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Cohen RT, Burrowes SAB, Williams CJ, Neri CM, Klings ES, Jones KC, Walkey AJ, Drainoni ML. SNAP: Supportive non-invasive ventilation for acute chest syndrome prevention for hospitalized children with sickle cell disease: Perspectives of patients, parents, and the healthcare team. Pediatr Blood Cancer 2024; 71:e31142. [PMID: 38896013 DOI: 10.1002/pbc.31142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024]
Abstract
RATIONALE Acute chest syndrome (ACS) often develops during hospitalizations for sickle cell disease (SCD) vaso-occlusive episodes and may be triggered by a combination of chest wall splinting, opioid use, hypoventilation, and atelectasis. In 2017, Boston Medical Center's general pediatric inpatient unit instituted the novel use of bi-level positive airway pressure (BiPAP) as "supportive non-invasive ventilation for ACS prevention" (SNAP) to prevent ACS and respiratory decompensation. OBJECTIVE The goals of this qualitative study were to identify perceived benefits, harms, facilitators, and barriers to use of SNAP. METHODS We conducted semi-structured key informant interviews at three sites with different levels of SNAP implementation (Site 1: extensive implementation; Site 2: limited implementation; Site 3: not yet implemented) regarding experiences with and/or perceptions of SNAP. Interviews and coding were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework. RESULTS Thirty-four participants (physicians, nurses, respiratory therapists, child life specialists, psychologists, youth with SCD, and parents) completed interviews. Major themes included: (i) participants perceive BiPAP as effective at preventing ACS, and for those with medically stable ACS, for preventing respiratory decompensation. (ii) BiPAP use is appropriate on the general pediatric inpatient unit for medically stable patients with SCD. (iii) Improving the patient experience is the most important factor to optimize acceptance of BiPAP by patients and families. CONCLUSION/FUTURE DIRECTIONS SNAP is perceived as effective and appropriate for hospitalized pediatric patients with SCD. Improving the patient experience is the biggest challenge. These data will inform a future protocol for a multicenter hybrid effectiveness/implementation trial of SNAP.
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Affiliation(s)
- Robyn T Cohen
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
- Sickle Cell Disease Center of Excellence, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Shana A B Burrowes
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- Evans Center for Implementation and Improvement Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Christopher J Williams
- Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Caitlin M Neri
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
- Sickle Cell Disease Center of Excellence, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Elizabeth S Klings
- Sickle Cell Disease Center of Excellence, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- Pulmonary Center, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Kayla C Jones
- Evans Center for Implementation and Improvement Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Allan J Walkey
- Division of Health Systems Science, UMass Chan Medical School, Worcester, Massachusetts, USA
| | - Mari-Lynn Drainoni
- Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- Evans Center for Implementation and Improvement Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Gillespie M, Afolabi-Brown O, Machogu E, Willen S, Kopp BT. Updates in Pediatric Sickle Cell Lung Disease. Clin Chest Med 2024; 45:749-760. [PMID: 39069335 DOI: 10.1016/j.ccm.2024.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024]
Abstract
Sickle cell lung disease presents a challenging care paradigm involving acute and chronic lower airway disease, sleep-disordered breathing, pulmonary vascular disease, and modification by environmental factors. Understanding the presentation, pathophysiology, and diagnostic approaches is essential for accurate identification and management. While significant progress has been made, there remains a need for research to develop effective treatments and interventions to decrease disease burden in these children. Additionally, the long-term impact of interventions on cardiopulmonary outcomes is unknown. Collaborative efforts among health care providers, researchers, advocacy groups, and policy makers are crucial to improving the lives of children with SCD.
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Affiliation(s)
- Michelle Gillespie
- Division of Pulmonary Medicine, The Ohio State University Wexner Medical Center, Nationwide Children's Hospital, 2050 Kenny Road, Suite 2200, Columbus, OH, USA
| | - Olufunke Afolabi-Brown
- Division of Pulmonary and Sleep Medicine, Children' Hospital of Philadelphia, 3500 Civic Center Boulevard, Philadelphia, PA, USA
| | - Evans Machogu
- Division of Pediatric Pulmonary, Allergy and Sleep Medicine, Riley Hospital for Children, Indiana University School of Medicine, 705 Riley Hospital, ROC 4270 Indianapolis, IN 46202, USA
| | - Shaina Willen
- Division of Pulmonology, Department of Pediatrics, UC Davis Medical Center, 2516 Stockton Boulevard, Sacramento, CA, USA; Division of Hematology/Oncology, Department of Pediatrics, UC Davis Medical Center, 2516 Stockton Boulevard, Sacramento, CA, USA
| | - Benjamin T Kopp
- Division of Pulmonology, Asthma, Cystic Fibrosis, and Sleep, Emory Children's Center, 2015 Uppergate Drive, Atlanta, GA 30322, USA; Children's Healthcare of Atlanta, Emory Children's Center, 2015 Uppergate Drive, Atlanta, GA 30322, USA.
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Aol PM, Fahdil G, Bongomin F, Okello B, Batte C, Kirenga BJ, Nantanda R, Aanyu HT. Prevalence, patterns, and factors associated with abnormal lung function among children with sickle cell disease in Uganda: a cross-sectional study. BMC Pediatr 2024; 24:516. [PMID: 39127673 DOI: 10.1186/s12887-024-04988-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/01/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Pulmonary complications are common among children with sickle cell disease (SCD). However, there is little literature on associated lung function abnormalities in Uganda. We aimed to determine the prevalence, patterns, and factors associated with abnormal lung function among children with SCD in a tertiary care hospital in Uganda. METHOD A cross-sectional study was conducted among children aged 6 to 18 years at the SCD clinic (SCC) of Mulago National Super-Specialized Hospital between January 2020 and April 2021. Data on sociodemographic and clinical characteristics was collected using a standardized questionnaire. Laboratory investigations, including a complete blood count and serum lactate dehydrogenase (LDH), were done. Spirometry was performed following the ATS/ERS standards. Multivariable modified Poisson regression analysis was performed to determine factors associated with abnormal lung function. RESULTS A total of 332 participants were enrolled. The mean age was 11.7 ± 3.4 years, and 184 (55.4%) were female. Overall, 126 (37.9%) participants had abnormal lung function: 67/126 (53.2%) restrictive, 57/126 (45.2%) obstructive, and 2/126 (1.6%) mixed-ventilatory patterns. Factors associated with abnormal lung function were; serum LDH level > 600UL (aIRR: 1.89 95% CI: 1.2 - 7.4, p = 0.049), a history of acute chest syndrome (aIRR: 1.55, 95% CI: 1.06-2.25, p = 0.024), wasting (aIRR: 1.33, 95%CI: 1.02 - 1.72, p = 0.032), and use of charcoal for household cooking (aIRR: 1.49, 95% CI: 1.03-2.15, p = 0.035). CONCLUSION More than one-third of children with SCD in Uganda have lung function abnormalities. Strategies to improve nutrition, reduce exposure to charcoal smoke, and monitoring serum LDH levels may be important in preventing or managing abnormal lung function in this population. The identification of reversible and irreversible airway obstruction in children with sickle cell disease also highlights the need for targeted interventions to address these specific patterns of abnormal lung function.
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Affiliation(s)
- Pamella Mwa Aol
- Department of Paediatrics and Child Health, St. Mary's Hospital Lacor, Gulu, Uganda
| | - Geriga Fahdil
- Uganda Cancer Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Felix Bongomin
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Gulu University, Gulu, Uganda
| | - Bonny Okello
- Department of Planning, Kwania District Local Government, Kwania, Uganda
| | - Charles Batte
- College of Health Sciences, Makerere University Lung Institute, Makerere University Kampala, Kampala, Uganda
| | - Bruce J Kirenga
- College of Health Sciences, Makerere University Lung Institute, Makerere University Kampala, Kampala, Uganda
| | - Rebecca Nantanda
- College of Health Sciences, Makerere University Lung Institute, Makerere University Kampala, Kampala, Uganda.
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4
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Yates AM, Aygun B, Nuss R, Rogers ZR. Health Supervision for Children and Adolescents With Sickle Cell Disease: Clinical Report. Pediatrics 2024; 154:e2024066842. [PMID: 39034826 DOI: 10.1542/peds.2024-066842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 07/23/2024] Open
Abstract
Sickle cell disease (SCD) is a group of complex genetic disorders of hemoglobin with multisystem manifestations. The scope of this clinical report is such that in-depth recommendations for management of all complications is not possible. Rather, the authors present an overview focused on the practical management of children and adolescents with SCD and the complications that are of particular relevance to pediatric primary care providers. References with detailed commentary provide further information. Timely and appropriate treatment of acute illness is critical, because life-threatening complications may develop rapidly. Specialized comprehensive medical care decreases morbidity and mortality during childhood. The provision of comprehensive care is a time-intensive endeavor that includes ongoing patient and family education, periodic comprehensive evaluations and other disease-specific health maintenance services, nursing support, psychosocial care, and genetic counseling. Ideally, this care includes comanagement by the pediatrician or other pediatric primary care provider and a team of specialist SCD experts: Hematologist, other pediatric specialists, advanced practice providers, nurse specialists, social workers, patient navigators, and educational liaisons.
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Affiliation(s)
- Amber M Yates
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | | | - Rachelle Nuss
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Zora R Rogers
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Heath, Dallas, Texas
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Raza M, Alshehri SS, Pasha MR. A child with sickle cell disease admitted with coronavirus disease 2019 pneumonia and acute chest syndrome in pediatric intensive care unit: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241266436. [PMID: 39071200 PMCID: PMC11282508 DOI: 10.1177/2050313x241266436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 06/14/2024] [Indexed: 07/30/2024] Open
Abstract
Management of sickle cell disease complications in the setting of the coronavirus disease 2019 (COVID-19) pandemic is complicated with little published pediatric data. We report the first documented case of a 9-year-old boy with sickle cell disease, presenting with fever, cough, and shortness of breath, diagnosed to have acute chest syndrome and coronavirus disease 2019 (COVID-19) pneumonia with inflammatory storm requiring ventilation, exchange blood transfusion, immunomodulatory agents, and prophylactic anticoagulation. The patient responded satisfactorily to the management of the acute illness and was found to be well at the next visit to the pediatric hematology outpatient department following hospital discharge.
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Affiliation(s)
- Mohammad Raza
- Pediatric Intensive Care Unit, Tawam Hospital, Al Ain, UAE
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Mayrand L, Elie J, Pinhas Y, Rignault-Bricard R, Taylor M, Brice J, de Montalembert M, Heilbronner C, Beranger A, Angyalosy S, Chhun S, Maciel TT, Hermine O, Allali S. Sputum interleukin-6 level as a marker of severity during acute chest syndrome in children with sickle cell disease. Br J Haematol 2024; 205:329-334. [PMID: 38783629 DOI: 10.1111/bjh.19561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
Acute chest syndrome (ACS) is a leading cause of morbimortality in sickle cell disease (SCD). In this prospective observational study, we investigated sputum interleukin-6 (IL-6) level as an ACS severity marker during 30 ACS episodes in 26 SCD children. Sputum IL-6 levels measured within the first 72 h of hospitalisation for ACS were significantly higher in patients with oxygen requirement ≥2 L/min, ventilation (invasive and/or non-invasive) length ≥5 days, bilateral and/or extensive opacities on chest X-ray or erythrocytapheresis requirement. Sputum IL-6 could serve as an ACS severity marker to help identify patients requiring targeted anti-inflammatory treatments such as tocilizumab.
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Affiliation(s)
- Lara Mayrand
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Imagine Institute, Inserm U1163, Université Paris Cité, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Juliette Elie
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Imagine Institute, Inserm U1163, Université Paris Cité, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Yael Pinhas
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Rachel Rignault-Bricard
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Imagine Institute, Inserm U1163, Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Melissa Taylor
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Joséphine Brice
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Mariane de Montalembert
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Claire Heilbronner
- Department of Pediatric Intensive Care, Necker-Enfants Malades Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Agathe Beranger
- Department of Pediatric Intensive Care, Necker-Enfants Malades Hospital, AP-HP, Université Paris Cité, Paris, France
- URP7323 Pharmacologie et évaluation des thérapeutiques chez l'enfant et la femme enceinte, Université Paris Cité, Paris, France
| | - Sofia Angyalosy
- Department of Pediatric Intensive Care, Necker-Enfants Malades Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Stephanie Chhun
- Laboratory of Immunology, Necker-Enfants Malades Hospital, AP-HP, INEM Institute, Inserm U1151, Université Paris Cité, Paris, France
| | - Thiago Trovati Maciel
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Imagine Institute, Inserm U1163, Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
| | - Olivier Hermine
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Imagine Institute, Inserm U1163, Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
- Department of Hematology, Necker-Enfants Malades Hospital, AP-HP, Université Paris Cité, Paris, France
- Reference Center for Mastocytosis, Necker-Enfants Malades Hospital, AP-HP, Paris, France
| | - Slimane Allali
- Laboratory of Cellular and Molecular Mechanisms of Hematological Disorders and Therapeutical Implications, Imagine Institute, Inserm U1163, Université Paris Cité, Paris, France
- Department of General Pediatrics and Pediatric Infectious Diseases, Sickle Cell Center, Necker-Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
- Laboratory of Excellence GR-Ex, Paris, France
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Hamdy M, Shaheen IA, Khallaf M, Selim YMM. Thrombin activatable fibrinolysis inhibitor plasma levels and TAFI Thr325Ile genetic polymorphism in a cohort of Egyptian sickle cell disease patients and impact on disease severity. Pediatr Blood Cancer 2024; 71:e30959. [PMID: 38520679 DOI: 10.1002/pbc.30959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/07/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Thrombin is a critical protease modulating thrombosis as well as inflammation, which are one of the main pathophysiological mechanisms in sickle vasculopathy, and its levels were reported to be high in sickle cell disease (SCD). The thrombin-thrombomodulin complex activates the TAFI inhibitor of fibrinolysis, which acts by reducing plasmin affinity for its substrate thus hindering fibrinolysis. OBJECTIVE We aimed to determine the influence of the Thr325Ile single nucleotide polymorphism (SNP) on TAFI antigen levels and potential effects on the severity of SCD in a cohort of Egyptian patients. METHODS Genotyping of Thr325lle polymorphism using Taq-Man SNP genotyping assay and TAFI level measurement using an enzyme-linked immunosorbent assay were performed for 80 SCD patients (45 homozygous HbSS, 16 S/β0 and 19 Sβ+) as well as 80 age- and gender-matched healthy control subjects. RESULTS Plasma TAFI levels were higher in SCD patients with Thr325Ile polymorphism, yet the difference was not statistically significant (p = .204). SCD patients with polymorphic genotypes had a greater number of hospital admissions (p = .03). Ten patients with acute chest syndrome had the homozygous polymorphic genotype (GG), and all patients with pulmonary hypertension had the polymorphic genotype (six were homozygous [GG] and five were heterozygous [GA]). Patients with SCD complicated with pulmonary hypertension showed significantly higher plasma TAFI levels (p = .044). CONCLUSION The analysis of Thr325Ile polymorphisms combined with plasma TAFI levels suggests that the analyzed SNP could influence plasma TAFL levels and SCD disease severity and hospitalization rates, which could be predictors for complex disease.
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Affiliation(s)
- Mona Hamdy
- Department of Pediatrics, Pediatric Hematology and BMT Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Iman A Shaheen
- Department of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed Khallaf
- Department of Pediatrics, Pediatric Hematology and BMT Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasmeen M M Selim
- Department of Pediatrics, Pediatric Hematology and BMT Unit, Faculty of Medicine, Cairo University, Cairo, Egypt
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Alp G, Oztas Y, Yalcinkaya A, Ozel S, Yildirim N, Unal S. Plasma sphingolipids in patients with sickle cell disease: Multiple-site vaso-occlusive crises could be associated with lower sphingolipid levels. Lipids 2024; 59:75-82. [PMID: 38332401 DOI: 10.1002/lipd.12389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/10/2024]
Abstract
Although sickle cell disease (SCD) and its manifestations have been associated with various lipid alterations, there are a few studies exploring the impact of sphingolipids in SCD. In this study, we determined plasma ceramide (Cer) and sphingomyelin (CerPCho) species and investigated their association with the crisis in SCD. SCD patients (N = 27) suffering from vaso-occlusive crisis (VOC) or acute chest syndrome (ACS) were involved in this study. Blood samples were drawn at crisis and later at steady state periods. Clinical history, white blood cell count (WBC), C-reactive protein and lactate dehydrogenase (LDH) levels were recorded. 16:0, 18:0, 20:0, 22:0 Cer and 16:0, 18:0, 24:0 CerPCho were measured via LC-MS/MS. All measured Cer and CerPCho levels of SCD patients at crisis and steady-state were found to be similar. Inflammation-related parameters were significantly higher in patients with ACS compared to single-site VOC. Patients with multiple-site VOC were found to have significantly lower sphingolipid levels compared with those with single-site VOC, at crisis (16, 18, 24 CerPCho and 18, 22 Cer) and at steady-state (24:0 CerPCho and 18 Cer). Our results show that sphingolipid levels in SCD patients are similar during crisis and at steady state. However, lower sphingolipid levels appear to be associated with the development of multiple-site VOC. Since the differences were observed at both crisis and steady-state, sphingolipid level could be an underlying factor associated with crisis characteristics in patients with SCD.
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Affiliation(s)
- Gokce Alp
- Faculty of Engineering, Department of Chemical Engineering, Hacettepe University, Ankara, Turkey
| | - Yesim Oztas
- Faculty of Medicine, Department of Medical Biochemistry, Hacettepe University, Ankara, Turkey
| | - Ahmet Yalcinkaya
- Faculty of Medicine, Department of Medical Biochemistry, Hacettepe University, Ankara, Turkey
| | - Selinay Ozel
- Faculty of Science, Department of Chemistry, Hacettepe University, Ankara, Turkey
| | - Nazim Yildirim
- Faculty of Medicine, Department of Pediatrics Hematology, Mersin University, Mersin, Turkey
| | - Selma Unal
- Faculty of Medicine, Department of Pediatrics Hematology, Mersin University, Mersin, Turkey
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Swed S, Sawaf B, Al-Obeidat F, Hafez W, Rakab A, Alibrahim H, Nasif MN, Alghalyini B, Zia Zaidi AR, Alshareef L, Alqatati F, Zamrath Zahir F, Ahmed AI, Alom M, Sultan A, AlMahmoud A, Bakkour A, Cherrez-Ojeda I. Asthma prevalence among United States population insights from NHANES data analysis. Sci Rep 2024; 14:8059. [PMID: 38580691 PMCID: PMC10997649 DOI: 10.1038/s41598-024-58429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
Asthma is a prevalent respiratory condition that poses a substantial burden on public health in the United States. Understanding its prevalence and associated risk factors is vital for informed policymaking and public health interventions. This study aims to examine asthma prevalence and identify major risk factors in the U.S. POPULATION Our study utilized NHANES data between 1999 and 2020 to investigate asthma prevalence and associated risk factors within the U.S. POPULATION We analyzed a dataset of 64,222 participants, excluding those under 20 years old. We performed binary regression analysis to examine the relationship of demographic and health related covariates with the prevalence of asthma. The study found that asthma affected 8.7% of the U.S. POPULATION Gender emerged as a significant factor, with 36.0% of asthma patients being male and 64.0% female (p < 0.001). Individuals aged 60 and older having the highest asthma prevalence at 34.0%. Non-Hispanic whites had the highest prevalence at 46.4%, followed by non-hispanic blacks at 26.0%. In contrast, Mexican Americans and other hispanic individuals had lower rates, at 9.6% and 9.0%, respectively. Females were 1.76 times more likely to have asthma than males (p < 0.001). Obese individuals had a 1.74 times higher likelihood of current asthma compared to underweight individuals (p < 0.001). Notably, both Non-Hispanic Whites and Non-Hispanic Blacks showed higher odds of current asthma compared to Mexican Americans (with adjusted odds ratios of 2.084 and 2.096, respectively, p < 0.001). The research findings indicate that asthma is prevalent in 8.7% of the U.S. POPULATION Our study highlights that individuals who are female, have low income, are obese, and smoke have the highest likelihood of being affected by asthma. Therefore, public health policies should prioritize addressing these risk factors in their preventive strategies.
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Affiliation(s)
- Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Feras Al-Obeidat
- Associate Professor at the College of Technological Innovation at Zayed University, Abu Dhabi - Khalifa City, FF2-0-032; Abu Dhabi Campus, Abu Dhabi, UAE
| | - Wael Hafez
- NMC Royal Hospital, 16Th Street, Khalifa City, Abu Dhabi, UAE
- Assistant Professor; Internal Medicine Department, Medical Research and Clinical Studies Institute,, The National Research Centre, 33 El Buhouth St, Ad Doqi, Dokki, Cairo Governorate 12622, Cairo, Egypt
| | | | | | | | - Baraa Alghalyini
- Department of Family and Community Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdul Rehman Zia Zaidi
- Department of Family and Community Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Fadel Alqatati
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Mulham Alom
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Anas Sultan
- Department of Internal Medicine, Pulmonary Division, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Abdullah AlMahmoud
- Internal Medicine, Gastroenterology, Hepatology; Dr. Soliman Fakeeh Hospital (DSFH), Jeddah, Saudi Arabia
| | | | - Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Ecuador
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10
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Alghamdi FA, Al-Kasim F, Alshhada F, Ghareeb E, Azmet FR, Almudaibigh A, Baitalmal L, Alnawfal B, Alluqmani R. Risk factors for acute chest syndrome among children with sickle cell anemia hospitalized for vaso-occlusive crises. Sci Rep 2024; 14:5978. [PMID: 38472301 DOI: 10.1038/s41598-023-48527-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 03/14/2024] Open
Abstract
Sickle cell anemia (SCA) is a globally prevalent inherited condition, with acute chest syndrome (ACS) being one of its most severe complications. ACS frequently leads to hospitalization, requires intensive care unit (ICU) admission, and can even result in death. This study aimed to discern the early indicators of impending ACS in children with SCA who were initially hospitalized due to painful vaso-occlusive crises (VOC). This was a retrospective, case‒control investigation of 120 patients aged 1-14 years seen at the King Saud Medical City in Riyadh, Saudi Arabia from January 2021 to December 2022. Patients were classified into cases and controls: those who developed and did not develop ACS during hospital stay, respectively. Demographic factors, laboratory results, vital and clinical signs, and treatment protocols were compared between these groups. The following were significant predictors of impending ACS: previous diagnosis of asthma, history of ACS, recent upper respiratory tract symptoms prior to admission, and need for a blood transfusion within the first 24 h of admission due to a drop in hemoglobin levels. Further regression analysis indicated that elevated steady-state mean corpuscular volume, leukocyte count, total bilirubin, and an increased absolute neutrophil count level 24 h after admission also foreshadowed impending ACS among patients admitted for VOC. The location of pain was also significant; the incidence of ACS was higher in patients with back pain, but lower in those with pain confined to the limbs. The ACS group had a longer average duration of hospital stay compared to those with VOC alone, (7.6 vs. 5.8 days). Among patients initially admitted for VOC, 15.7% were diagnosed with ACS. Most ACS cases were managed with transfusions and antibiotics, and nearly one-third of patients needed admission to an ICU or a high-dependency area.
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Affiliation(s)
- Faisal A Alghamdi
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia.
| | - Fawaz Al-Kasim
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Forat Alshhada
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
- Medical Specialized Center, Riyadh, Saudi Arabia
| | - Eatedal Ghareeb
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Fauzia R Azmet
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Adel Almudaibigh
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Lobna Baitalmal
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bedah Alnawfal
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rehab Alluqmani
- Department of Pediatric Hematology and Oncology, King Saud Medical City, Riyadh, Saudi Arabia
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11
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Munaretto V, Corti P, Bertoni E, Tripodi SI, Guerzoni ME, Cesaro S, Arcioni F, Piccolo C, Mina T, Zecca M, Cuzzubbo D, Casale M, Palazzi G, Notarangelo LD, Masera N, Samperi P, Perrotta S, Russo G, Sainati L, Colombatti R. Acute chest syndrome in children with sickle cell disease: Data from a national AIEOP cohort identify priority areas of intervention in a hub-and-spoke system. Br J Haematol 2024; 204:1061-1066. [PMID: 37671902 DOI: 10.1111/bjh.19084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/01/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023]
Abstract
Acute chest syndrome (ACS) is a frequent cause of hospitalization in sickle cell disease (SCD). Despite advances in acute care, many settings still lack knowledge about ACS best practices. After the AIEOP Guidelines were published in 2012, suggesting standardized management in Italy, a retrospective study was performed to assess the diagnostic and therapeutic pathways of ACS in children. From 2013 to 2018, 208 ACS episodes were presented by 122/583 kids in 11 centres. 73 were male, mean age 10.9 years, 85% African, 92% HbSS or Sβ°. In our hub-and-spoke system, a good adherence to Guidelines was documented, but discrepancies between reference centres and general hospitals were noted. Improvement is needed for timely transfer to reference centres, use of incentive spirometry, oxygen therapy and pain management.
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Affiliation(s)
- V Munaretto
- Pediatric Hematology Oncology Unit, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | - P Corti
- Clinica si Onco-Ematologia Pediatrica, Fondazione MBBM Azienda Ospedaliera S. Gerardo, Monza, Italy
| | - E Bertoni
- Clinica di Onco-Ematologia Pediatrica, ASS Spedali Civili di Brescia, Brescia, Italy
| | - S I Tripodi
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M E Guerzoni
- Azienda Ospedaliera-Università di Modena, Modena, Italy
| | - S Cesaro
- Pediatric Hematology-Oncology, Ospedale della Donna e del Bambino, Verona, Italy
| | - F Arcioni
- Clinica di Oncoematologia Pediatrica, Ospedale Santa Maria della Misericordia, Perugia, Italy
| | - C Piccolo
- Clinica di Onco-Ematologia Pediatrica, Ospedale del Ponte, Varese, Italy
| | - T Mina
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - M Zecca
- Pediatric Hematology/Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - D Cuzzubbo
- Clinica di Onco-EmatologiaPediatrica, Azienda Ospedaliero Universitaria Meyer, Florence, Italy
| | - M Casale
- Università degli studi della Campania Luigi Vanvitelli, Naples, Italy
| | - G Palazzi
- Azienda Ospedaliera-Università di Modena, Modena, Italy
| | - L D Notarangelo
- Clinica di Onco-Ematologia Pediatrica, ASS Spedali Civili di Brescia, Brescia, Italy
| | - N Masera
- Clinica si Onco-Ematologia Pediatrica, Fondazione MBBM Azienda Ospedaliera S. Gerardo, Monza, Italy
| | - P Samperi
- Pediatric Hematology/Oncology Unit, Azienda Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - S Perrotta
- Università degli studi della Campania Luigi Vanvitelli, Naples, Italy
| | - G Russo
- Pediatric Hematology/Oncology Unit, Azienda Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy
| | - L Sainati
- Pediatric Hematology Oncology Unit, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
| | - R Colombatti
- Pediatric Hematology Oncology Unit, Department of Woman's and Child's Health, Azienda Ospedale-Università di Padova, Padova, Italy
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12
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Alarcón Sisamón S, Ordás Miguélez MS, López Peña A, Rodríguez Sanz J. Acute Chest Syndrome in a Patient With Sickle Cell Disease: A Case Report. OPEN RESPIRATORY ARCHIVES 2024; 6:100300. [PMID: 38414581 PMCID: PMC10897885 DOI: 10.1016/j.opresp.2024.100300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Affiliation(s)
| | | | - Amaia López Peña
- Hematology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
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13
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Assad Z, Valtuille Z, Rybak A, Kaguelidou F, Lazzati A, Varon E, Pham LL, Lenglart L, Faye A, Caseris M, Cohen R, Levy C, Vabret A, Gravey F, Angoulvant F, Koehl B, Ouldali N. Unique Changes in the Incidence of Acute Chest Syndrome in Children With Sickle Cell Disease Unravel the Role of Respiratory Pathogens: A Time Series Analysis. Chest 2024; 165:150-160. [PMID: 37544426 DOI: 10.1016/j.chest.2023.07.4219] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Acute chest syndrome (ACS) is a life-threatening complication of sickle cell disease (SCD). Although respiratory pathogens are frequently detected in children with ACS, their respective role in triggering the disease is still unclear. We hypothesized that the incidence of ACS followed the unprecedented population-level changes in respiratory pathogen dynamics after COVID-19-related nonpharmaceutical interventions (NPIs). RESEARCH QUESTION What is the respective role of respiratory pathogens in ACS epidemiology? STUDY DESIGN AND METHODS This study was an interrupted time series analysis of patient records from a national hospital-based surveillance system. All children aged < 18 years with SCD hospitalized for ACS in France between January 2015 and May 2022 were included. The monthly incidence of ACS per 1,000 children with SCD over time was analyzed by using a quasi-Poisson regression model. The circulation of 12 respiratory pathogens in the general pediatric population over the same period was included in the model to assess the fraction of ACS potentially attributable to each respiratory pathogen. RESULTS Among the 55,941 hospitalizations of children with SCD, 2,306 episodes of ACS were included (median [interquartile range] age, 9 [5-13] years). A significant decrease was observed in ACS incidence after NPI implementation in March 2020 (-29.5%; 95% CI, -46.8 to -12.2; P = .001) and a significant increase after lifting of the NPIs in April 2021 (24.4%; 95% CI, 7.2 to 41.6; P = .007). Using population-level incidence of several respiratory pathogens, Streptococcus pneumoniae accounted for 30.9% (95% CI, 4.9 to 56.9; P = .02) of ACS incidence over the study period and influenza 6.8% (95% CI, 2.3 to 11.3; P = .004); other respiratory pathogens had only a minor role. INTERPRETATION NPIs were associated with significant changes in ACS incidence concomitantly with major changes in the circulation of several respiratory pathogens in the general population. This unique epidemiologic situation allowed determination of the contribution of these respiratory pathogens, in particular S pneumoniae and influenza, to the burden of childhood ACS, highlighting the potential benefit of vaccine prevention in this vulnerable population.
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Affiliation(s)
- Zein Assad
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France.
| | - Zaba Valtuille
- Centre d'Investigation Clinique, INSERM CIC1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris Cité University, Paris, France
| | - Alexis Rybak
- INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France; Urgences Pédiatriques, Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France; Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France
| | - Florentia Kaguelidou
- Centre d'Investigation Clinique, INSERM CIC1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; EA7323 Perinatal and Pediatric Pharmacology and Therapeutic Assessment, Paris Cité University, Paris, France
| | - Andrea Lazzati
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Centre de Recherche Clinique et Biologique, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Luu-Ly Pham
- INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; Department of General Pediatrics, Jean Verdier University Hospital, Assistance Publique-Hôpitaux de Paris, Bondy, France
| | - Léa Lenglart
- INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; Service d'Accueil des Urgences Pédiatriques, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France
| | - Marion Caseris
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France; Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), St Maur-des-Fossés, France; Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Astrid Vabret
- Department of Virology, Caen University Hospital, Caen, France; Univ Caen Normandie, Univ Rouen Normandie, INSERM UMR 1311, DYNAMICURE, Caen, France
| | - François Gravey
- Univ Caen Normandie, Univ Rouen Normandie, INSERM UMR 1311, DYNAMICURE, Caen, France
| | - François Angoulvant
- Paris Sorbonne University, Centre de Recherche des Cordeliers, INSERM UMRS 1138, Paris, France
| | - Bérengère Koehl
- Department of Child Hematology, Reference Center for Sickle-Cell Disease, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR S1134, Integrated Biology of Red Blood Cells, Paris Cité University, Paris, France
| | - Naïm Ouldali
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; INSERM UMR 1137, Infection, Antimicrobials, Modelling, Evolution (IAME), Paris Cité University, Paris, France; INSERM UMR 1123, ECEVE, Paris Cité University, Paris, France
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14
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Azar SS, Simeone FJ, Jarolimova J, Nussbaum EZ. Case 37-2023: A 29-Year-Old Man with Sickle Cell Disease and Right Hip Pain. N Engl J Med 2023; 389:2088-2096. [PMID: 38048191 DOI: 10.1056/nejmcpc2309497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Affiliation(s)
- Sharl S Azar
- From the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Massachusetts General Hospital, and the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Harvard Medical School - both in Boston
| | - F Joseph Simeone
- From the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Massachusetts General Hospital, and the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Harvard Medical School - both in Boston
| | - Jana Jarolimova
- From the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Massachusetts General Hospital, and the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Harvard Medical School - both in Boston
| | - E Zachary Nussbaum
- From the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Massachusetts General Hospital, and the Departments of Medicine (S.S.A., J.J.), Radiology (F.J.S.), and Pathology (E.Z.N.), Harvard Medical School - both in Boston
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15
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Campbell A, Rizio AA, McCausland KL, Iorga S, Yen GP, Paulose J, Lee S. The Burden of Sickle Cell Disease on Children and Their Caregivers: Caregiver Reports of Children's Health-Related Quality of Life and School Experiences, Caregiver Burden, and Their Association with Frequency of Vaso-Occlusive Crises. Patient Relat Outcome Meas 2023; 14:369-381. [PMID: 38046665 PMCID: PMC10693247 DOI: 10.2147/prom.s419607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 10/28/2023] [Indexed: 12/05/2023] Open
Abstract
Background Children with sickle cell disease (SCD) experience a multiplex of disease-related symptoms and complications, including vaso-occlusive crises (VOCs), episodes characterized by extreme pain. Methods A cross-sectional observational survey examined the health-related quality of life (HRQoL) and school experiences of children with SCD 2 months-11 years, burden experienced by their caregivers, and associations between these outcomes and VOC frequency. Caregivers (N=167) of children with SCD in the US completed the Infant-Toddler Quality of Life-Short Form 47 (ITQoL-SF47) for children 2 months-4 years, the Child Health Questionnaire-Parent Form 50 (CHQ-PF50) and PROMIS Pain Interference and Sleep Disturbance Parent Proxy short forms for children 5-11 years, and a study-specific survey of school experiences. Results Children with SCD 2 months-4 years had lower ITQoL-SF47 scores (ie, worse HRQoL, p<0.001) than a normative sample of children; across domains, differences ranged from 18.73-45.03 points and exceeded minimal important difference (MID) thresholds. Except for the behavior domain, children with SCD 5-11 years had lower scores on all CHQ-PF50 domains than the normative sample (p<0.001); differences ranged from 6.78-36.37 points and exceeded MID thresholds. Children with more frequent VOCs had lower HRQoL and worse school experiences than children with less frequent VOCs (p<0.05, except for behavior domains). The largest differences based on VOC frequency were observed for overall health and bodily pain/discomfort among children 2 months-4 years (differences=40.88 and 32.50 points, respectively), and bodily pain and role/social limitations due to physical health among children 5-11 years (differences=38.99 and 37.80, respectively). Caregivers of children with more frequent VOCs experienced greater burden than caregivers of children with less frequent VOCs, though specific areas of impact (eg, caregiver emotions, time) differed across child age groups. Conclusion VOC frequency is negatively associated with HRQoL, highlighting the burden experienced by children with SCD and their caregivers.
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Affiliation(s)
| | | | | | - Serban Iorga
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Glorian P Yen
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Jincy Paulose
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | - Soyon Lee
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
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16
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Jacob SA, Talati R, Kanter J. The evolving treatment landscape for children with sickle cell disease. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:797-808. [PMID: 37858508 DOI: 10.1016/s2352-4642(23)00201-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 10/21/2023]
Abstract
Sickle cell disease is the most common inherited pathological haemoglobinopathy. Over the past 30 years, disease-related morbidity and mortality have improved in high-income countries due to advances in preventive care and treatments. Established disease-modifying therapies, such as hydroxyurea (hydrocarbamide), are continuing to have an important role in the treatment of sickle cell disease, and newer agents also show promise. In the past 5 years, the US Food and Drug Administration approved three additional sickle cell disease-modifying medications, and new gene therapies have been developed as an alternative curative treatment to haematopoietic stem-cell transplantation. In this Review, we discuss the current treatment landscape for paediatric sickle cell disease and emerging innovations in care. We also review the need for close, long-term management for children receiving newer therapies and the importance of ongoing investment in people with sickle cell disease in low-income and middle-income countries.
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Affiliation(s)
- Seethal A Jacob
- Division of Pediatric Hematology Oncology, Riley Hospital for Children, Indianapolis, IN, USA
| | - Ravi Talati
- Division of Pediatric Hematology, Oncology & Blood/Marrow Transplantation, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
| | - Julie Kanter
- Lifespan Comprehensive Sickle Cell Center, University of Alabama, Birmingham, AL, USA.
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17
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Alshehri A, Alfadhel A, AlZahrani A, Alqahtani Y, Al Qahtani A. Elective Laparoscopic Cholecystectomy Complicated by Hemorrhagic Crisis in a Patient With Sickle Cell Disease. Cureus 2023; 15:e49502. [PMID: 38161830 PMCID: PMC10756027 DOI: 10.7759/cureus.49502] [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] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Sickle cell disease (SCD) is a common genetic disorder associated with complications such as cholelithiasis. Cholecystectomy is often performed in SCD patients, but they have a higher risk of postoperative complications. Blood transfusion, while beneficial, can also have adverse effects. The optimal approach to perioperative transfusion in SCD patients is still debated. This case report presents a rare surgical presentation of gallbladder stones in an SCD patient complicated by a hemolysis crisis and bleeding after laparoscopic cholecystectomy. A 24-year-old SCD patient with symptomatic gallbladder stones underwent laparoscopic cholecystectomy. Preoperative exchange transfusions were done to optimize hemoglobin and hemoglobin S (HbS) levels. Postoperatively, the patient experienced abdominal pain, tachycardia, and hypotension, indicating a possible hemolysis versus hemorrhagic crisis. Supportive management started but patient was still not improving and persisted to be tachycardic and hypotensive and laboratory results showed a drop in hemoglobin level (4.7 g/dL) and low platelets. A massive transfusion was activated and the patient received four units of packed red blood cells, four units of platelet and four units of fresh frozen plasma, but bleeding persisted. Laparoscopic exploration was done and oozing from liver bed was controlled and shifted again to surgical intensive care unit. Unfortunately, the next day, patient again experienced rebleeding which mandating laparoscopic converted to open laparotomy, and multiple sites of ongoing bleeding were identified and controlled with liver packing. The patient required subsequent interventions, including additional transfusions and second look and abdominal closure. After several days of intensive care, the patient's condition improved, and he was discharged with follow-up arrangements. Optimal management of surgical cases in SCD patients necessitates a multidisciplinary approach and personalized perioperative care. Preoperative transfusion should be tailored based on risk factors and the procedure. Standardized protocols and guidelines are needed to enhance perioperative management and outcomes. Prioritizing perioperative care can help mitigate complications and improve results for SCD patients undergoing surgery. Further research is required in this area.
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Affiliation(s)
- Abdulaziz Alshehri
- Department of General Surgery, King Fahad Military Medical Complex, Jeddah, SAU
| | - Anwar Alfadhel
- Department of General Surgery, King Fahad Military Medical Complex, Jeddah, SAU
| | - Abdullah AlZahrani
- Department of General Surgery, King Fahad Military Medical Complex, Jeddah, SAU
| | - Yousif Alqahtani
- Department of General Surgery, King Fahad Military Medical Complex, Jeddah, SAU
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18
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Dubois G, Virot E, Marie M, Poutrel S, Cannas G, Hot A. Impact of COVID-19 on incidence, clinical presentation, and prognosis of acute chest syndrome in patients with sickle cell disease. EJHAEM 2023; 4:970-976. [PMID: 38024591 PMCID: PMC10660110 DOI: 10.1002/jha2.768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/01/2023] [Accepted: 08/02/2023] [Indexed: 12/01/2023]
Abstract
Acute chest syndrome (ACS) is a frequent complication of sickle cell disease (SCD). Because coronavirus disease 2019 (COVID-19) increases mortality and morbidity in many diseases, we retrospectively analyzed the impact of SARS-CoV-2 infection on the incidence, the clinical presentation, and the prognosis of ACS in patients with SCD by comparing ACS episode before and during COVID-19 pandemic. Ninety-nine episodes of ACS were registered over 24 months before pandemic versus 81 episodes over 24 months during the pandemic period. The number of ACS episodes varies among children regarding the two period of time: 26 episodes (26%) for the pre-pandemic period versus 11 episodes (13%) for the pandemic period (p = 0.03). Comparisons between adults and children showed a higher incidence of initial VOC (45% vs. 24%; p = 0.04) in adults, and a higher incidence of initial pneumonia (35% vs. 15%; p = 0.01) and documented infection (35% vs. 7%; p < 0.001) in children. One patient died during the pandemic period but without any relationship with ACS or COVID-19. During this pandemic period, 13 episodes of ACS (16%) were found related to coronavirus infection. These ACS episodes did not show any significant differences in terms of outcome when compared to the other ACS episodes observed during this period. Overall, coronavirus infection did not demonstrate a negative impact on incidence, clinical presentation, and outcome of ACS in patients with SCD. Early management, chronic treatment with HU, and exchange transfusions could likely explain the low morbidity and mortality rates.
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Affiliation(s)
- Gabin Dubois
- Emergency Department, Hospices Civils de LyonEdouard Herriot HospitalLyonFrance
| | - Emilie Virot
- Internal Medicine, Hospices Civils de LyonEdouard Herriot HospitalLyonFrance
- Constitutive Reference Center: Major Sickle Cell Syndromes, Thalassemias and Other Rare Pathologies of Red Blood Cell and ErythropoiesisEdouard Herriot HospitalLyonFrance
| | - Manon Marie
- Internal Medicine, Hospices Civils de LyonEdouard Herriot HospitalLyonFrance
- Constitutive Reference Center: Major Sickle Cell Syndromes, Thalassemias and Other Rare Pathologies of Red Blood Cell and ErythropoiesisEdouard Herriot HospitalLyonFrance
| | - Solène Poutrel
- Internal Medicine, Hospices Civils de LyonEdouard Herriot HospitalLyonFrance
- Constitutive Reference Center: Major Sickle Cell Syndromes, Thalassemias and Other Rare Pathologies of Red Blood Cell and ErythropoiesisEdouard Herriot HospitalLyonFrance
| | - Giovanna Cannas
- Internal Medicine, Hospices Civils de LyonEdouard Herriot HospitalLyonFrance
- Constitutive Reference Center: Major Sickle Cell Syndromes, Thalassemias and Other Rare Pathologies of Red Blood Cell and ErythropoiesisEdouard Herriot HospitalLyonFrance
| | - Arnaud Hot
- Internal Medicine, Hospices Civils de LyonEdouard Herriot HospitalLyonFrance
- Constitutive Reference Center: Major Sickle Cell Syndromes, Thalassemias and Other Rare Pathologies of Red Blood Cell and ErythropoiesisEdouard Herriot HospitalLyonFrance
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19
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Gbadoé AD, Guédénon KM, N'zonou M, Adamou M, Akolly D, Guédéhoussou T, Dagnra AY. Severe Acute Bacterial Infections in Children With Sickle Cell Disease in Togo. J Pediatr Hematol Oncol 2023; 45:404-408. [PMID: 37526417 DOI: 10.1097/mph.0000000000002710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/04/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Bacterial infections are considered a major cause of morbidity and mortality in patients, especially children, with sickle cell disease. OBJECTIVES This study aims at determining, a year after the introduction of the 13-valent pneumococcal conjugate vaccine the distribution of severe acute bacterial infections and germs in children with sickle cell disease. PATIENTS AND METHODS Records of children 0 to 15 years of age and admitted from January 1, 2015 to December 31, 2019 (5 y), were examined retrospectively in the four sickle cell monitoring units in Lomé. RESULTS The main infections found were pleuropulmonary (46.1%), urinary tract (32.8%), and osteoarticular (9.3%). A germ was isolated in 139 of the 265 cases (52.4%). 65.5% of the microorganisms isolated were Gram-negative organisms, with mostly Escherichia coli (31.6%) , and Klebsiella pneumoniae (18%) being the main germs. They were mainly responsible of urinary tract and osteoarticular infections. The majority of these Enterobacteriaceae was Extended-Spectrum Beta-Lactamase-Producing (41.1%, n = 37). Gram-positive cocci were represented by Staphylococcus sp (25.9%), Streptococcus sp (4.3%), Streptococcus pneumoniae (2.9%), and Enterococcus (1.4%). Staphylococcus aureus was the most common germ in pleuropulmonary (40%), osteoarticular (47.3%), and sepsis (28.6%) infections. CONCLUSION Even if the infections found remained classic, there is a redistribution of germs with a decline in Salmonella and increase of Escherichia coli , Klebsiella pneumoniae , and Staphylococcus aureus .
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Affiliation(s)
- Adama Dodji Gbadoé
- Hemato-oncology Unit of the Pediatrics Department
- Pediatrics Department of the District Hospital of Be
- Faculty of Health Sciences, University of Lomé (Togo)
| | - Koffi Mawuse Guédénon
- Hemato-oncology Unit of the Pediatrics Department
- Faculty of Health Sciences, University of Lomé (Togo)
| | | | | | - Djatougbé Akolly
- Hemato-oncology Unit of the Pediatrics Department
- Faculty of Health Sciences, University of Lomé (Togo)
| | - Têtê Guédéhoussou
- Faculty of Health Sciences, University of Lomé (Togo)
- Pediatrics Department of the Regional Hospital of Lomé, Lomé, Togo
| | - Anoumou Yaotsé Dagnra
- Microbiology Department, Sylvanus Olympio Teaching Hospital
- Faculty of Health Sciences, University of Lomé (Togo)
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Naramreddy S, Varma A, Taksande A, Meshram RJ. The Role of Antiplatelet in the Management of Sickle Cell Disease Patients. Cureus 2023; 15:e42058. [PMID: 37602132 PMCID: PMC10434724 DOI: 10.7759/cureus.42058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Sickle cell disease (SCD) is a genetic disorder characterized by abnormal hemoglobin, leading to red blood cell deformities and subsequent vaso-occlusive events. Platelet activation and adhesion play a significant role in the pathophysiology of SCD, contributing to the development of complications such as vaso-occlusive events, stroke, acute chest syndrome, and other manifestations. Antiplatelet therapy has emerged as a potential strategy to mitigate these complications by modulating the platelet function and reducing thrombotic events. This review article provides an overview of antiplatelet therapy's role in managing SCD patients. It discusses the pathophysiological abnormalities in the platelet function in SCD, the rationale for antiplatelet therapy, and the evidence supporting its use in various clinical scenarios. The article explores aspirin as the primary antiplatelet agent in SCD, including its mechanism of action, dosing considerations, and efficacy and safety data. Additionally, it highlights other antiplatelet agents, such as clopidogrel, prasugrel, ticagrelor, and emerging therapies under investigation. Clinical applications of antiplatelet therapy in primary and secondary prevention and the management of acute chest syndrome and other SCD complications are also discussed. Safety considerations are emphasized, including bleeding risk assessment, monitoring, and patient selection for antiplatelet therapy. Finally, the review highlights future research and clinical practice directions, including the development of novel antiplatelet agents, combination therapies, and the integration of antiplatelet therapy with other SCD treatments. Overall, this review provides a comprehensive understanding of the current role of antiplatelet therapy in SCD management, the challenges faced, and future directions for improving patient outcomes.
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Affiliation(s)
- Sudheeshreddy Naramreddy
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ashish Varma
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Revat J Meshram
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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21
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Bhasin N, Sarode R. Acute Chest Syndrome in Sickle Cell Disease. Transfus Med Rev 2023; 37:150755. [PMID: 37741793 DOI: 10.1016/j.tmrv.2023.150755] [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: 05/30/2023] [Revised: 08/18/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023]
Abstract
Acute chest syndrome (ACS) is the leading cause of mortality among individuals with sickle cell disease (SCD) accounting for 25% of all deaths. The etiologies and clinical manifestations of ACS are variable among children and adults, with a lack of clear risk stratification guidelines for the practicing clinician. In addition, the management of ACS is based on limited evidence and is currently guided primarily by expert opinion. This manuscript reviews the pathophysiology, risk factors, and current management strategies for ACS through a review of published data on this subject between 1988 and 2022. Blood transfusion is often used as a therapeutic intervention for ACS to increase blood's oxygen-carrying capacity and reduce complications by reducing hemoglobin S (HbS) percentage, based on the very low quality of the evidence about its efficacy. The benefit of RBC transfusion for ACS has been described in case series and observational studies, but randomized studies comparing simple transfusion vs. exchange transfusions for ACS are lacking. In this review, we conclude that the development of clinical and laboratory risk stratification is necessary to further study an optimal management strategy for individuals with ACS to avoid transfusion-related complications while minimizing mortality.
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Affiliation(s)
- Neha Bhasin
- Division of Hematology, Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, USA.
| | - Ravi Sarode
- Department of Pathology and Internal Medicine (Hematology/Oncology), UT Southwestern Medical Center, USA
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Chan KH, Stark JM, Mosquera RA, Brown DL, Menon N, Nguyen TT, Yadav A. Screening for asthma in preschool children with sickle cell disease. J Asthma 2023:1-6. [PMID: 36867136 DOI: 10.1080/02770903.2023.2187305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
BACKGROUND Asthma in preschool children is poorly defined, proving to be a challenge for early detection. The Breathmobile Case Identification Survey (BCIS) has been shown to be a feasible screening tool in older SCD children and could be effective in younger children. We attempted to validate the BCIS as an asthma screening tool in preschool children with SCD. METHODS This is a prospective, single-center study of 50 children aged 2-5 years with SCD. BCIS was administered to all patients and a pulmonologist blinded to the results evaluated patients for asthma. Demographic, clinical, and laboratory data were obtained to assess risk factors for asthma and acute chest syndrome in this population. RESULTS Asthma prevalence (n = 3/50; 6%) was lower than atopic dermatitis (20%) and allergic rhinitis (32%). Sensitivity (100%), specificity (85%), positive predictive value (30%), and negative predictive value (100%) of the BCIS were high. Clinical demographics, atopic dermatitis, allergic rhinitis, asthma, viral respiratory infection, hematology parameters, sickle hemoglobin subtype, tobacco smoke exposure, and hydroxyurea were not different between patients with or without history of ACS, although eosinophil was significantly lower in the ACS group (p = 0.0093). All those with asthma had ACS, known viral respiratory infection resulting in hospitalization (3 RSV and 1 influenza), and HbSS (homozygous Hemoglobin SS) subtype. CONCLUSION The BCIS is an effective asthma screening tool in preschool children with SCD. Asthma prevalence in young children with SCD is low. Previously known ACS risk factors were not seen, possibly from the beneficial effects of early life initiation of hydroxyurea.
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Affiliation(s)
- Kok Hoe Chan
- Division of Hematology/Oncology, Department of Internal Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston), Houston, TX, USA
| | - James M Stark
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Ricardo A Mosquera
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Deborah L Brown
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Neethu Menon
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, TX, USA
| | - Trinh T Nguyen
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Aravind Yadav
- Department of Pediatrics, McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth Houston) and Children's Memorial Hermann Hospital, Houston, TX, USA
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23
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Lins CF, Salmon CEG, Amorim de Souza L, Quesado RCS, de Souza Moraes R, Silva-Pinto AC, Matos MA, Nogueira-Barbosa MH. Quantitative MRI evaluation of bone marrow in sickle cell disease: relationship with haemolysis and clinical severity. Clin Radiol 2023; 78:e268-e278. [PMID: 36623977 DOI: 10.1016/j.crad.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/06/2022] [Accepted: 11/17/2022] [Indexed: 12/27/2022]
Abstract
AIM To evaluate bone marrow fat fraction using the Dixon technique (FFDix) of magnetic resonance imaging (MRI) as a potential biomarker of haemolysis and clinical severity in the overall assessment and follow-up of sickle cell disease (SCD) patients. MATERIAL AND METHODS The present study was a cross-sectional study in which healthy individuals and SCD patients (matched for age, sex, and weight) were subjected to MRI of the lumbar spine and pelvis to quantify FFDix in the bone marrow using the Dixon technique. SCD severity was analysed by clinical and laboratory data, and an online calculator. A high degree of haemolysis was defined using the cut-off values haemoglobin (Hb) ≤10 g/dl, lactate dehydrogenase (LDH) ≥325 U/l, reticulocytes ≥3% and total bilirubin (TB) ≥1.2 mg/dl. Pearson's correlation, receiver operating characteristic (ROC) curve and binary logistic regression analysis were performed. RESULTS Forty-eight SCD patients (26 homozygous: HbSS and 22 compound heterozygous: HbSC) and 48 healthy individuals participated in the study. FFDix was lower in SCD patients than in the control group, showing even lower values in the HbSS subtype and patients with a higher degree of haemolysis. HbSC patients with a higher degree of haemolysis using hydroxyurea (medium dosage 9.8 mg/kg/day) had lower FFDix. ROC curves and odds ratios for detecting patients with a higher degree of haemolysis at the different FFDix measurement sites demonstrated excellent performance: iliac bones (cut-off ≤16.75%, AUC = 0.824, p<0.001), femoral heads (cut-off ≤46.7%, AUC = 0.775, p=0.001), lumbar vertebrae (cut-off ≤7.8%, AUC = 0.755, p=0.002). CONCLUSION Decreased FFDix is indicative of higher degree of haemolysis and SCD severity with great potential as a non-invasive biomarker contributing to the overall assessment and follow-up of SCD patients.
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Affiliation(s)
- C Freitas Lins
- Bahiana School of Medicine and Public Health (EBMSP), Av. Dom João VI, 275, Brotas, Salvador, Bahia, Brazil; Clínica Delfin Medicina Diagnóstica, Av. Antônio Carlos Magalhães, 442, Pituba, Salvador, Bahia, Brazil; Ribeirão Preto Medical School, USP Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Campus Universitário s/n - Monte Alegre, Ribeirão Preto, SP, Brazil; Ribeirão Preto Medical School Musculoskeletal Imaging Research Laboratory, Brazil.
| | - C E Garrido Salmon
- Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto da Universidade de São Paulo (FFCLRP-USP), Av. Bandeirantes, 3900, Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - L Amorim de Souza
- Bahiana School of Medicine and Public Health (EBMSP), Av. Dom João VI, 275, Brotas, Salvador, Bahia, Brazil
| | - R C Saldanha Quesado
- Bahiana School of Medicine and Public Health (EBMSP), Av. Dom João VI, 275, Brotas, Salvador, Bahia, Brazil
| | - R de Souza Moraes
- Clínica Delfin Medicina Diagnóstica, Av. Antônio Carlos Magalhães, 442, Pituba, Salvador, Bahia, Brazil
| | - A C Silva-Pinto
- Ribeirão Preto Medical School, USP Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Campus Universitário s/n - Monte Alegre, Ribeirão Preto, SP, Brazil
| | - M Almeida Matos
- Bahiana School of Medicine and Public Health (EBMSP), Av. Dom João VI, 275, Brotas, Salvador, Bahia, Brazil
| | - M H Nogueira-Barbosa
- Ribeirão Preto Medical School, USP Ribeirão Preto, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, Campus Universitário s/n - Monte Alegre, Ribeirão Preto, SP, Brazil; Ribeirão Preto Medical School Musculoskeletal Imaging Research Laboratory, Brazil; Department of Orthopedic Surgery, University of Missouri Health Care, Columbia, MO, USA
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Gbotosho OT, Gollamudi J, Hyacinth HI. The Role of Inflammation in The Cellular and Molecular Mechanisms of Cardiopulmonary Complications of Sickle Cell Disease. Biomolecules 2023; 13:381. [PMID: 36830749 PMCID: PMC9953727 DOI: 10.3390/biom13020381] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/09/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
Cardiopulmonary complications remain the major cause of mortality despite newer therapies and improvements in the lifespan of patients with sickle cell disease (SCD). Inflammation has been identified as a major risk modifier in the pathogenesis of SCD-associated cardiopulmonary complications in recent mechanistic and observational studies. In this review, we discuss recent cellular and molecular mechanisms of cardiopulmonary complications in SCD and summarize the most recent evidence from clinical and laboratory studies. We emphasize the role of inflammation in the onset and progression of these complications to better understand the underlying pathobiological processes. We also discuss future basic and translational research in addressing questions about the complex role of inflammation in the development of SCD cardiopulmonary complications, which may lead to promising therapies and reduce morbidity and mortality in this vulnerable population.
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Affiliation(s)
- Oluwabukola T. Gbotosho
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267-0525, USA
| | - Jahnavi Gollamudi
- Division of Hematology & Oncology, Department of Internal Medicine, 3125 Eden Avenue, ML 0562, Cincinnati, OH 45219-0562, USA
| | - Hyacinth I. Hyacinth
- Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH 45267-0525, USA
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25
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Chiang KC, Gupta A, Sundd P, Krishnamurti L. Thrombo-Inflammation in COVID-19 and Sickle Cell Disease: Two Faces of the Same Coin. Biomedicines 2023; 11:338. [PMID: 36830874 PMCID: PMC9953430 DOI: 10.3390/biomedicines11020338] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 01/12/2023] [Accepted: 01/15/2023] [Indexed: 01/26/2023] Open
Abstract
People with sickle cell disease (SCD) are at greater risk of severe illness and death from respiratory infections, including COVID-19, than people without SCD (Centers for Disease Control and Prevention, USA). Vaso-occlusive crises (VOC) in SCD and severe SARS-CoV-2 infection are both characterized by thrombo-inflammation mediated by endothelial injury, complement activation, inflammatory lipid storm, platelet activation, platelet-leukocyte adhesion, and activation of the coagulation cascade. Notably, lipid mediators, including thromboxane A2, significantly increase in severe COVID-19 and SCD. In addition, the release of thromboxane A2 from endothelial cells and macrophages stimulates platelets to release microvesicles, which are harbingers of multicellular adhesion and thrombo-inflammation. Currently, there are limited therapeutic strategies targeting platelet-neutrophil activation and thrombo-inflammation in either SCD or COVID-19 during acute crisis. However, due to many similarities between the pathobiology of thrombo-inflammation in SCD and COVID-19, therapies targeting one disease may likely be effective in the other. Therefore, the preclinical and clinical research spurred by the COVID-19 pandemic, including clinical trials of anti-thrombotic agents, are potentially applicable to VOC. Here, we first outline the parallels between SCD and COVID-19; second, review the role of lipid mediators in the pathogenesis of these diseases; and lastly, examine the therapeutic targets and potential treatments for the two diseases.
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Affiliation(s)
| | - Ajay Gupta
- KARE Biosciences, Orange, CA 89128, USA
- Division of Nephrology, Hypertension and Kidney Transplantation, Department of Medicine, University of California Irvine (UCI) School of Medicine, Irvine, CA 92868, USA
| | - Prithu Sundd
- Vascular Medicine Institute and Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15261, USA
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology-Oncology, Yale School of Medicine, New Haven, CT 06510, USA
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26
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Elia GM, Konstantyner T, Nais RP, Santos ARAD, Angel A, Braga JAP. Clinical and laboratory differences between pediatric hospitalized patients with sickle cell disease infected or not by SARS-CoV-2. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2023; 41:e2021407. [PMID: 36921171 PMCID: PMC10013992 DOI: 10.1590/1984-0462/2023/41/2021407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/08/2022] [Indexed: 03/18/2023]
Abstract
OBJECTIVE The aim of this study was to identify clinical and complete blood count differences between pediatric hospitalized patients with sickle cell disease infected or not by SARS-CoV-2 and compare the complete blood count of patients with sickle cell disease infected by SARS-CoV-2 before hospitalization and on admission. METHODS This study was a single-center prospective cohort. Data were collected from medical records of pediatric inpatients with sickle cell disease under 18 years old infected or not with SARS-CoV-2 from the first visit to the hospital until discharge and from the last medical appointment. All patients were tested for SARS-CoV-2 by the real-time reverse transcription polymerase chain reaction. RESULTS Among 57 pediatric patients with sickle cell disease hospitalized from March to November 2020 in a Brazilian academic hospital, 11 (19.3%) had a positive result for SARS-CoV-2. Patients infected by SARS-CoV-2 had a higher prevalence of comorbidities than the ones who were not infected (63.6 vs. 30.4%; p=0.046). During hospital stay, no clinical or complete blood count differences between groups were found. There was a decrease in eosinophil count on hospital admission in patients with sickle cell disease infected by SARS-CoV-2 (p=0.008). CONCLUSIONS Pediatric hospitalized patients with sickle cell disease infected by SARS-CoV-2 had more comorbidities and had a decrease in eosinophil count between hospital admission and the last medical appointment.
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Affiliation(s)
- Gabriella Mafra Elia
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Tulio Konstantyner
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | - Rafaela Pilotto Nais
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
| | | | - Andrea Angel
- Universidade Federal de São Paulo, Escola Paulista de Medicina, São Paulo, SP, Brazil
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Khalaf Z, Mahmood M. Acute chest syndrome in post-operative sickle cell disease patients: a systematic review of predisposing factors and interventions. SURGERY IN PRACTICE AND SCIENCE 2022. [DOI: 10.1016/j.sipas.2022.100143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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28
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Acute Care Physical Therapy and Sickle Cell Disease. JOURNAL OF ACUTE CARE PHYSICAL THERAPY 2022. [DOI: 10.1097/jat.0000000000000207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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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..
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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
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30
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Preoperative Transfusion and Surgical Outcomes for Children with Sickle Cell Disease. J Am Coll Surg 2022; 235:530-538. [PMID: 35972175 DOI: 10.1097/xcs.0000000000000267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Current guidelines recommending preoperative transfusion to a hemoglobin level of 9 to 10 g/dL for patients with sickle cell disease (SCD) are based on imperfect evidence. The benefit of preoperative transfusion in children specifically is not known. This study aimed to evaluate whether preoperative RBC transfusion is associated with different rates of sickle cell crisis and surgical complications, compared with no preoperative transfusion, among children with SCD undergoing common abdominal operations. STUDY DESIGN The NSQIP-Pediatrics database (2013 to 2019) was queried. Patients who underwent cholecystectomy, splenectomy, or appendectomy with a preoperative Hct level of less than 30% were included. The primary outcome was 30-day readmission for sickle cell crisis. Secondary outcomes were 30-day surgical complications and hospital length of stay. Propensity score matching methods were used to obtain two statistically similar cohorts of patients comprised of those who were preoperatively transfused and those who were not. RESULTS Among 357 SCD patients, 200 (56%) received preoperative transfusion. In the matched cohort of 278 patients (139 per group), there was no statistically significant difference in 30-day readmission for sickle cell crisis in the transfused and non-transfused groups (5.8% vs 7.2%, p = 0.80). The rate of 30-day surgical complications did not differ between matched groups (10.8% vs 9.4%, p = 0.84). Subgroups defined by presenting Hct levels of 27.3% or greater or less than 27.3%, American Society of Anesthesiologists classification, wound class, and index operation were not associated with an altered risk of sickle cell crisis or surgical complications after preoperative transfusion compared with no transfusion. CONCLUSIONS Preoperative transfusion for children with SCD undergoing semi-elective abdominal operations was not associated with improved outcomes. Prospective investigation is warranted to strengthen guidelines and minimize unnecessary perioperative transfusions in this population.
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31
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Khan MI, Patel N, Meda RT, Nuguru SP, Rachakonda S, Sripathi S. Sickle Cell Disease and Its Respiratory Complications. Cureus 2022; 14:e28528. [PMID: 36185937 PMCID: PMC9517690 DOI: 10.7759/cureus.28528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2022] [Indexed: 11/10/2022] Open
Abstract
Sickle cell disease (SCD) is a hematological disorder that is inherited in an autosomal recessive (AR) fashion. It is caused by mutations in the genes encoding for the globin apoprotein of hemoglobin (Hb), leading to diminished oxygen-carrying ability. Its pathophysiologic mechanism affects multiple organ systems, making it crucial to understand the complications of SCD and find the best ways to prevent and treat them. Some important ways that SCD manifests in the respiratory system are acute chest syndrome (ACS), pulmonary hypertension (PH), asthma, and venous thromboembolism (VTE). This article summarizes their salient features, including pathogenesis related to the adverse outcomes, screening practices, and management guidelines, with the intent to provide greater insight into forming better practices that increase the quality of life in SCD patients.
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Assad Z, Michel M, Valtuille Z, Lazzati A, Boizeau P, Madhi F, Gaschignard J, Pham LL, Caseris M, Cohen R, Kaguelidou F, Varon E, Alberti C, Faye A, Angoulvant F, Koehl B, Ouldali N. Incidence of Acute Chest Syndrome in Children With Sickle Cell Disease Following Implementation of the 13-Valent Pneumococcal Conjugate Vaccine in France. JAMA Netw Open 2022; 5:e2225141. [PMID: 35917121 PMCID: PMC9346553 DOI: 10.1001/jamanetworkopen.2022.25141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Acute chest syndrome (ACS) is one of the leading acute severe complications of sickle-cell disease (SCD). Although Streptococcus pneumoniae (S pneumoniae) is highly prevalent in children with SCD, its precise role in ACS is unclear. The efficacy of 13-valent pneumococcal conjugate vaccine (PCV13) implementation on ACS is still unknown. OBJECTIVE To assess the association of PCV13 implementation in the general pediatric population with the incidence of ACS in children with SCD. DESIGN, SETTING, AND PARTICIPANTS This cohort study used an interrupted time-series analysis of patient records from a national hospital-based French surveillance system. All children younger than 18 years with SCD (based on the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision definition) hospitalized in France between January 2007 and December 2019 were included. EXPOSURES PCV13 implementation. MAIN OUTCOMES AND MEASURES Monthly incidence of ACS per 1000 children with SCD over time as analyzed by segmented linear regression with autoregressive error; monthly incidence of hospitalization for vaso-occlusive crisis, asthma crisis, and acute pyelonephritis per 1000 children with SCD over the same period as the control outcomes. RESULTS Among the 107 694 hospitalizations of children with SCD, 4007 episodes of ACS were included (median [IQR] age, 8 [4-12] years; 2228 [55.6%] boys). PCV13 implementation in 2010 was followed by a significant decrease in the incidence of ACS (-0.9% per month; 95% CI, -1.4% to -0.4%; P < .001), with an estimated cumulative change of -41.8% (95% CI, -70.8% to -12.7%) by 2019. Sensitivity analyses yielded the same results, including the incidence of ACS adjusted for that of vaso-occlusive crisis over time. The results were similar among different age groups. By contrast, no change was found for the 3 control outcomes over the study period. CONCLUSIONS AND RELEVANCE PCV13 implementation was associated with an important reduction in the incidence of ACS in children with SCD. This vaccine benefit provides new evidence of the key role of S pneumoniae in ACS and should be considered when estimating outcomes associated with current PCVs and the potential benefit of next-generation PCVs in children.
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Affiliation(s)
- Zein Assad
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Clinical Epidemiology Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Université Caen-Normandie, Caen, France
| | - Morgane Michel
- Clinical Epidemiology Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Unité de Recherche Clinique en Économie de la Santé, Hôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- ECEVE (Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables), Institut national de la santé et de la recherche médicale, Unité mixte de recherche 1123, Paris University, Paris, France
| | - Zaba Valtuille
- Institut national de la santé et de la recherche médicale, Centre d'Investigation Clinique 1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Andrea Lazzati
- Department of General Surgery, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Priscilla Boizeau
- Clinical Epidemiology Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Fouad Madhi
- Department of General Pediatrics, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Jean Gaschignard
- Department of General Pediatrics, Groupe Hospitalier Nord Essonne, Longjumeaux, France
- IAME (Infection, Antimicrobials, Modelling, Evolution), Institut national de la santé et de la recherche médicale, Unité mixte de recherche 1137, Paris University, Paris, France
| | - Luu-Ly Pham
- Department of General Pediatrics, Jean Verdier University Hospital, Assistance Publique-Hôpitaux de Paris, Bondy, France
| | - Marion Caseris
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France
- Centre Hospitalier Intercommunal, Research Centre, Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Florentia Kaguelidou
- Institut national de la santé et de la recherche médicale, Centre d'Investigation Clinique 1426, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Laboratoire de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges-Pompidou, Paris, France
| | - Corinne Alberti
- Clinical Epidemiology Unit, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- ECEVE (Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables), Institut national de la santé et de la recherche médicale, Unité mixte de recherche 1123, Paris University, Paris, France
| | - Albert Faye
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- ECEVE (Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables), Institut national de la santé et de la recherche médicale, Unité mixte de recherche 1123, Paris University, Paris, France
| | - François Angoulvant
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Centre de Recherche des Cordeliers, Institut national de la santé et de la recherche médicale (Unité mixte de recherche S1138), Sorbonne Université, Université de Paris, Paris, France
| | - Bérengère Koehl
- Department of Child Hematology, Reference Center for Sickle-Cell Disease Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- Integrated Biology of Red Blood Cells, Institut national de la santé et de la recherche médicale, Unité mixte de recherche S1134, Paris University, Paris, France
| | - Naïm Ouldali
- Department of General Pediatrics, Pediatric Infectious Disease and Internal Medicine, Robert Debré University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- ECEVE (Epidémiologie Clinique et Evaluation Economique Appliquées aux Populations Vulnérables), Institut national de la santé et de la recherche médicale, Unité mixte de recherche 1123, Paris University, Paris, France
- Association Clinique et Thérapeutique Infantile du Val-de-Marne, St Maur-des-Fossés, France
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Manejo clínico de las complicaciones agudas de la anemia falciforme: 11 años de experiencia en un hospital terciario. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2021.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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González-Pérez C, Gómez-Carpintero García A, Cervera Bravo Á. Influencia de la hidroxiurea en la gravedad de los episodios de síndrome torácico agudo en pacientes con drepanocitosis. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Fat embolism after intraosseous catheters in pediatric forensic autopsies. Int J Legal Med 2022; 137:787-791. [PMID: 35771256 PMCID: PMC10085886 DOI: 10.1007/s00414-022-02848-4] [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: 04/12/2022] [Accepted: 05/27/2022] [Indexed: 10/17/2022]
Abstract
In our center, we performed the autopsy of a child who died from drowning and presented, at autopsy, a major pulmonary fat embolism (PFE). A cardiopulmonary resuscitation (CPR) was performed, including infusion by intraosseous catheter (IIC). No other traumatic lesions and diseases classically related to a risk of PFE were detected. According to some animal studies, we considered the IIC as the only possible cause for PFE. However, we could not find literature to confirm this hypothesis in humans, especially in a pediatric population. To verify the occurrence of PFE after IIC in a pediatric population, we retrospectively selected 20 cases of pediatric deaths autopsied in our center, in which a CPR was performed, without bone fractures or other possible causes of PFE: 13 cases with IIC (group A) and 7 cases without IIC (group B). Several exclusion criteria were considered. The histology slides of the pulmonary tissue were stained by Oil Red O. PFE was classified according to the Falzi scoring system. In group A, 8 cases showed PFE: 4 cases with a score 1 of Falzi and 4 cases with a score 2 of Falzi. In group B, no case showed PFE. The difference between the two groups was statistically significant. The results of our study seem to confirm that IIC can lead to PFE in a pediatric population and show that the PFE after IIC can be important (up to score 2 of Falzi). To the best of our knowledge, our study is the first specifically focused on the occurrence of PFE after IIC in a pediatric population by using autoptic data.
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Jeyamurugan K, Jung MK, Kupferman FE, Viswanathan K. Role of Steroids in Sickle Cell Patients With Acute Chest Syndrome. Cureus 2022; 14:e26196. [PMID: 35891855 PMCID: PMC9306685 DOI: 10.7759/cureus.26196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 01/19/2023] Open
Abstract
Background The role of corticosteroids to treat acute chest syndrome (ACS) in patients with sickle cell disease (SCD) has always been a matter of debate. In clinical practice, systemic steroids were given for ACS with more severe disease. With the lack of standard treatment guidelines, their use to treat ACS is highly physician-dependent and varies widely across different hospitals. The utility of corticosteroids in ACS remains unclear. The objective of our study was to describe the differences between SCD patients treated with corticosteroids for ACS and those who were not and to evaluate the association between corticosteroid use, length of stay, and readmission rates. Methodology We performed a retrospective chart review of patients with SCD ≤18 years of age hospitalized for ACS at Brookdale University Hospital Medical Center between January 2016 and May 2021. Results We identified 43 patients with 60 episodes of ACS (median age was 11 years and 55% were males). In total, 32 such episodes were treated with corticosteroids. The use of bronchodilators (p = 0.23), hydroxyurea (p = 0.13), and the presence of fever (p = 0.86) showed no significant difference between the two groups. The need for blood transfusions (p = 0.005), intensive care unit admission (p = 0.031), respiratory support (p = 0.011), and chest X-ray finding with more than one lobe involvement (p = 0.003) all point to moderate or severe ACS, which has been linked to steroid use. The length of hospital stay (p = 0.07) and the readmission rate (p = 0.31) were not statistically significant between the groups. Even in the subgroup with asthma, the length of stay was not different between the groups (p = 0.44). Conclusions Our results show that treatment with systemic steroids for ACS is associated with more severe disease. The length of hospital stay was not different between the steroid-treated and untreated groups. Corticosteroids were not associated with a higher readmission rate in our study population, even in ACS patients with comorbid asthma. Further adequately powered prospective trials are needed to investigate the efficacy of corticosteroids in ACS.
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Reparaz P, Serrano I, Adan-Pedroso R, Astigarraga I, de Pedro Olabarri J, Echebarria-Barona A, Garcia-Ariza M, Lopez-Almaraz R, Del Orbe-Barreto RA, Vara-Pampliega M, Gonzalez-Urdiales P. Clinical management of the acute complications of sickle cell anemia: 11 years of experience in a tertiary hospital. An Pediatr (Barc) 2022; 97:4-11. [PMID: 35729060 DOI: 10.1016/j.anpede.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/25/2021] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Sickle cell disease is an emerging anemia in Europe leading to high morbidity with severe acute complications requiring hospital admission and chronic consequences. The management of these patients is complex and needs interdisciplinary care. The objective is to analyze clinical characteristics and management of patients with sickle cell disease admitted for acute complications. METHODS Retrospective descriptive study of admissions for acute complications of patients with sickle cell disease under 16 years of age in a tertiary hospital between 2010 and 2020. Clinical, laboratory and radiological data were reviewed. RESULTS We included 71 admissions corresponding to 25 patients, 40% diagnosed by neonatal screening. Admissions increased during this period. The most frequent diagnoses were vaso-occlusive crisis (35.2%), febrile syndrome (33.8%) and acute chest syndrome (32.3%). Nine patients required critical care at PICU. Positive microbiological results were confirmed in 20 cases, bacterial in 60%. Antibiotic therapy was administered in 86% of cases and the vaccination schedule of asplenia was adequately fulfilled by 89%. Opioid analgesia was required in 28%. Chronic therapy with hydroxyurea prior to admission was used in 41%. CONCLUSIONS Acute complications requiring hospital admission are frequent in patients with sickle cell disease, being vaso-occlusive crisis and febrile syndrome the most common. These patients need a high use of antibiotics and opioid analgesia. Prior diagnosis facilitates the recognition of life-threatening complications such as acute chest syndrome and splenic sequestration. Despite the prophylactic and therapeutic measures currently provided to these patients, many patients suffer acute complications that require hospital management.
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Affiliation(s)
- Patricia Reparaz
- Servicio de Pediatría, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain
| | - Idoya Serrano
- Servicio de Pediatría, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain
| | - Rosa Adan-Pedroso
- Servicio de Pediatría, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Itziar Astigarraga
- Servicio de Pediatría, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain; Departamento de Pediatría, Universidad del País Vasco UPV/EHU, Spain
| | - Jimena de Pedro Olabarri
- Servicio de Pediatría, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Aizpea Echebarria-Barona
- Servicio de Pediatría, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Miguel Garcia-Ariza
- Servicio de Pediatría, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Ricardo Lopez-Almaraz
- Servicio de Pediatría, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain
| | - Rafael A Del Orbe-Barreto
- Servicio de Hematología y Hemoterapia, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain
| | - Miriam Vara-Pampliega
- Servicio de Hematología y Hemoterapia, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain
| | - Paula Gonzalez-Urdiales
- Servicio de Pediatría, Hospital Universitario Cruces, Osakidetza, Barakaldo, Bizkaia, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Bizkaia, Spain.
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Niazi MRK, Chukkalore D, Jahangir A, Sahra S, Macdougall K, Rehan M, Odaimi M. Management of acute chest syndrome in patients with sickle cell disease: a systematic review of randomized clinical trials. Expert Rev Hematol 2022; 15:547-558. [PMID: 35666654 DOI: 10.1080/17474086.2022.2085089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Acute chest syndrome (ACS) accounts for the highest mortality in Sickle cell disease patients. Early diagnosis and timely management of ACS results in better outcomes. However, the effectiveness of most treatment modalities for ACS management has not been established. AREAS COVERED To review the treatment modalities management protocols and highlight the effectiveness of each option a literature search was done. Randomized controlled trials that assessed the efficacy of different treatment modalities in ACS management in SCD patients were chosen and reviewed. EXPERT OPINION 11 randomized controlled trials were found that evaluated the efficacy of incentive spirometry, positive expiratory pressure device, intravenous dexamethasone, oral vs. intravenous morphine, inhaled nitric oxide, unfractionated heparin, and blood transfusion in the prevention or treatment of ACS. Although there are guidelines for ACS treatment, the available evidence is very limited to delineating the effectiveness of various interventions in ACS management. More high-quality studies and trials with a larger patient population can benefit this area to support the recommendations with stronger evidence.
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Affiliation(s)
- Muhammad Rafay Khan Niazi
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, New York, NY, USA
| | - Divya Chukkalore
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, New York, NY, USA
| | - Abdullah Jahangir
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, New York, NY, USA
| | - Syeda Sahra
- Department of Internal Medicine, Staten Island University Hospital/Northwell Health, New York, NY, USA
| | - Kira Macdougall
- Department of Hematology and Medical Oncology, Oklahoma University of Health and Science, Oklahoma, OK, USA
| | - Maryam Rehan
- Department of Hematology and Medical Oncology, Staten Island University Hospital/Northwell Health, New York, NY, USA
| | - Marcel Odaimi
- Department of Hematology and Medical Oncology, Staten Island University Hospital/Northwell Health, New York, NY, USA
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González-Pérez C, Gómez-Carpintero García A, Cervera Bravo Á. Influence of hydroxyurea on the severity of acute chest syndrome in patients with sickle cell disease. An Pediatr (Barc) 2022; 97:63-65. [PMID: 35595635 DOI: 10.1016/j.anpede.2021.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/25/2021] [Indexed: 10/18/2022] Open
Affiliation(s)
| | | | - Áurea Cervera Bravo
- Servicio de Pediatría, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
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40
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Mawalla WF, Nasser A, Jingu JS, Joseph H, Mmbaga LG, Shija E, Kakumbula H, Lubuva NB, Meda C, Chamba C. Acute chest syndrome and COVID‐19 in hydroxyurea naïve sickle cell disease patient in a low resource setting. EJHAEM 2022; 3:507-512. [PMID: 35602245 PMCID: PMC9110990 DOI: 10.1002/jha2.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 12/15/2022]
Abstract
Acute chest syndrome (ACS) is a severe complication of sickle cell disease (SCD) and one of the leading causes of mortality in SCD patients. The management of ACS is challenging and requires prompt intervention to halt clinical deterioration. With the outbreak of the Coronavirus Disease 2019 (COVID‐19) pandemic, which also primarily results in acute respiratory illness, the clinical picture and treatment outcome in SCD patients with ACS remain unknown. We present a case of a 30‐year‐old male who came in with features of painful vaso‐occlusive episode and haemolysis that later evolved to acute chest syndrome. Chest X‐ray showed pneumonic changes and mild bilateral pleural effusion, and nasal Reverse Transcription‐Polymerase Chain Reaction (RT‐PCR) for COVID‐19 test came out positive. He was managed supportively with simple transfusion, antibiotics, dexamethasone and oxygen support with a good clinical outcome. Presenting with non‐specific symptoms and similar respiratory symptoms and signs, the clinical picture of COVID‐19 can prove difficult to discern from that of ACS due to other causes. This report emphasizes a need for a higher index of suspicion whenever a SCD patient presents with symptoms of acute respiratory distress.
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Affiliation(s)
- William Frank Mawalla
- Department of Haematology and Blood Transfusion Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Ahlam Nasser
- Department of Haematology and Blood Transfusion Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - James Salumu Jingu
- Department of Internal Medicine Muhimbili National Hospital Dar es Salaam Tanzania
| | - Happiness Joseph
- Department of Haematology and Blood Transfusion Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Lilian Gasper Mmbaga
- Department of Haematology and Blood Transfusion Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Eunice Shija
- Department of Haematology and Blood Transfusion Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
| | - Helena Kakumbula
- Department of Internal Medicine Muhimbili National Hospital Dar es Salaam Tanzania
| | - Neema Budodi Lubuva
- Department of Internal Medicine Muhimbili National Hospital Dar es Salaam Tanzania
| | - Collins Meda
- Department of Internal Medicine Muhimbili National Hospital Dar es Salaam Tanzania
| | - Clara Chamba
- Department of Haematology and Blood Transfusion Muhimbili University of Health and Allied Sciences Dar es Salaam Tanzania
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Liguoro I, Arigliani M, Tan HL, Gupta A. The burden of sleep disordered breathing in children with sickle cell disease. Pediatr Pulmonol 2021; 56:3607-3633. [PMID: 34432958 DOI: 10.1002/ppul.25632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 12/16/2022]
Abstract
Children with sickle cell disease (SCD) have an increased risk of sleep disordered breathing (SDB) compared with the general pediatric population. There has been a growing research interest on this field in recent years, yet many questions regarding risk factors and clinical implications of SDB remain unclear. The aim of this review is to provide a concise narrative and systematic synthesis of the available evidence on the epidemiology, clinical presentation, complications, and management, of SDB in children with SCD. An electronic search was conducted on studies published from the 1st of January 2000 to the 31st of December 2020 in PubMed/Medline, Scopus, and Cochrane databases. All studies focusing on SDB in children with SCD aged from 0 to 20 years were included. Studies were eligible for inclusion if available in the English language. A quantitative synthesis of the included studies was performed. Only studies focusing on specific treatment outcomes were included in a meta-analytic process. A total of 190 papers were initially identified. After screening the title and abstract, 112 articles were evaluated for eligibility. At the end of the selection process, 62 studies were included in the analysis. Sleep disordered breathing is associated with worse neurological, neurocognitive, and cardiological outcomes, whereas the association with frequency or severity of vaso-occlusive pain events and acute chest syndrome was not clarified. Therapeutic interventions like adenotonsillectomy or oxygen supplementation may result in a significant increase in mean nocturnal oxygen saturation but effective clinical implications remain still unclear.
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Affiliation(s)
- Ilaria Liguoro
- Department of Medicine, Division of Paediatrics, University Hospital of Udine, Udine, Italy
| | - Michele Arigliani
- Pediatric Respiratory Unit, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Hui-Leng Tan
- Department of Pediatric Respiratory Medicine, Royal Brompton Hospital, London, UK
| | - Atul Gupta
- Department of Paediatric Respiratory Medicine, King's College Hospital, London, UK
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Yildirim N, Unal S, Yalcinkaya A, Karahan F, Oztas Y. Evaluation of the relationship between intravascular hemolysis and clinical manifestations in sickle cell disease: decreased hemopexin during vaso-occlusive crises and increased inflammation in acute chest syndrome. Ann Hematol 2021; 101:35-41. [PMID: 34564750 DOI: 10.1007/s00277-021-04667-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/15/2021] [Indexed: 11/30/2022]
Abstract
The aims of this study were to determine the possible relationships between the levels of hemin, hemopexin, acid sphingomyelinase, nitrite/nitrate (NOx), and other parameters in patients with SCD and to assess whether they were associated with vaso-occlusive crises (VOCs) or acute chest syndrome (ACS). Patients with SCD (homozygous or sickle beta-thalassemia) who were confirmed to have VOC or ACS were included. Blood samples were obtained at admission, on the third day of hospitalization, and at steady state. Demographic characteristics, pain (visual analog scale), complication history, complete blood count, lactate dehydrogenase, and C-reactive protein levels were recorded. Hemin, hemopexin, acid sphingomyelinase, and NOx were measured via ELISA. A total of 31 patients (22 VOC, 9 ACS) were included. Mean age was 16.4 ± 4.7 years. Admission white blood cell count and C-reactive protein levels were significantly higher in the ACS group. Patients with ACS also demonstrated a significant decreasing trend of LDH and an increasing trend of NOx values from admission to steady state. Notably, hemopexin levels were significantly lower on the third day of hospitalization compared to steady-state levels. Despite limited patient count in the ACS group, these patients appear to have strikingly greater inflammatory activation at admission, and the progression of ACS may be associated with LDH and NOx levels. Lower hemopexin levels during hospitalization versus steady state appear to support a role for the administration of hemopexin therapy during crises.
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Affiliation(s)
- Nazim Yildirim
- Department of Pediatric Hematology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Selma Unal
- Department of Pediatric Hematology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Ahmet Yalcinkaya
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, 06100 Sıhhiye, Ankara, Turkey.
| | - Feryal Karahan
- Department of Pediatric Hematology, Faculty of Medicine, Mersin University, Mersin, Turkey
| | - Yesim Oztas
- Department of Medical Biochemistry, Faculty of Medicine, Hacettepe University, 06100 Sıhhiye, Ankara, Turkey
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Taksande A, Jameel PZ, Pujari D, Taksande B, Meshram R. Variation in pulmonary function tests among children with sickle cell anemia: a systematic review and meta-analysis. Pan Afr Med J 2021; 39:140. [PMID: 34527156 PMCID: PMC8418170 DOI: 10.11604/pamj.2021.39.140.28755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/06/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction the spectrum of pulmonary complications in sickle cell anemia (SCA) comprises mainly of acute chest syndrome (ACS), pulmonary hypertension (PH) and airway hyper-responsiveness (AHR). This study was conducted to examine the abnormalities in pulmonary function tests (PFTs) seen in children with SCA. Methods electronic databases (Cochrane library, PubMed, EMBASE, Scopus, Web of Science) were used as data sources. Two authors independently reviewed studies. All case-control studies with PFT performed in patients with SCA and normal controls were reviewed. Pulmonary functions were assessed with the help of spirometry, lung volume and gas diffusion findings. Results nine studies with 788 SCA children and 1101 controls were analyzed. For all studies, the pooled mean difference for forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FEV1/FVC ratio, peak expiratory flow rate (PEFR), total lung capacity (TLC) and carbon mono-oxide diffusing capacity (DLCO) were -12.67, (95% CI: -15.41,-9.94), -11.69, (95% CI: -14.24, -9.14), -1.90, (95% CI: -4.32, 0.52), -3.36 (95% CI: -6.69, -0.02), -7.35, (95% CI: -14.97, -0.27) and -4.68, (95% CI -20.64, -11.29) respectively. FEV1 and FVC and were the only parameters found to be significantly decreased. Conclusion sickle cell anemia was associated with lower FEV1 and FVC, thus, supporting the role of routine monitoring for the progression of lung function decline in children with SCA with ACS. We recommend routine screening and lung function monitoring for early recognition of pulmonary function decline.
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Affiliation(s)
- Amar Taksande
- Department of Paediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra State, India
| | - Patel Zeeshan Jameel
- Department of Paediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra State, India
| | - Divya Pujari
- Department of Paediatrics, Bai Jerbai Wadia Hospital for Children, Parel, Mumbai, Maharashtra, India
| | - Bharati Taksande
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences (MGIMS), Sewagram, Wardha, Maharashtra State, India
| | - Revat Meshram
- Department of Paediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi Meghe, Wardha, Maharashtra State, India
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44
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Griffin R, Panayiotou A, Allen P, Height S, Chakravorty S, Rees DC. What is the role of chest X-ray imaging in the acute management of children with sickle cell disease? Br J Haematol 2021; 196:402-413. [PMID: 34528246 DOI: 10.1111/bjh.17831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/09/2021] [Accepted: 08/30/2021] [Indexed: 02/02/2023]
Abstract
Children with sickle cell disease (SCD) frequently present to hospital acutely unwell and are often exposed to diagnostic chest X-rays (CXRs). Little evidence exists to determine when CXRs are clinically useful. Using electronic hospital records, we audited CXR use in children aged 0-18 who presented to hospital over the past 10 years in both an inpatient and emergency department setting. From a total of 915 first CXRs, only 28·2% of CXRs (n = 258) had clinically significant findings that altered management or final diagnosis. Of these abnormalities, consolidation represented 52·3%, effusion 8·9%, cardiomegaly 8·4% and sickle cell-related bone changes 6·3%. Indications for CXR of respiratory distress (OR = 3·74, 95% CI 2·28-6·13), hypoxia (OR = 1·86, 95% CI 1·50-2·31) and cough (OR = 1·64, 95% CI 1·33-2·02), were more likely to have significant CXR findings. Patients who had higher peak fever (38·4°C vs. 37·4°C, P = 0·001), higher peak CRP (156·4 vs. 46·1, P < 0·001) and higher WCC (20·2 vs. 13·6, P < 0·001) were more likely to have clinically significant abnormalities on CXR. We found a decision tool using either hypoxia, cough, respiratory distress, T > 38°C, CRP > 50 or WCC > 15 × 109 /l as indications for CXR, to have a sensitivity of 88% (with 95% CI 0·78-0·95) and specificity of 46% (95% CI 0·43-0·50) for clinically significant findings.
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Affiliation(s)
- Ryan Griffin
- Department of Paediatric Haematology, King's College Hospital NHS Trust, London, UK
| | | | - Pamela Allen
- Department of Radiology, King's College Hospital NHS Trust, London, UK
| | - Sue Height
- Department of Paediatric Haematology, King's College Hospital NHS Trust, London, UK
| | - Subarna Chakravorty
- Department of Paediatric Haematology, King's College Hospital NHS Trust, London, UK
| | - David C Rees
- Department of Paediatric Haematology, King's College Hospital NHS Trust, London, UK
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45
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El-Amin N, Lauzon SD, Nietert PJ, Kanter J. Which adults with sickle cell disease need an evaluation for pulmonary embolism? Br J Haematol 2021; 195:447-455. [PMID: 34472094 DOI: 10.1111/bjh.17552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 02/02/2023]
Abstract
Individuals living with sickle cell disease (SCD) are at an increased risk of venous thrombo-embolism (VTE) including pulmonary embolisms (PEs). There is a high mortality associated with PE in individuals with SCD. It can be difficult to diagnose PE since presenting symptoms of PE often mimic those of other forms of vaso-occlusive crisis in SCD. Currently, there are no validated models for predicting PEs in patients with sickle cell disease, which often leads to frequent CT scans and exposure to harmful radiation and intravenous contrast. The aim of this study was to evaluate different host variables and potential clinical biomarkers of patients with SCD including those used in the Wells score to assess predictability for PE in order to create a more accurate diagnostic algorithm to predict PE. A retrospective chart review was performed on 349 patients with SCD who underwent testing for a PE with a CT scan of the chest. Forward and backward stepwise model selection was performed to obtain a parsimonious model of the predictors of PEs. The incidence of PE in this population was 9·7%. Of the factors evaluated for this study, the Wells score was the only one with clinical significance. A Wells score greater than 4 had a sensitivity and specificity of 72·5% and 70·1%, respectively, and a score greater than 6 had a sensitivity and specificity of 50% and 87%, respectively. The Wells score is an acceptable clinical tool which may prove useful in individuals with SCD to predict who is most likely to have a PE and therefore should undergo a CT scan. A prospective study is needed to further confirm these findings.
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Affiliation(s)
- Nadirah El-Amin
- Division of Pediatric Hematology-Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Paul J Nietert
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Julie Kanter
- Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA
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46
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Kashari O, Alghamdi B, Al-Hebshi A, Asiri A, Fallatah E, Alshehri F, Alsamiri S, Masmali H, Nabulsi M, Assiri M, Alwasaidi TA. COVID-19 in Saudi Patients With Sickle Cell Disease: A Retrospective Multi-Center Study. Cureus 2021; 13:e17238. [PMID: 34422504 PMCID: PMC8369254 DOI: 10.7759/cureus.17238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2021] [Indexed: 12/15/2022] Open
Abstract
Background The prevalence of sickle cell disease (SCD) within Saudi Arabia is relatively high, with an estimated 145/10,000 cases. There is an urgent need for researching many aspects of the Coronavirus disease of 2019 (COVID-19) due to the widespread of the virus among SCD patients in Saudi Arabia. The aim of this study is to determine how COVID-19 affects SCD patients in order to reach the best strategy for their management protocols. Methods This is a retrospective chart review study from a multi-center in Saudi Arabia that evaluated a total of 33 patients with sickle cell anemia/disease who were confirmed to have COVID-19. The diagnosis of COVID-19 was confirmed by using the reverse transcription-polymerase chain reaction (RT-PCR) tests based on the nasopharyngeal swabs of the included patients. Results The mean age of patients was 10.75+9.11 years, and nearly all patients (n= 32; 96.9%) were Saudi, and 48.4% of them were females. Twenty-two patients were admitted (59.5%); the main reasons for admission included vaso-occlusive crisis (VOC) only (n= 6; 27.3%), fever (n= 6; 27.3%), acute chest syndrome (n= 5; 22.7%), and VOC combined with other conditions (n= 4; 18.2%). During hospitalization, 54.1% of the patients received at least one medication, while antibiotics (54.1%), analgesia (32.4%), anticoagulants (16.2%), and steroids (16.2%) were the most commonly administered drugs. The mean length of hospitalization was 7.6±4.5 days, with only one patient (2.7%) requiring intensive care unit admission and assisted ventilation. Conclusion The overall prognosis was good since only one patient has passed away, while all others recovered and, subsequently, were discharged. Manifestations, laboratory investigations, and management modalities should be utilized promptly to enhance the prognosis and obtain better outcomes.
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Affiliation(s)
- Ohoud Kashari
- Department of Pediatrics, East Jeddah General Hospital, Jeddah, SAU
| | - Badriah Alghamdi
- Department of Pediatrics, East Jeddah General Hospital, Jeddah, SAU
| | - Abdulqader Al-Hebshi
- Division of Hematology, Department of Pediatrics, Prince Mohammed bin AbdulAziz Hospital, Ministry of National Guard - Health Affairs, Medina, SAU.,Department of Pediatrics, King Abdullah International Medical Research Center (KAIMRC), Riyadh, SAU.,Faculty of Medicine, Department of Pediatrics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Riyadh, SAU
| | - Aljawharah Asiri
- Department of Pediatrics, East Jeddah General Hospital, Jeddah, SAU
| | - Ebtehal Fallatah
- Department of Pediatrics, East Jeddah General Hospital, Jeddah, SAU
| | - Fayez Alshehri
- Department of Pediatrics, Maternity and Children Hospital, Khamis Mushayt, SAU
| | - Salihah Alsamiri
- Medicine, Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, IRL
| | - Hassan Masmali
- Department of Pediatrics, Maternity and Children Hospital, Mecca, SAU
| | - Mohammad Nabulsi
- Department of Medicine, King Abdullah Medical Complex, Jeddah, SAU
| | - Mona Assiri
- Department of Pediatrics, Maternity and Children Hospital, Abha, SAU
| | - Turki A Alwasaidi
- Division of Hematology, Department of Medicine, Prince Mohammed bin Abdulaziz Hospital, Ministry of National Guard - Health Affairs, Madinah, SAU.,Department of Medicine, King Abdullah International Medical Research Centers (KAIMRC), Medina, SAU.,Department of Medicine, College of Medicine, Taibah University, Medinah, SAU.,Faculty of Medicine, Department of Pediatrics, King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), Jeddah, SAU
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47
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Guenther CS, Pae VJ, Neri CM, Barry K, Duggan MA, Cohen RT. SNAP: Supportive noninvasive ventilation for acute chest syndrome prevention in children with sickle cell disease. Pediatr Blood Cancer 2021; 68:e29136. [PMID: 34101983 DOI: 10.1002/pbc.29136] [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: 12/17/2020] [Revised: 05/07/2021] [Accepted: 05/08/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute chest syndrome (ACS) is a leading cause of morbidity and mortality among children with sickle cell disease (SCD). Preventing hypoxemia by optimizing lung aeration during sleep remains a challenge. OBJECTIVES To explore safety, feasibility, and tolerability of noninvasive, bi-level positive airway pressure ventilation (BiPAP) as preventative, supportive care for hospitalized, medically stable children with SCD on a general pediatric inpatient unit. METHODS Retrospective chart review of patients ≤22 years of age with SCD admitted to the general pediatric inpatient unit from February 1, 2017 to March 1, 2020 for whom BiPAP was recommended as supportive care. Hospitalizations were excluded if patients were admitted to the pediatric intensive care unit (PICU), required BiPAP for respiratory failure, or used BiPAP at home for obstructive sleep apnea. RESULTS Twenty-three patients had 53 hospitalizations in which BiPAP was recommended. Fifty-two (98%) hospitalizations included acute SCD pain. Indications for BiPAP included prior ACS (94%), chest or back pain (79%), and/or oxygen desaturation (66%). On 17 occasions, patients already had mild to moderate ACS but were stable when BiPAP was recommended. BiPAP was used successfully during 75% of hospitalizations for a median of two nights. There were no adverse effects associated with BiPAP. PICU transfer for respiratory support occurred during three hospitalizations. In 26 hospitalizations of children at risk for ACS who tolerated BiPAP, 23 (88%) did not develop ACS. CONCLUSIONS BiPAP is safe, feasible, and well tolerated as supportive care for hospitalized children with SCD. Next steps include an intervention trial to further assess the efficacy of BiPAP on ACS prevention.
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Affiliation(s)
- Cara S Guenther
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | - Victoria J Pae
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | - Caitlin M Neri
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA.,Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Karan Barry
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | - Molly A Duggan
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA
| | - Robyn T Cohen
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts, USA.,Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
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48
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Henry T, Wyatt K. Thoracic epidural analgesia for pediatric patients with sickle cell disease acute chest syndrome: The resurgence of an old technique. Paediatr Anaesth 2021; 31:911-912. [PMID: 34270829 DOI: 10.1111/pan.14227] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Affiliation(s)
- TeKesha Henry
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA
| | - Karla Wyatt
- Department of Anesthesiology, Baylor College of Medicine, Houston, TX, USA.,Department of Perioperative and Pain Medicine, Texas Children's Hospital, Houston, TX, USA
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49
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Nourani AR, Fazlur Rahman AKM, Pernell B, Maddox MH, Hilliard L, Lebensburger J, Alishlash AS. Nocturnal hypoxemia measured by polysomnogram is associated with acute chest syndrome in pediatric sickle cell disease. J Clin Sleep Med 2021; 17:219-226. [PMID: 33006312 DOI: 10.5664/jcsm.8852] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
STUDY OBJECTIVES Nocturnal hypoxemia is associated with increased risk of sickle cell disease (SCD) complications. The association of nighttime hypoxemia and acute chest syndrome (ACS) in children with SCD has yet to be determined. METHODS This is a retrospective study of children with SCD who underwent polysomnography at a SCD center. Univariate logistic regression was used to assess the association between nocturnal hypoxemia and ACS admissions. Multivariate logistic regression was performed to verify the effects of different clinical covariates on ACS. Secondary analysis comparing patients with one vs multiple ACS admissions was performed. RESULTS One hundred ten individuals with SCD who completed their polysomnogram (mean age of 9.4 years) were identified. Fifty-nine (54%) had a history of at least one episode of ACS admission (mean age of 4.1 years), including 40 with multiple episodes. The percentage of total sleep time with O₂ saturation < 90% was greater in the ACS group (P < .05). Similarly, mean nocturnal O₂ saturation was lower in the ACS group (P < .0005). Mean nocturnal O₂ saturation of < 97.3% and the percentage of total sleep time with O₂ saturation < 90% higher than 2.7% were associated with ACS. There was no difference in nocturnal hypoxemia between patients with single and multiple ACS admissions. CONCLUSIONS Nocturnal hypoxemia later in life is associated with previous ACS admissions in children with SCD. This can increase the yield of interpreting polysomnograms in this vulnerable population. Prospective studies are needed to determine the temporal relations of nocturnal hypoxemia and ACS, which may identify a modifiable risk for ACS.
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Affiliation(s)
- Anis Rabbani Nourani
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - A K M Fazlur Rahman
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Brandi Pernell
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Mary H Maddox
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lee Hilliard
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey Lebensburger
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ammar Saadoon Alishlash
- Department of Pediatrics, School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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50
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Sange I, Cherukuri PB, Parchuri V, Srinivas N, Ramanan SP, Sange AH, Modi S, Khot FA. Sickle Cell Disease and the Respiratory System: A Tangential Perspective to the Hematopulmonological Dilemma. Cureus 2021; 13:e15562. [PMID: 34277185 PMCID: PMC8271619 DOI: 10.7759/cureus.15562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 06/10/2021] [Indexed: 11/05/2022] Open
Abstract
Sickle cell disease (SCD) is a genetically inherited hematological condition that predominantly affects the African-American subset of the population. It leads to the precipitation of multi-systematic manifestations throughout the course of the life of the patient leading to an increased rate of inpatient admissions and decreased quality of life. This article has reviewed some of the most common pulmonary complications of SCD with a brief overview of the clinical features and their management and has also highlighted the fatality of the complications placing a strong focus on screening, monitoring, and the treatment of the disease. The article has also discussed the management of SCD from a pulmonological perspective rather than hematological alone.
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Affiliation(s)
- Ibrahim Sange
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Research, K. J. Somaiya Medical College, Mumbai, IND
| | | | | | - Natasha Srinivas
- Research, B.G.S. Global Institute of Medical Sciences, Bangalore, IND
| | - Sruthi Priyavadhana Ramanan
- Neurology, California Institute of Behavioral Neurosciences & Psychology, California, USA.,Medicine/Surgery, Saveetha Medical College, Chennai, IND
| | | | - Srimy Modi
- Research, K. J. Somaiya Medical College, Mumbai, IND
| | - Farhat A Khot
- Research, Maharashtra Institute of Medical Education and Research (MIMER) Medical College, Pune, IND
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