cell Disease after Hematopoietic Stem Cell Transplantation? J Clin Med 2019; 8:jcm8111796. [PMID: 31717804 PMCID: PMC6912463 DOI: 10.3390/jcm8111796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/16/2019] [Accepted: 10/23/2019] [Indexed: 12/21/2022] Open
Abstract
Several components of the clotting system are modified towards hypercoagulability in sickle cell disease (SCD). To date, hematopoietic stem cell transplantation (HSCT) is the only validated curative treatment of SCD. Here, we investigated the changes in the hemostatic potential of SCD children who've received a successful HSCT. Seventeen children with severe SCD were enrolled in the study. Thrombin generation (TG) was performed on citrated platelet-poor plasma, obtained before and 3, 6, 9, 12 and 15 months after HSCT. TG was triggered using 1 pM tissue factor and 4 µM phospholipids with or without thrombomodulin (TM). Before the HSCT, SCD children showed a higher endogenous thrombin potential (ETP), higher peak, higher velocity and shorter time-to-peak of TG than the normal controls (NC). ETP did not significantly change following the HSCT. However, the peak, velocity and time-to-peak of TG reversed to normal ranges from 3 months post-HSCT and remained so up to 15 months post-HSCT. The reduction of ETP after the addition of thrombomodulin (RETP) was dramatically reduced in SCD children before HSCT as compared with the NC. A partial reversal of RETP was observed from 3 months through 15 months post-HSCT. No statistical difference was observed for patient age or donor hemoglobinopathy status. In summary, successful HSCT improves the kinetics of TG but not the total thrombin capacity in SCD children.
Collapse
Affiliation(s)
- Laurence Rozen
- Laboratory of Hematology LHUB-ULB ULB Université Libre de Bruxelles, 1020 Brussels, Belgium; (D.F.N.); (A.D.)
- Correspondence: ; Tel.: +32-2477-2921
| | - Denis F. Noubouossie
- Laboratory of Hematology LHUB-ULB ULB Université Libre de Bruxelles, 1020 Brussels, Belgium; (D.F.N.); (A.D.)
| | - Laurence Dedeken
- Hematology Oncology Unit, Hôpital and niversitaire des Enfants Reine Fabiola, ULB Université Libre de Bruxelles, 1020 Brussels, Belgium; (L.D.); (P.Q.L.); (A.F.)
| | - Phu Quoc Lê
- Hematology Oncology Unit, Hôpital and niversitaire des Enfants Reine Fabiola, ULB Université Libre de Bruxelles, 1020 Brussels, Belgium; (L.D.); (P.Q.L.); (A.F.)
| | - Alina Ferster
- Hematology Oncology Unit, Hôpital and niversitaire des Enfants Reine Fabiola, ULB Université Libre de Bruxelles, 1020 Brussels, Belgium; (L.D.); (P.Q.L.); (A.F.)
| | - Anne Demulder
- Laboratory of Hematology LHUB-ULB ULB Université Libre de Bruxelles, 1020 Brussels, Belgium; (D.F.N.); (A.D.)
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Sharma R, Woods GM, Creary S, O'Brien S, Stanek J, Hor K, Gallagher C, Dunn AL, Kumar R. Impact of erythrocytapheresis on natural anticoagulant levels in children with sickle cell disease: A pilot study. Pediatr Blood Cancer 2019; 66:e27588. [PMID: 30548773 DOI: 10.1002/pbc.27588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 12/18/2022]
Abstract
Venous thromboembolism (VTE) is being increasingly recognized in children with sickle cell disease (SCD). In a retrospective cohort study, we identified bilateral central venous catheter (CVC) placement as an independent risk factor for VTE. At our institution, the only indication for bilateral CVC placement in children with SCD is erythrocytapheresis. To investigate the impact of erythrocytapheresis on coagulation, we measured levels of natural anticoagulants in 11 patients with SCD on chronic erythrocytapheresis, immediately before and after apheresis. We demonstrated a statistically significant reduction in most parameters. Additional studies are needed to further investigate the exact etiology and clinical impact of this acute decrease.
Collapse
Affiliation(s)
- Ruchika Sharma
- Department of Pediatrics, Division of Hematology/Oncology, Medical College of Wisconsin/Blood Center of Wisconsin, Milwaukee, Wisconsin
| | - Gary M Woods
- Department of Pediatrics, Eastern Virginia Medical School, Division of Hematology/Oncology, Children's Hospital of the King's Daughters, Norfolk, Virginia
| | - Susan Creary
- Department of Pediatrics, The Ohio State University, Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Sarah O'Brien
- Department of Pediatrics, The Ohio State University, Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Joseph Stanek
- Division of Biostatistics, Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kan Hor
- Department of Pediatrics, The Ohio State University, Division of Cardiology, Nationwide Children's Hospital, Columbus, Ohio
| | - Christina Gallagher
- Department of Pediatrics, The Ohio State University, Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Amy L Dunn
- Department of Pediatrics, The Ohio State University, Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| | - Riten Kumar
- Department of Pediatrics, The Ohio State University, Division of Hematology/Oncology, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|
21
|
Akinbami AA, Uche EI, Suleiman AM, Ogbenna AA, Olowoselu FO, Augustine B, Badiru MA, Bamiro RA, Kamson OR. On artherogenic index of plasma in sickle cell anaemia patients. Pan Afr Med J 2019; 32:141. [PMID: 31308859 PMCID: PMC6609855 DOI: 10.11604/pamj.2019.32.141.17166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 02/26/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Sickle cell anaemia (SCA) is an inherited abnormality of haemoglobin associated with reduced life expectancy. Patients' complications include dyslipideamia. This study was aimed at determining the artherogenic index of plasma (AIP) in sickle cell anaemia patients and compares the value to HbAA controls value. A high AIP is strongly predictive of elevated cardiovascular risk. METHODS A comparative study was conducted among SCA patients attending the haematology clinic, Lagos State University Teaching Hospital (LASUTH) and HbAA Phenotype controls. A total of 304 participants were recruited consisting of equal numbers of SCA and HbAA controls. Single lipid profiles were done; logarithms of triglycerides/high density lipoprotein were calculated to obtain AIP and lipid profile ratios established for all participants. RESULTS There were lower mean values of Total Cholesterol (TC), High Density Lipoprotein(HDL) and Low Density Lipoprotein (LDL) amongst SCD participants than controls and higher mean values of triglycerides (TG) and Very Low Density Lipoprotein (VLDL) in SCD p < 0.05. The AIP in SCD ranges from -0.62 to 1.32 while that of controls ranges from -0.56 to 0.61.The mean AIP were 0.14 ± 0.29 and -0.009 ± 0.26 in SCD and controls respectively. P value = 0.002. CONCLUSION AIP value is higher in sickle cell anaemia than controls, the former have lower mean values of TC, HDL and LDL and higher mean values of TG and VLDL.
Collapse
Affiliation(s)
- Akinsegun Abduljaleel Akinbami
- Department of Haematology and Blood Transfusion, Lagos State University, College of Medicine PMB 21266, Ikeja, Lagos, Lagos State, Nigeria
| | - Ebele Ifeyinwa Uche
- Department of Haematology and Blood Transfusion, Lagos State University, College of Medicine PMB 21266, Ikeja, Lagos, Lagos State, Nigeria
| | - Aishatu Maude Suleiman
- Department of Haematology and Blood Transfusion, Faculty of Basic Clinical Sciences, College of Health Sciences, Ahmadu Bello University, Zaria
| | - Ann Abiola Ogbenna
- Department of Haematology and Blood Transfusion, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Nigeria
| | - Festus Olusola Olowoselu
- Department of Haematology and Blood Transfusion, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Nigeria
| | - Benjamin Augustine
- Department of Haematology and Blood Transfusion, Faculty of Basic Clinical Sciences, College of Health Sciences, Ahmadu Bello University, Zaria
| | - Mulikat Adesola Badiru
- Department of Hematology and Blood Transfusion, Lagos State University, Teaching Hospital, PMB 21266, Ikeja, Lagos State, Nigeria
| | - Rafat Abiodun Bamiro
- Department of Hematology and Blood Transfusion, Lagos State University, Teaching Hospital, PMB 21266, Ikeja, Lagos State, Nigeria
| | - Omolara Risqat Kamson
- Department of Hematology and Blood Transfusion, Lagos State University, Teaching Hospital, PMB 21266, Ikeja, Lagos State, Nigeria
| |
Collapse
|
22
|
Toledo SLDO, Guedes JVM, Alpoim PN, Rios DRA, Pinheiro MDB. Sickle cell disease: Hemostatic and inflammatory changes, and their interrelation. Clin Chim Acta 2019; 493:129-137. [PMID: 30825426 DOI: 10.1016/j.cca.2019.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 12/23/2022]
Abstract
Sickle cell disease, the most common genetic blood disorder in the world, has high clinical variability, negatively impacts quality of life and contributes to early mortality. Sickled erythrocytes cause blood flow obstruction, hemolysis, and several hemostatic changes that promote coagulation. These events, in turn, induce chronic inflammation, characterized by elevated plasma levels of pro-inflammatory markers, which aggravates the already unfavorable state of the circulatory system. Empirical evidence indicates that the hemostatic and inflammatory systems continuously interact with each other and thereby further propagate the hypercoagulability and inflammatory conditions. In this review article, we discuss the pathophysiological aspects of sickle cell disease and the hemostatic and inflammatory changes that underlie its pathogenesis.
Collapse
Affiliation(s)
- Sílvia L de O Toledo
- Federal University of São João del-Rei (UFSJ), Dona Lindu Center-West Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour, 35501-296 Divinópolis, MG, Brazil
| | - João V M Guedes
- Federal University of São João del-Rei (UFSJ), Dona Lindu Center-West Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour, 35501-296 Divinópolis, MG, Brazil
| | - Patrícia N Alpoim
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais (MG), Brazil
| | - Danyelle R A Rios
- Federal University of São João del-Rei (UFSJ), Dona Lindu Center-West Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour, 35501-296 Divinópolis, MG, Brazil
| | - Melina de B Pinheiro
- Federal University of São João del-Rei (UFSJ), Dona Lindu Center-West Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour, 35501-296 Divinópolis, MG, Brazil.
| |
Collapse
|
23
|
Belhaj Nefissi R, Doggui R, Ouali F, Messaoud T, Gritli N. Factor V Leiden G1691A, Prothrombin G20210A, and MTHFR C677T and A1298C Mutations in Patients With Sickle Cell Disease in Tunisia. Hemoglobin 2018; 42:96-102. [PMID: 30200836 DOI: 10.1080/03630269.2018.1451340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Sickle cell disease is a genetic disorder characterized by a hypercoagulable state. Several complications in this hemoglobinopathy are increased by thrombosis. Factor V Leiden (FVL), prothrombin (PRT) G20210A, and methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C mutations are major inherited risk factors of thrombotic complications. In this study, our aim was to compare the frequencies of these mutations in sickle cell patients with healthy controls. The study population comprised 35 homozygous Hb S (HBB: c.20A>T) patients, 29 compound heterozygous patients [16 Hb S/β0-thalassemia (β0-thal), four Hb S/β+-thal, seven Hb S/Hb C (HBB: c.19G>A) and two Hb S/Hb O-Arab (HBB: c.364G>A)] and 100 healthy subjects. All patients and controls were subjected to laboratory investigations as well as mutation genotyping. Our findings showed a severe anemia with the lowest values of protein S (PS), protein C (PC) and antithrombin (AT) in the homozygous Hb S group compared to Hb S/Hb C and Hb S/β-thal subjects. No significant difference in FVL genotype between patients and controls was observed, whereas high frequencies of PRT G20210A, MTHFR C677T and MTHFR A1298C mutations in the Hb S patients and a significant association between the MTHFR C677T mutation and Hb S/β0-thal were found.
Collapse
Affiliation(s)
- Rim Belhaj Nefissi
- a Laboratory of Molecular Biology, Department of Hematology , Military Hospital of Tunis , Tunisia
| | - Radhouene Doggui
- b Laboratory of Biochemistry and Molecular Biology , Children's Hospital of Tunis , Tunisia
| | - Faida Ouali
- c National Institute of Nutrition and Food Technology (INNTA) Tunis , Tunisia
| | - Taieb Messaoud
- c National Institute of Nutrition and Food Technology (INNTA) Tunis , Tunisia
| | - Nasreddine Gritli
- a Laboratory of Molecular Biology, Department of Hematology , Military Hospital of Tunis , Tunisia
| |
Collapse
|
24
|
Noubiap JJ, Temgoua MN, Tankeu R, Tochie JN, Wonkam A, Bigna JJ. Sickle cell disease, sickle trait and the risk for venous thromboembolism: a systematic review and meta-analysis. Thromb J 2018; 16:27. [PMID: 30305805 PMCID: PMC6171302 DOI: 10.1186/s12959-018-0179-z] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/08/2018] [Indexed: 01/21/2023] Open
Abstract
Background Globally, sickle cell disease (SCD) is one of the most common haemoglobinopathy. Considered a public health problem, it leads to vessel occlusion, blood stasis and chronic activation of the coagulation system responsible for vaso-occlussive crises and venous thromboembolism (VTE) which may be fatal. Although contemporary observational studies suggest a relationship between SCD or sickle trait (SCT) and VTE, there is lack of a summary or meta-analysis data on this possible correlation. Hence, we propose to summarize the available evidence on the association between SCD, SCT and VTE including deep vein thrombosis (DVT) and pulmonary embolism (PE). Methods We searched PubMed and Scopus to identify all cross-sectional, cohort and case-control studies reporting on the association between SCD or SCT and VTE, DVT or PE in adults or children from inception to April 25, 2017. For measuring association between SCD or SCT and VTE, DVT, or PE, a meta-analysis using the random-effects method was performed to pool weighted odds ratios (OR) of risk estimates. Results From 313 records initially identified from bibliographic databases, 10 studies were eligible and therefore included the meta-analysis. SCD patients had significantly higher risk for VTE (pooled OR 4.4, 95%CI 2.6–7.5, p < 0.001), DVT (OR 1.1, 95% CI 1.1–1.2, p < 0.001) and PE (pooled OR 3.7, 95% CI 3.6–3.8, p < 0.001) as compared to non SCD-adults. A higher risk of VTE (OR 33.2, 95% CI 9.7–113.4, p < 0.001) and DVT (OR 30.7, 95% CI 1.6–578.2, p = 0.02) was found in pregnant or postpartum women with SCD as compared to their counterparts without SCD. Compared to adults with SCT, the risk of VTE was higher in adults with SCD (pooled OR 3.1, 95% CI 1.8–5.3, p < 0.001), and specifically in SCD pregnant or postpartum women (OR 20.3, 95% CI 4.1–102, p = 0.0003). The risk of PE was also higher in adults with SCD (OR 3.1, 95% CCI 1.7–5.9, p = 0.0004) as compared to those with SCT. The risk of VTE was higher in individuals with SCT compared to controls (pooled OR 1.7, 95% CI 1.3–2.2, p < 0.0001), but not in pregnant or postpartum women (OR 0.9, 95% CI 0.3–2.9, p = 0.863). Compared to controls, SCT was associated with a higher risk of PE (pooled OR 2.1, 95% CI 1.2–3.8, p = 0.012) but not of DVT (pooled OR 1.2, 95% CI 0.9–1.7, p = 0.157). Conclusion Individuals with SCD, especially pregnant or postpartum women, might have a higher risk of VTE compared to the general population. SCT might also increases the risk of VTE. However, currently available data are not sufficient to allow a definite conclusion. Further larger studies are needed to provide a definitive conclusion on the association between SCD, SCT and VTE. Electronic supplementary material The online version of this article (10.1186/s12959-018-0179-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jean Jacques Noubiap
- 1Department of Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, 7925 South Africa
| | - Mazou N Temgoua
- 2Department of Internal Medicine and sub-Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Ronni Tankeu
- 2Department of Internal Medicine and sub-Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Joel Noutakdie Tochie
- 3Department of Surgery and sub-Specialties, Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon
| | - Ambroise Wonkam
- 4Division of Human Genetics, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jean Joël Bigna
- Department of Epidemiology and Public Health, Centre Pasteur of Cameroon, Yaoundé, Cameroon.,6Faculty of Medicine, University of Paris Sud XI, Le Kremlin Bicêtre, France
| |
Collapse
|
25
|
Woods GM, Sharma R, Creary S, O'Brien S, Stanek J, Hor K, Young J, Dunn AL, Kumar R. Venous Thromboembolism in Children with Sickle Cell Disease: A Retrospective Cohort Study. J Pediatr 2018; 197:186-190.e1. [PMID: 29605397 DOI: 10.1016/j.jpeds.2018.01.073] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/20/2017] [Accepted: 01/26/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To describe the cumulative incidence of venous thromboembolism (VTE) in children with sickle cell disease (SCD) followed at a single institution and report on the risk factors associated with VTE development. STUDY DESIGN Charts for all patients with SCD, aged 0-21 years, followed at Nationwide Children's Hospital over a 6-year period (January 1, 2009, to January 31, 2015) were reviewed. Data on VTE diagnosis, sex, body mass index/weight-for-length, SCD genotype, SCD clinical complications, central venous catheter (CVC) placement, and thrombophilia testing were collected. RESULTS Cumulative incidence of VTE in children with SCD followed at a single tertiary care institution was found to be 2.9% (12/414). Nine of the 12 VTE were CVC-associated. On univariate analysis, hemoglobin SS genotype (OR 10.7, 95% CI 1.4-83.5), CVC presence (OR 34.4, 95% CI 8.9-134.6), central nervous system vasculopathy (OR 19.4, 95% CI 5.6-63.4), chronic transfusion therapy (OR 30.6, 95% CI 8.9-122.2), and older age (P = .03) were associated with VTE. However, presence of CVC was the only independent risk factor identified on multivariable logistic regression analysis (OR 33.8, 95% CI 8.7-130.9). CONCLUSION In our institution, nearly 3% of children with SCD had a history of VTE. CVC is an independent predictor of VTE in children with SCD.
Collapse
Affiliation(s)
- Gary M Woods
- Division of Pediatric Hematology/Oncology, Children's Hospital of the King's Daughters, Norfolk, VA
| | - Ruchika Sharma
- Division of Pediatric Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - Susan Creary
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Sarah O'Brien
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Joseph Stanek
- Division of Biostatistics, Nationwide Children's Hospital, Columbus, OH
| | - Kan Hor
- Department of Pediatrics, The Ohio State University, Columbus, OH; Division of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH
| | - Jennifer Young
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH
| | - Amy L Dunn
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University, Columbus, OH
| | - Riten Kumar
- Division of Pediatric Hematology/Oncology, Nationwide Children's Hospital, Columbus, OH; Department of Pediatrics, The Ohio State University, Columbus, OH.
| |
Collapse
|
26
|
How I diagnose and treat venous thromboembolism in sickle cell disease. Blood 2018; 132:1761-1769. [PMID: 29764840 DOI: 10.1182/blood-2018-03-822593] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 05/12/2018] [Indexed: 01/16/2023] Open
Abstract
The incidence of venous thromboembolism (VTE) in adult patients with sickle cell disease (SCD) is high. However, overlapping features between the clinical presentation of VTE and SCD complications and a low index of suspicion for thrombosis can influence patient management decisions. VTE in SCD can therefore present management challenges to the clinical hematologist. Herein, we present 3 distinct clinical vignettes that are representative of our clinical practice with SCD patients. These vignettes are discussed with specific reference to the hypercoagulable state in SCD patients, recent VTE diagnosis and anticoagulant therapy guidelines from the general population, and evaluation of the risk of bleeding as a result of long-term exposure to anticoagulant therapy. We examine current diagnostic and treatment options, highlight limitations of the existing clinical prognostic models that offer personalized guidance regarding the duration of anticoagulation, and propose a clinical approach to guide the decision to extend anticoagulation beyond 3 months.
Collapse
|
27
|
Faes C, Sparkenbaugh EM, Pawlinski R. Hypercoagulable state in sickle cell disease. Clin Hemorheol Microcirc 2018; 68:301-318. [DOI: 10.3233/ch-189013] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Camille Faes
- Interuniversity Laboratory of Human Movement Biology EA7424, Vascular biology and Red Blood Cell Team, University Claude Bernard Lyon1, Villeurbanne, France; Laboratory of Excellence “GR-Ex, ” Paris, France
| | - Erica M. Sparkenbaugh
- McAllister Heart Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rafal Pawlinski
- Department of Medicine, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
28
|
Agrawal A, Shah R, Bacchetta MD, Talwar A. Successful pulmonary thromboendarterectomy in a patient with sickle cell disease and associated resolution of a leg ulcer. Lung India 2018; 35:73-77. [PMID: 29319041 PMCID: PMC5760875 DOI: 10.4103/lungindia.lungindia_47_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Pulmonary hypertension (PH) is a relatively frequent and severe complication of sickle cell disease (SCD). PH associated with SCD is classified as Group 5 PH. The exact pathogenesis of PH in SCD in not known. There are also very limited treatment options available at this time for such patients with Group 5 PH. Patients with SCD are predisposed to a hypercoagulable state and thus can also suffer from chronic thromboembolism. These patients can have associated chronic thromboembolic pulmonary hypertension (CTEPH), thus being classified as Group 4 PH. We present such a case of a patient with SCD diagnosed with severe PH who was found to have CTEPH and successfully underwent a thromboendarterectomy with resolution of his symptoms such as reduction of his oxygen requirements and healing of chronic leg ulcer. This case illustrates the importance of screening patients with SCD and elevated pulmonary artery pressures for CTEPH as this would offer possible treatment options such as pulmonary thromboendarterectomy and/or riociguat in this subset of patients.
Collapse
Affiliation(s)
- Abhinav Agrawal
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra Northwell School of Medicine, New York, NY, USA
| | - Rakesh Shah
- Department of Radiology, Division of Thoracic Radiology, Hofstra Northwell School of Medicine, New York, NY, USA
| | - Matthew D Bacchetta
- Department of Thoracic Surgery, Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA
| | - Arunabh Talwar
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Hofstra Northwell School of Medicine, New York, NY, USA
| |
Collapse
|
29
|
Awoda S, Daak AA, Husain NE, Ghebremeskel K, Elbashir MI. Coagulation profile of Sudanese children with homozygous sickle cell disease and the effect of treatment with omega-3 fatty acid on the coagulation parameters. BMC HEMATOLOGY 2017; 17:18. [PMID: 29152307 PMCID: PMC5679360 DOI: 10.1186/s12878-017-0089-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/19/2017] [Indexed: 02/02/2023]
Abstract
Background It has been reported that patients with SCD do have an abnormal coagulation profile. Coagulopathy is thought to be one of the key factors that contribute to the vaso-occlusive crisis that characterises sickle cell disease (SCD). In this study, we investigated whether Sudanese sickle cell patients have an abnormal coagulation profile. In addition, the effect of treatment with either omega-3 fatty acids or hydroxyurea on coagulation profile was assessed. Methods Homozygous SCD patients untreated (n = 52), omega-3 treated (n = 44), hydroxyurea (HU) treated (n = 8) and healthy (HbAA) controls (n = 52) matched for age (4–20 years), gender and socioeconomic status were enrolled. Patients on omega-3 fatty acids, according to age, received one to four capsules containing 277.8 mg DHA and 39.0 mg eicosapentnoic. Patients on Hydroxyurea were in on dosage more than 20 mg/kg/day. The steady state levels of the coagulation parameters and the effect of the treatments with either HU or omega-3 fatty acids on markers of coagulation were investigated. Results Compared to the healthy controls, treated and untreated HbSS patients had lower hemoglobin, plasma Protein C, proteins S and higher white blood cell count (WBC), platelets count (PLTs) and plasma D-dimer levels,(p < 0.05). In comparison to untreated HbSS, treatment with neither omega-3 nor HU had effect on the WBC, plasma proteins C and S, (p > 0.05). HU treated group had a lower PLTs count compared to HbSS untreated group (p < 0.5). The prothrombin and activated partial thromboplastin times and international normalized ratio (INR) of untreated patients are significantly higher than n-3 treated, HU-treated patients and health controls, (p < 0.05). Patients treated with omega-3 had lowered D-dimer levels in comparison to HU-treated and untreated HbSS patients, (p < 0.001). Conclusion This study provides evidence that Sudanes patients have abnormal coagulation profile and treatment with either HU or omega-3 fatty acids might partially ameliorate SCD-associated chronic coagulopathic state.
Collapse
Affiliation(s)
- Shiekh Awoda
- Department of Medical Biochemistry, Faculty of Medicine, University of Khartoum, Alghasr Street, Khartoum, Sudan.,College of Medical Laboratory Sciences, Sudan University of Science& Technology, Khartoum, Sudan
| | - Ahmed A Daak
- Department of Medical Biochemistry, Faculty of Medicine, University of Khartoum, Alghasr Street, Khartoum, Sudan.,Center of Molecular Biology and Biotechnology (CMBB), Florida Atlantic University (FAU), Boca Raton, USA.,Lipidomics and Nutrition Research Centre, London Metropolitan University, London, UK
| | - Nazik Elmalaika Husain
- College of Medical Laboratory Sciences, Sudan University of Science& Technology, Khartoum, Sudan
| | - Kebreab Ghebremeskel
- Lipidomics and Nutrition Research Centre, London Metropolitan University, London, UK
| | - Mustafa I Elbashir
- Department of Medical Biochemistry, Faculty of Medicine, University of Khartoum, Alghasr Street, Khartoum, Sudan
| |
Collapse
|
30
|
Association of silent infarcts in sickle cell anemia with decreased annexin A5 resistance. Blood Cells Mol Dis 2017; 69:53-56. [PMID: 28911832 DOI: 10.1016/j.bcmd.2017.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 08/31/2017] [Accepted: 09/01/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sickle cell anemia (SCA) is characterized by abnormally shaped, adhesive RBCs that interact with white blood cells and the endothelium, leading to chronic hemolysis, vasculopathy and a prothrombotic state. About 10% of subjects with a thrombotic event in the general population will have an associated antiphospholipid (aPL) antibody. One proposed mechanism for the thrombophilic nature of aPL antibodies is the disruption of the potent anticoagulant annexin A5 or Annexin A5 resistance (A5R). We designed a pilot study assessing the presence of aPL antibodies and disruption of A5R in pediatric sickle cell subjects. METHODS 39 subjects with SCA participated in this study. A5R, DRVVT, anti-β2GP1, anti-β2GP1, anti-phosphatidylserine and anti-cardiolipin antibody assays were performed. RESULTS There was a high prevalence of abnormal A5R despite a low prevalence of antiphospholipid antibodies. Multivariate logistic regression analyses showed an association with silent infarcts (p=0.015), lower hemoglobin (p=0.037), older age (p=0.047) and abnormal A5R. CONCLUSION We report an association between annexin A5 resistance and presence of silent infarct, low hemoglobin, and older age in a subgroup of SCA subjects. A potential role for perturbed A5R in the pathophysiology of SCA needs to be evaluated further.
Collapse
|
31
|
Fernandes Q. Therapeutic strategies in Sickle Cell Anemia: The past present and future. Life Sci 2017; 178:100-108. [PMID: 28435037 DOI: 10.1016/j.lfs.2017.03.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 01/15/2023]
Abstract
Sickle Cell Anemia (SCA) was one of the first hemoglobinopathies to be discovered. It is distinguished by the mutation-induced expression of a sickle cell variant of hemoglobin (HbS) that triggers erythrocytes to take a characteristic sickled conformation. The complex physiopathology of the disease and its associated clinical complications has initiated multi-disciplinary research within its field. This review attempts to lay emphasis on the evolution, current standpoint and future scope of therapeutic strategies in SCA.
Collapse
|
32
|
Whelihan MF, Lim MY, Mooberry MJ, Piegore MG, Ilich A, Wogu A, Cai J, Monroe DM, Ataga KI, Mann KG, Key NS. Thrombin generation and cell-dependent hypercoagulability in sickle cell disease. J Thromb Haemost 2016; 14:1941-1952. [PMID: 27430959 DOI: 10.1111/jth.13416] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Indexed: 02/03/2023]
Abstract
Essentials Sickle cell disease is increasingly being recognized as a chronic hypercoagulable state. Thrombin generation is elevated in the whole blood, but not the plasma of sickle cell patients. Whole blood thrombin generation inversely correlates to erythrocyte phosphatidylserine exposure. Acquired protein S deficiency is likely explained by binding of protein S to sickle red cells. Click to hear Dr Hillery discuss coagulation and vascular pathologies in mouse models of sickle cell disease. SUMMARY Introduction Sickle cell disease (SCD) is a hypercoagulable state with chronic activation of coagulation and an increased incidence of thromboembolic events. However, although plasma pre-thrombotic markers such as thrombin-anithrombin complexes and D-dimer are elevated, there is no consensus on whether global assays of thrombin generation in plasma are abnormal in patients with SCD. Based on our recent observation that normal red blood cells (RBCs) contribute to thrombin generation in whole blood, we hypothesized that the cellular components in blood (notably phosphatidylserine-expressing erythrocytes) contribute to enhanced thrombin generation in SCD. Methods Whole blood and plasma thrombin generation assays were performed on blood samples from 25 SCD patients in a non-crisis 'steady state' and 25 healthy race-matched controls. Results Whole blood thrombin generation was significantly elevated in SCD, whereas plasma thrombin generation was paradoxically reduced compared with controls. Surprisingly, whole blood and plasma thrombin generation were both negatively correlated with phosphatidylserine exposure on RBCs. Plasma thrombin generation in the presence of exogenous activated protein C or soluble thrombomodulin revealed deficiencies in the protein C/S anticoagulant pathway in SCD. These global changes were associated with significantly lower plasma protein S activity in SCD that correlated inversely with RBC phosphatidylserine exposure. Conclusion Increased RBC phosphatidylserine exposure in SCD is associated with acquired protein S deficiency. In addition, these data suggest a cellular contribution to thrombin generation in SCD (other than RBC phosphatidylserine exposure) that explains the elevated thrombin generation in whole blood.
Collapse
Affiliation(s)
| | - M Y Lim
- Department of Medicine, Chapel Hill, NC, USA
| | | | - M G Piegore
- Department of Medicine, Chapel Hill, NC, USA
| | - A Ilich
- Department of Medicine, Chapel Hill, NC, USA
| | - A Wogu
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Cai
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - D M Monroe
- Department of Medicine, Chapel Hill, NC, USA
| | - K I Ataga
- Department of Medicine, Chapel Hill, NC, USA
| | - K G Mann
- Department of Biochemistry, University of Vermont, Burlington, VT, USA
| | - N S Key
- Department of Medicine, Chapel Hill, NC, USA.
- Department of Pathology and Laboratory Medicine, Chapel Hill, NC, USA.
| |
Collapse
|
33
|
Noubouossie D, Key NS, Ataga KI. Coagulation abnormalities of sickle cell disease: Relationship with clinical outcomes and the effect of disease modifying therapies. Blood Rev 2015; 30:245-56. [PMID: 26776344 DOI: 10.1016/j.blre.2015.12.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/11/2015] [Accepted: 12/17/2015] [Indexed: 12/31/2022]
Abstract
Sickle cell disease (SCD) is a hypercoagulable state. Patients exhibit increased platelet activation, high plasma levels of markers of thrombin generation, depletion of natural anticoagulant proteins, abnormal activation of the fibrinolytic system, and increased tissue factor expression, even in the non-crisis "steady state." Furthermore, SCD is characterized by an increased risk of thrombotic complications. The pathogenesis of coagulation activation in SCD appears to be multi-factorial, with contributions from ischemia-reperfusion injury and inflammation, hemolysis and nitric oxide deficiency, and increased sickle RBC phosphatidylserine expression. Recent studies in animal models suggest that activation of coagulation may contribute to the pathogenesis of SCD, but the data on the contribution of coagulation and platelet activation to SCD-related complications in humans are limited. Clinical trials of new generations of anticoagulants and antiplatelet agents, using a variety of clinical endpoints are warranted.
Collapse
Affiliation(s)
- Denis Noubouossie
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, USA
| | - Nigel S Key
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, USA
| | - Kenneth I Ataga
- Division of Hematology/Oncology, University of North Carolina at Chapel Hill, USA.
| |
Collapse
|
34
|
Abstract
Antiphospholipid syndrome (APS) is a multisystem autoimmune condition characterized by vascular thromboses associated with persistently positive antiphospholipid antibodies. There is currently a paucity of data (incidence, prevalence, thrombosis risk, and effective treatment) in pediatric APS. The purpose of this report is to review the current literature on APS in children and neonates, identify the gaps in current knowledge, and suggest avenues for studies to fill those gaps.
Collapse
|
35
|
Izuwa G, Akpotuzor J, Okpokam D, Akpan P, Ernest N, Asuquo J. Haemorrheologic and Fibrinolytic Activities of HbSS, HbAS and HbAA Subjects in Abuja, Nigeria. JOURNAL OF MEDICAL SCIENCES 2015. [DOI: 10.3923/jms.2016.32.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
36
|
Colella MP, de Paula EV, Machado-Neto JA, Conran N, Annichino-Bizzacchi JM, Costa FF, Olalla Saad ST, Traina F. Elevated hypercoagulability markers in hemoglobin SC disease. Haematologica 2015; 100:466-71. [PMID: 25596272 DOI: 10.3324/haematol.2014.114587] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Hemoglobin SC disease is a very prevalent hemoglobinopathy; however, very little is known about this condition specifically. There appears to be an increased risk of thromboembolic events in hemoglobin SC disease, but studies evaluating the hemostatic alterations are lacking. We describe the findings of a cross-sectional observational study evaluating coagulation activation markers in adult patients with hemoglobin SC, comparing them with those in sickle cell anemia patients and healthy controls. A total of 56 hemoglobin SC and 39 sickle cell anemia patients were included in the study, all in steady state, and 27 healthy controls. None of the patients was taking hydroxyurea. Hemoglobin SC patients had a significantly up-regulated relative expression of tissue factor, as well as elevations in thrombin-antithrombin complex and D-dimer, in comparison to controls (P<0.01). Hemoglobin SC patients had lower tissue factor expression, and thrombin-antithrombin complex and D-dimer levels when compared to sickle cell anemia patients (P<0.05). Markers of endothelial activation (soluble thrombomodulin and soluble vascular cell adhesion molecule-1) and inflammation (tumor necrosis factor-alpha) were both significantly elevated in hemoglobin SC patients when compared to controls, being as high as the levels seen in patients with sickle cell anemia. Overall, in hemoglobin SC patients, higher hemolytic activity and inflammation were associated with a more intense activation of coagulation, and hemostatic activation was associated with two very prevalent chronic complications seen in hemoglobin SC disease: retinopathy and osteonecrosis. In summary, our results demonstrate that hemoglobin SC patients have a hypercoagulable state, although this manifestation was not as intense as that seen in sickle cell anemia.
Collapse
Affiliation(s)
- Marina P Colella
- Hematology and Hemotherapy Center - University of Campinas/Hemocentro UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas
| | - Erich V de Paula
- Hematology and Hemotherapy Center - University of Campinas/Hemocentro UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas
| | - João A Machado-Neto
- Hematology and Hemotherapy Center - University of Campinas/Hemocentro UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas
| | - Nicola Conran
- Hematology and Hemotherapy Center - University of Campinas/Hemocentro UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas
| | - Joyce M Annichino-Bizzacchi
- Hematology and Hemotherapy Center - University of Campinas/Hemocentro UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas
| | - Fernando F Costa
- Hematology and Hemotherapy Center - University of Campinas/Hemocentro UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas
| | - Sara T Olalla Saad
- Hematology and Hemotherapy Center - University of Campinas/Hemocentro UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas
| | - Fabiola Traina
- Hematology and Hemotherapy Center - University of Campinas/Hemocentro UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, Campinas Currently at the Department of Internal Medicine, University of São Paulo at Ribeirão Preto Medical School, São Paulo, Brazil
| |
Collapse
|
37
|
Brunetta DM, De Santis GC, Silva-Pinto AC, Oliveira de Oliveira LC, Covas DT. Hydroxyurea increases plasma concentrations of microparticles and reduces coagulation activation and fibrinolysis in patients with sickle cell anemia. Acta Haematol 2014; 133:287-94. [PMID: 25472687 DOI: 10.1159/000362148] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 03/10/2014] [Indexed: 12/17/2022]
Abstract
Microparticles (MPs) are present in healthy subjects and their concentration increases in patients at high risk of thrombosis. We evaluated 10 patients with sickle cell anemia (SCA) treated with hydroxyurea (HU) and 13 SCA patients without this treatment. MP concentrations were determined by flow cytometry. Coagulation was evaluated using the thrombin-antithrombin complex (TAT) and D-dimers. Total MP concentrations were increased in the HU-treated group (265 × 10(6)/ml vs. 67.45 × 10(6)/ml; p = 0.0026), as well as MPs derived from RBC (67.83 × 10(6)/ml vs. 26.31 × 10(6)/ml; p = 0.05), monocytes (51.31 × 10(6)/ml vs. 9.03 × 10(6)/ml; p = 0.0084), monocytes with tissue factor (TF) expression (2.27 × 10(6)/ml vs. 0.27 × 10(6)/ml; p = 0.0058), endothelium (49.42 × 10(6)/ml vs. 7.23 × 10(6)/ml; p = 0.007) and endothelium with TF (1.42 × 10(6)/ml vs. 0.26 × 10(6)/ml; p = 0.0043). Furthermore, the concentrations of TAT (7.56 vs. 10.98 µg/l; p = 0.014) and D-dimers (0.65 vs. 1.29 µg/ml; p = 0.007) were reduced with HU. The MP elevation may suggest a direct cytotoxic effect of HU. Another explanation is a cell surface increase secondary to a megaloblastic process, resulting in increased vesicle release. In our opinion, the known benefits of HU on SCA patients, along with the reduction in coagulation activation, surpass its potential detrimental effect on MPs. Future studies should elucidate the role of MPs and demonstrate their significance in different contexts.
Collapse
Affiliation(s)
- Denise Menezes Brunetta
- Center for Cell-Based Therapy, Medical School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | | | | |
Collapse
|
38
|
Jakubowski JA, Zhou C, Winters KJ, Lachno DR, Howard J, Payne CD, Mant T, Jurcevic S, Frelinger AL. The effect of prasugrel on ADP-stimulated markers of platelet activation in patients with sickle cell disease. Platelets 2014; 26:474-9. [PMID: 25140584 DOI: 10.3109/09537104.2014.940887] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Platelets of patients with sickle cell disease (SCD) show evidence of mild activation in the non-crisis steady state and greater activation during vaso-occlusive crises (VOC). Prasugrel, a potent inhibitor of ADP-mediated platelet activation and aggregation, may be useful in attenuating VOC. We compared platelet responses to ADP stimulation in patients with SCD and healthy subjects before and after treatment with prasugrel. In a phase 1 study, platelet biomarker levels were assessed in 12 adult patients with SCD and 13 healthy subjects before and after 12 ± 2 days of 5.0 or 7.5 mg/day prasugrel. The following were determined in whole blood samples stimulated with 20 µM ADP: (i) percentages of monocytes and neutrophils with adherent platelets (cell-platelet aggregates); (ii) the relative number (mass) of platelets associated with each monocyte and neutrophil as reported by CD61 mean fluorescence intensity (MFI) of the monocyte-platelet and neutrophil-platelet aggregates; (iii) the percentages of platelets positive for surface expression of CD40 ligand (CD40L), P-selectin (CD62p) and activated glycoprotein IIb-IIIa (GPIIb-IIIa); and (iv) the percentages of platelets and monocyte-platelet aggregates positive for surface tissue factor (TF) expression. At baseline, there were no significant differences between cohorts in the percentages of platelets expressing activation biomarkers. Following 12 days of prasugrel administration, the percentages of platelets expressing activation biomarkers following ADP stimulation were reduced in both cohorts, and there were no significant differences between groups. Both patients with SCD and healthy subjects had significant reductions in the monocyte-platelet and neutrophil-platelet aggregate MFI and the percentage of platelets expressing P-selectin and activated GPIIb-IIIa (all p < 0.05). Healthy subjects also had significant reductions in monocyte-platelet aggregate percentages (p = 0.004), neutrophil-platelet aggregate percentages (p = 0.011) and the percentage of CD40L-positive platelets (p = 0.044) that were not observed in patients with SCD. Prasugrel administration to SCD patients attenuates ex vivo ADP-stimulated platelet activation as measured by the percentage of platelets positive for P-selectin and GPIIb-IIIa, thus reducing the proportion of platelets that may participate in aggregates. Furthermore, prasugrel decreases ex vivo ADP-stimulated platelet aggregation with monocytes and neutrophils as measured by the monocyte-platelet and neutrophil-platelet aggregate MFI. This implies that in the presence of prasugrel, fewer platelets adhere to monocytes and neutrophils, which may result in reducing cell-platelet aggregate size. Therefore, reduced platelet reactivity and decreased size of leukocyte-platelet aggregates suggest additional mechanisms by which prasugrel may provide benefit to patients with SCD and support further investigation of possible therapeutic benefits of prasugrel in this population.
Collapse
|
39
|
Abstract
The prothrombotic nature of sickle cell disease (SCD) is evidenced by the chronically elevated levels of almost all coagulation activation biomarkers, and an increased incidence of certain thrombotic events, including venous thromboembolism. Numerous studies have attempted to define the extent and elucidate the mechanism of the observed increase in thrombin generation in SCD patients in vivo. In general, these studies were performed using thrombin generation assays in platelet poor or platelet rich plasma and showed little difference in endogenous thrombin potential between the SCD cohort and healthy matched controls. In SCD, erythrocytes and monocytes have been demonstrated to exhibit procoagulant characteristics. Thus, the absence of these cellular components in standard thrombin generation assays may fail to reflect global hypercoagulability in the whole blood of patients with SCD. We were therefore surprised to see no difference in net thrombin generation in tissue factor-initiated initiated clotting of whole blood from patients with SCD. However, we are continuing to reconcile these seemingly disparate observations by slight modifications of the whole blood model that include alternative coagulation triggers and a re-examination of the net thrombin generation when the protein/protein S system is simultaneously interrogated.
Collapse
Affiliation(s)
- Matthew F Whelihan
- Division of Hematology/Oncology, Department of Medicine, University of NC at Chapel Hill, USA
| | - Ming Y Lim
- Division of Hematology/Oncology, Department of Medicine, University of NC at Chapel Hill, USA
| | - Nigel S Key
- Division of Hematology/Oncology, Department of Medicine, University of NC at Chapel Hill, USA.
| |
Collapse
|
40
|
Kernan WN, Ovbiagele B, Black HR, Bravata DM, Chimowitz MI, Ezekowitz MD, Fang MC, Fisher M, Furie KL, Heck DV, Johnston SCC, Kasner SE, Kittner SJ, Mitchell PH, Rich MW, Richardson D, Schwamm LH, Wilson JA. Guidelines for the prevention of stroke in patients with stroke and transient ischemic attack: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2014; 45:2160-236. [PMID: 24788967 DOI: 10.1161/str.0000000000000024] [Citation(s) in RCA: 2860] [Impact Index Per Article: 286.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The aim of this updated guideline is to provide comprehensive and timely evidence-based recommendations on the prevention of future stroke among survivors of ischemic stroke or transient ischemic attack. The guideline is addressed to all clinicians who manage secondary prevention for these patients. Evidence-based recommendations are provided for control of risk factors, intervention for vascular obstruction, antithrombotic therapy for cardioembolism, and antiplatelet therapy for noncardioembolic stroke. Recommendations are also provided for the prevention of recurrent stroke in a variety of specific circumstances, including aortic arch atherosclerosis, arterial dissection, patent foramen ovale, hyperhomocysteinemia, hypercoagulable states, antiphospholipid antibody syndrome, sickle cell disease, cerebral venous sinus thrombosis, and pregnancy. Special sections address use of antithrombotic and anticoagulation therapy after an intracranial hemorrhage and implementation of guidelines.
Collapse
|
41
|
Fall AO, Proulle V, Sall A, Mbaye A, Ba PS, Diao M, Seck M, Gadji M, Gning SB, Diop S, Dièye TN, Faye BF, Thiam D, Dreyfus M. Risk factors for thrombosis in an african population. PLASMATOLOGY 2014; 7:1-6. [PMID: 25512718 PMCID: PMC4251055 DOI: 10.4137/cmbd.s13401] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Revised: 01/19/2014] [Accepted: 01/29/2014] [Indexed: 11/18/2022]
Abstract
SUMMARY Little is known about the biological, epidemiological, and clinical risk factors for thrombosis and venous thromboembolism (VTE) among Black Africans. We undertook a study of the prevalence of VTE risk factors for thrombosis in a Senegalese population. A three-year cross-sectional and case–control study involving 105 cases and 200 controls was conducted in various hospitals in Dakar (Senegal). Our results demonstrate that oral contraception, immobilization by casts, surgery, and blood group were significantly associated with VTE occurrence. Additionally, 16 cases and 2 controls had protein S (PS) values of less than 48.4% (M-2SD), exhibiting a highly significant difference (P < 1 × 10−4). The number of cases with a low protein C (PC) level was significantly higher than the respective number of controls. Using logistic regression methods, we established a correlation between significantly associated variables and deep venous thrombosis (DVT) occurrence. Age, obesity, sickle cell disease, and PC deficiency were not significantly associated with thrombosis. In contrast, gender, PS deficiency, varicose veins, surgery, non-O blood type, and the presence of antiphospholipid antibodies were significantly and independently associated with DVT. These findings are extremely useful for clinical management of patients suffering from DVT and can help to reduce the high recurrence rate observed in our study.
Collapse
Affiliation(s)
- Awa Ot Fall
- Laboratory of Hematology, Cheikh Anta Diop University of Dakar, Senegal
| | | | - Abibatou Sall
- Laboratory of Hematology, Cheikh Anta Diop University of Dakar, Senegal
| | - Alassane Mbaye
- Cardiology Department, "Grand Yoff" Hospital of Dakar, Senegal
| | - Pape Samba Ba
- Cardiology Department, Dakar Principal Hospital, Senegal
| | - Maboury Diao
- Cardiology Department, Aristide Le Dantec hospital of Dakar, Senegal
| | - Moussa Seck
- Laboratory of Hematology, Cheikh Anta Diop University of Dakar, Senegal
| | - Macoura Gadji
- Laboratory of Hematology, Cheikh Anta Diop University of Dakar, Senegal
| | - Sara B Gning
- Cardiology Department, Dakar Principal Hospital, Senegal
| | - Saliou Diop
- Laboratory of Hematology, Cheikh Anta Diop University of Dakar, Senegal
| | - Tandakha Nd Dièye
- Laboratory of Hematology, Cheikh Anta Diop University of Dakar, Senegal
| | - Blaise Félix Faye
- Laboratory of Hematology, Cheikh Anta Diop University of Dakar, Senegal
| | - Doudou Thiam
- Laboratory of Hematology, Cheikh Anta Diop University of Dakar, Senegal
| | - Marie Dreyfus
- Laboratory of Hematology, Bicêtre Hospital of Paris, France
| |
Collapse
|
42
|
Pakbaz Z, Wun T. Role of the hemostatic system on sickle cell disease pathophysiology and potential therapeutics. Hematol Oncol Clin North Am 2014; 28:355-74. [PMID: 24589271 DOI: 10.1016/j.hoc.2013.11.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Recent studies suggest that sickle cell disease (SCD) is a hypercoagulable state contributing to vaso-occlusive events in the microcirculation, resulting in acute and chronic sickle cell-related organ damage. In this article, we review the existing evidence for contribution of hemostatic system perturbation to SCD pathophysiology. We also review the data showing increased risk of thromboembolic events, particularly newer information on the incidence of venous thromboembolism. Finally, the potential role of platelet inhibitors and anticoagulants in SCD is briefly reviewed.
Collapse
Affiliation(s)
- Zahra Pakbaz
- Division of Hematology Oncology, Davis School of Medicine, 4501 X Street, Suite 3016, Sacramento, CA 95817, USA
| | - Ted Wun
- Division of Hematology Oncology, Davis School of Medicine, 4501 X Street, Suite 3016, Sacramento, CA 95817, USA; UC Davis Clinical and Translational Sciences Center, VA Northern California Health Care System, Sacramento, CA, USA.
| |
Collapse
|
43
|
Abstract
PURPOSE OF REVIEW Although it has long been recognized that sickle cell disease (SCD) and other hemoglobinopathies are associated with a state of chronic hyperactivation of coagulation, the study of the epidemiology of venous thromboembolic (VTE) complications in SCD is only now beginning to evolve. In parallel, mechanistic studies of the hypercoagulable state in humans and mouse models implicate an increasingly important causative role of hemolysis. RECENT FINDINGS The case for SCD as a thrombophilic state has been strengthened by the recent literature. In an attempt to better understand the underlying mechanism(s), global assays of coagulation (thromboelastography and thrombin generation assays) have been utilized by several groups, but thus far, the results have been inconsistent, probably because of the technical differences. However, global assays continue to support the case for an important role of peripheral blood cells and their derived microparticles in promoting coagulation activation. SUMMARY VTE is an underappreciated and potentially morbid complication of SCD. The mechanisms underlying this hypercoagulable state are complex. A greater understanding of these pathways may lead to the rational selection of therapies that not only prevent thrombosis, but also impact on many of the other vaso-occlusive complications of SCD.
Collapse
|
44
|
Naik RP, Streiff MB, Lanzkron S. Sickle cell disease and venous thromboembolism: what the anticoagulation expert needs to know. J Thromb Thrombolysis 2013; 35:352-8. [PMID: 23435703 DOI: 10.1007/s11239-013-0895-y] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Venous thromboembolism (VTE) is common in patients with sickle cell disease (SCD). The etiology of increased risk of VTE in SCD patients is multifactorial and is related to both traditional factors and SCD-specific factors. Traditional risk factors such as central venous catheters, frequent hospitalization, orthopedic surgeries for avascular necrosis, and pregnancy may lead to increased incidence of VTE in the SCD population. In addition, SCD itself appears to be a hypercoagulable state, and many SCD-specific factors such as thrombophilic defects, genotype and splenectomy may modify the risk of VTE. SCD complications such as acute chest syndrome and pulmonary hypertension may also be related to VTE. Anticoagulation experts should be aware of these factors to help inform prophylaxis and treatment decisions.
Collapse
Affiliation(s)
- Rakhi P Naik
- Department of Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
| | | | | |
Collapse
|
45
|
Nsimba MM, Lami JN, Hayakawa Y, Yamamoto C, Kaji T. Decreased thrombin activity by a Congolese herbal medicine used in sickle cell anemia. JOURNAL OF ETHNOPHARMACOLOGY 2013; 148:895-900. [PMID: 23711829 DOI: 10.1016/j.jep.2013.05.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Revised: 02/13/2013] [Accepted: 05/17/2013] [Indexed: 06/02/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Aqueous extracts from Ceiba pentandra (Malvaceae/Bombacoideae) and Quassia africana (Simaroubaceae) are used as crude medicines for the management of sickle cell anemia (SCA) in the Democratic Republic of Congo (DR Congo). Since it is postulated that the pathogenesis of SCA is associated with an increased blood coagulation activity, the present study is conducted to determine the effect of the two extracts on the coagulation by assessing the thrombin activity and the plasma clotting time. MATERIALS AND METHODS Thrombin activity was measured by chromogenic assay in the presence of the aqueous extracts (10, 100 or 200 µg/ml); and plasma clotting times were measured by activated partial thromboplastin time (APTT) and prothrombin time (PT) in the presence of C. pentandra (10, 100 or 200 µg/ml) and Q. africana (5, 20 or 50 µg/ml). RESULTS Reduced thrombin activity and prolonged plasma clotting time measured by APTT were observed in the presence of C. pentandra extract only. However, plasma clotting time measured by PT was not modified by the use of the two extracts. CONCLUSIONS This study suggests that the aqueous extract of C. pentandra may contain active components that reduce the thrombin activity and prolong the plasma clotting time by affecting the coagulation intrinsic pathway.
Collapse
Affiliation(s)
- Marie Miezi Nsimba
- Organization for Frontier Research, Department of Environmental Health, Faculty of Pharmaceutical Sciences, Hokuriku University, Ho-3 Kanazawa-machi, Kanazawa 920-1181, Japan
| | | | | | | | | |
Collapse
|
46
|
Naik RP, Streiff MB, Haywood C, Nelson JA, Lanzkron S. Venous thromboembolism in adults with sickle cell disease: a serious and under-recognized complication. Am J Med 2013; 126:443-9. [PMID: 23582935 PMCID: PMC3627211 DOI: 10.1016/j.amjmed.2012.12.016] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/17/2012] [Accepted: 12/28/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sickle cell disease is recognized as a hypercoagulable state; however, the frequency and characteristics of venous thromboembolism in sickle cell patients have not been well defined. The purpose of this study was to establish the prevalence and risk factors for venous thromboembolism in a large cohort of patients with sickle cell disease and determine the relationship between venous thromboembolism and mortality. METHODS We performed a cross-sectional study of 404 sickle cell disease patients cared for at the Sickle Cell Center for Adults at Johns Hopkins. Demographic, sickle cell disease-specific comorbidity, and venous thromboembolism data were collected on all patients. RESULTS One hundred one patients (25%) had a history of venous thromboembolism with a median age at diagnosis of 29.9 years. A history of non-catheter-related venous thromboembolism was found in 18.8% of patients. Sickle variant genotypes conferred a higher risk of non-catheter-related venous thromboembolism compared with sickle cell anemia genotypes (SS/Sβ(0)) (relative risk [RR] 1.77; 95% confidence interval [CI], 1.18-2.66). Tricuspid regurgitant jet velocity ≥2.5 m/s also was associated with non-catheter-related venous thromboembolism (RR 1.65; 95% CI, 1.12-2.45). Thirty patients (7.4%) died during the study period. Adjusting for all variables, non-catheter-related venous thromboembolism was independently correlated with death (RR 3.63; 95% CI, 1.66-7.92). CONCLUSION Venous thromboembolism is common in adults with sickle cell disease. Sickle variant genotypes and tricuspid regurgitant jet velocity ≥2.5 m/s are associated with non-catheter-related venous thromboembolism. In addition, non-catheter-related venous thromboembolism appears to be an independent risk factor for death in our cohort. These results suggest that disease-specific prophylaxis and treatment strategies for venous thromboembolism should be investigated in sickle cell disease patients.
Collapse
Affiliation(s)
- Rakhi P Naik
- Department of Medicine, Division of Hematology, Johns Hopkins University, Baltimore, MD 21205, USA.
| | | | | | | | | |
Collapse
|
47
|
Sparkenbaugh E, Pawlinski R. Interplay between coagulation and vascular inflammation in sickle cell disease. Br J Haematol 2013; 162:3-14. [PMID: 23593937 DOI: 10.1111/bjh.12336] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sickle cell disease is the most common inherited haematological disorder that leads to the irreversible damage of multiple organs. Although sickling of red blood cells and vaso-occlusion are central to the pathophysiology of sickle cell disease, the importance of haemolytic anaemia and vasculopathy has been recently recognized. A hypercoagulable state is another prominent feature of sickle cell disease and is mediated by activation of both intrinsic and extrinsic coagulation pathways. Growing evidence demonstrates that coagulation may not only contribute to the thrombotic complications, but also to vascular inflammation associated with this disease. This article summarizes the role of vascular inflammation and coagulation activation, discusses potential mechanisms responsible for activation of coagulation and reviews recent data demonstrating the crosstalk between coagulation and vascular inflammation in sickle cell disease.
Collapse
Affiliation(s)
- Erica Sparkenbaugh
- Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, NC 27599, USA
| | | |
Collapse
|
48
|
Setty BNY, Key NS, Rao AK, Gayen-Betal S, Krishnan S, Dampier CD, Stuart MJ. Tissue factor-positive monocytes in children with sickle cell disease: correlation with biomarkers of haemolysis. Br J Haematol 2012; 157:370-80. [PMID: 22360627 PMCID: PMC3323750 DOI: 10.1111/j.1365-2141.2012.09065.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Accepted: 01/16/2012] [Indexed: 02/02/2023]
Abstract
Tissue Factor (TF) initiates thrombin generation, and whole blood TF (WBTF) is elevated in sickle cell disease (SCD). We sought to identify the presence of TF-positive monocytes in SCD and their relationship with the other coagulation markers including WBTF, microparticle-associated TF, thrombin-antithrombin (TAT) complexes and D-dimer. Whether major SCD-related pathobiological processes, including haemolysis, inflammation and endothelial activation, contribute to the coagulation abnormalities was also studied. The cohort comprised children with SCD (18 HbSS, 12 HbSC, mean age 3·6 years). We demonstrated elevated levels of TF-positive monocytes in HbSS, which correlated with WBTF, TAT and D-dimer (P = 0·02 to P = 0·0003). While TF-positive monocytes, WBTF, TAT and D-dimer correlated with several biomarkers of haemolysis, inflammation and endothelial activation in univariate analyses, in multiple regression models the haemolytic markers (reticulocytes and lactate dehydrogenase) contributed exclusively to the association with all four coagulant markers evaluated. The demonstration that haemolysis is the predominant operative pathology in the associated perturbations of coagulation in HbSS at a young age provides additional evidence for the early use of therapeutic agents, such as hydroxycarbamide to reduce the haemolytic component of this disease.
Collapse
Affiliation(s)
- B N Yamaja Setty
- Division of Research Haematology, Department of Pediatrics, Marian Anderson Comprehensive Sickle Cell Anaemia Care and Research Centre, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA.
| | | | | | | | | | | | | |
Collapse
|
49
|
Weitz IC, Razavi P, Rochanda L, Zwicker J, Furie B, Manly D, Mackman N, Green R, Liebman HA. Eculizumab therapy results in rapid and sustained decreases in markers of thrombin generation and inflammation in patients with PNH independent of its effects on hemolysis and microparticle formation. Thromb Res 2012; 130:361-8. [PMID: 22542362 DOI: 10.1016/j.thromres.2012.04.001] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 03/28/2012] [Accepted: 04/03/2012] [Indexed: 12/28/2022]
Abstract
Paroxysmal Nocturnal Hemoglobinuria (PNH) is a clonal bone marrow disorder which results in the loss of glycosylphosphatidyl inositol (GPI) anchors from cell membranes. As a consequence, membrane inhibitors of complement are lost rendering the cells more susceptible to complement mediated destruction. This results in hemolysis, leukopenia, thrombocytopenia and thrombophilia. Eculizumab, a monoclonal antibody to complement protein 5, has been approved for the treatment of PNH and is associated with a significant reduction in hemolysis, thromboembolic events and fatigue. We prospectively studied the effect of Eculizumab therapy on plasma markers of thrombin generation (D-Dimers, TAT), inflammation (IL-6), soluble P-selectin (sP-selectin), antigenic (TFMP) and functional (fTFMP) tissue factor bearing microparticles and total plasma microparticle ex vivo factor Xa generation (MPFXa) in eleven Eculizumab naive PNH patients. Blood sampling occurred day 1, prior to Eculizumab treatment, then on days 8,15,22,29, 43, 90. Our results demonstrate a statistically significant reduction in D-Dimer, TAT, IL-6, sP-selectin, and TFMP during the induction phase of treatment (day 1-29) which was sustained during the maintenance treatment (day 29-90). Although the serum LDH levels decreased rapidly, there was no correlation between the change in LDH and the markers of thrombin generation and inflammation. Although there was a statistically significant decrease in TFMP, this decrease did not correlate with changes in markers of thrombin generation or inflammation. Ex vivo MPFXa generation did not decrease with Eculizumab treatment suggesting continued microparticle formation despite inhibition of hemolysis. Ex vivo total microparticle FXa generation was found to have an inverse correlation with markers of thrombin generation, suggesting that in PNH patients in vivo thrombin generation occurs by a pathway independent of hemolysis and microparticle generation.
Collapse
Affiliation(s)
- Ilene C Weitz
- Department of Medicine, University of Southern California-Keck School of Medicine, Los Angeles 90033, CA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Piccin A, Murphy C, Eakins E, Kinsella A, McMahon C, Smith OP, Murphy WG. Protein C and free protein S in children with sickle cell anemia. Ann Hematol 2012; 91:1669-71. [PMID: 22434279 DOI: 10.1007/s00277-012-1447-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Accepted: 03/05/2012] [Indexed: 10/28/2022]
|