1
|
Bhangu G, Uminski K, Roessner C, Goodyear D, Sale T, Rydz N. Dry gangrene in a patient with sickle cell disease on hydroxyurea: a case report. Ann Hematol 2024; 103:3277-3279. [PMID: 38630130 DOI: 10.1007/s00277-024-05732-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/25/2024] [Indexed: 07/28/2024]
Affiliation(s)
- Gurjeet Bhangu
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kelsey Uminski
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Calgary, AB, Canada
| | - Cameron Roessner
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Calgary, AB, Canada
| | - Dawn Goodyear
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Calgary, AB, Canada
| | - Trudy Sale
- Department of Medicine, University of Calgary, Calgary, AB, Canada
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Calgary, AB, Canada
| | - Natalia Rydz
- Department of Medicine, University of Calgary, Calgary, AB, Canada.
- Southern Alberta Rare Blood and Bleeding Disorders Comprehensive Care Program, Calgary, AB, Canada.
- Division of Hematology & Hematological Malignancies, Room 681 Foothills Medical Centre, 1403 29th Street NW T2N 2T9, Calgary, AB, Canada.
| |
Collapse
|
2
|
Patel JR, Montejano R, Hopkins C, Siatecka H, Rosen T. The Curious Case of a Painful Leg Ulcer. Cureus 2024; 16:e54127. [PMID: 38487135 PMCID: PMC10939161 DOI: 10.7759/cureus.54127] [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: 02/13/2024] [Indexed: 03/17/2024] Open
Abstract
Sickle cell disease is a condition that can involve numerous organ systems secondary to vascular occlusion. Herein, we present a case of a 21-year-old male with sickle cell disease requiring long-term hydroxyurea therapy. Upon migrating to the United States from Yemen, the patient developed a rapidly progressive, exquisitely painful ulcer on his right lower extremity. Given his country of origin, a broad differential, including select infectious diseases, was essential. Moreover, establishing the unequivocally correct diagnosis was crucial to determine proper and safe therapy. Ultimately, a lesional biopsy demonstrated numerous sickled red blood cells occluding blood vessels, leading to the diagnosis of sickle cell disease-related leg ulceration.
Collapse
Affiliation(s)
- Jay R Patel
- Dermatology, Baylor College of Medicine, Houston, USA
| | | | | | - Hanna Siatecka
- Pathology and Immunology, Baylor College of Medicine, Houston, USA
| | - Theodore Rosen
- Dermatology, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, USA
| |
Collapse
|
3
|
Benites BD, Ciol H, Saad STO, Suguitani RO. Acupuncture as a Complementary Treatment for Leg Ulcers in Sickle-Cell Disease. Med Acupunct 2024; 36:39-44. [PMID: 38380168 PMCID: PMC10874816 DOI: 10.1089/acu.2023.0046] [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: 02/22/2024] Open
Abstract
Background Sickle-cell diseases (SCD) are a group of hereditary disorders in which a specific mutation in the gene that encodes the hemoglobin ß chain leads to formation of an anomalous hemoglobin molecule (HbS) with high polymerization power. This leads to sickling of erythrocytes in situations of low oxygen tension, such as in microcirculation, resulting in peripheral microvasculature occlusion, chronic hemolysis, inflammation, and damage to several target organs. Malleolar ulcers are among the most-debilitating complications of the disease, as they are associated with significant pain, secondary infections, and social impact due to their aesthetic impairment. There are no completely satisfactory therapeutic options for this complication; local healing agents, antibiotics, and dressings are used, with high rates of recurrence and complications, such as osteomyelitis and even limb amputation. Case This case study evaluated the effect of Traditional Chinese Medicine techniques on chronic malleolar ulcers in a 49-year-old male patient. Ten sessions of systemic acupuncture (combinations involving Source, Master, Energetic Action, and Extraordinary Vessels points), auriculotherapy, and dressing with magnets were conducted. Results Although the primary outcome sought was not reached (decrease in ulcer diameters), this patient had great reduction of local pain, a decrease in limb edema, and important reduction of his inflammatory condition, reflected in his decreasing blood levels of C-reactive protein. Conclusions These results show that acupuncture should be considered as an important auxiliary treatment for SCD complications.
Collapse
Affiliation(s)
- Bruno Deltreggia Benites
- Hematology and Transfusion Medicine Center, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Centro de Estudos de Terapias Naturais-CETN (Center of Study of Natural Therapies), Campinas, São Paulo, Brazil
| | - Heloise Ciol
- Centro de Estudos de Terapias Naturais-CETN (Center of Study of Natural Therapies), Campinas, São Paulo, Brazil
| | - Sara Teresinha Olalla Saad
- Hematology and Transfusion Medicine Center, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Rogerio Oliva Suguitani
- Centro de Estudos de Terapias Naturais-CETN (Center of Study of Natural Therapies), Campinas, São Paulo, Brazil
| |
Collapse
|
4
|
Ramadoss T, Weimer DS, Mayrovitz HN. Topical Iron Chelator Therapy: Current Status and Future Prospects. Cureus 2023; 15:e47720. [PMID: 38022031 PMCID: PMC10675985 DOI: 10.7759/cureus.47720] [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: 08/22/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023] Open
Abstract
Systemic iron chelation therapy has long been used for iron overload, providing a role in returning iron levels to proper homeostatic concentrations. Recently, topical iron chelation therapy has emerged as a potential strategy for treating skin damage. This narrative review explores the current status and future prospects of topical iron chelation therapy for treating ultraviolet (UV) and non-UV skin damage, as well as its potential application in wound healing. The review was conducted through a literature search across PubMed, Web of Science, and EMBASE databases, spanning publications from 1990 to 2023. The selection of articles was focused on primary research studies, either experimental or clinical, that explored the implications and formulations of topical iron chelators used alone or in conjunction with another therapeutic agent. The search strategy employed a combination of terms, including "topical iron chelation", "topical deferoxamine", "UV", "wound healing", "skin inflammation", "radiation-induced fibrosis", and "skin cancer". Relevant studies, including methods, intervention strategies, measured outcomes, and findings, are summarized. The review also considered the potential challenges in translating research findings into clinical practice. Results indicate that topical iron chelators, such as deferoxamine, are effective in mitigating UV-induced skin damage, reducing tumorigenesis, and decreasing oxidative damage. In addition, the use of these agents in radiation-induced fibrosis has been shown to significantly increase skin elasticity and reduce dermal fibrosis. Several studies also highlight the use of topical iron chelators in difficult-to-treat chronic wounds, such as diabetic neuropathic ulcers and sickle cell ulcers. In conclusion, topical iron chelation therapy represents a novel and promising approach for skin protection and wound healing. Its potential makes it a promising area of future research.
Collapse
Affiliation(s)
- Tanya Ramadoss
- Medical School, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Derek S Weimer
- Medical School, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Harvey N Mayrovitz
- Medical Education, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| |
Collapse
|
5
|
Caboche-Salouhi P, Le Seac'h A, Lionnet F, Santin A, Mattioni S, Tamboura F, Steichen O, Barbaud A, Senet P. "SCULP" study: The benefits of skin graft pellets on the pain of sickle cell leg ulcers (SCLU). JOURNAL DE MEDECINE VASCULAIRE 2023; 48:100-104. [PMID: 37914454 DOI: 10.1016/j.jdmv.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 09/20/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Leg ulcers associated with major sickle cell disease (SCLU) are a chronic, painful complication, often treated by autologous skin graft. The analgesic effect of skin grafting in SCLU is poorly studied. The aim of this study was to evaluate the effect of skin grafting on the pain and healing of SCLU. METHODS Patients hospitalized for SCLU skin grafting were included in a retrospective and prospective observational cohort, between 2019 and 2023: 53 autologous pinch grafts were performed on a total of 35 SCLUs in 25 sickle cell patients. The primary endpoint was the evaluation of the analgesic effect of the skin graft, measured by visual analog scale (VAS) and weekly cumulative analgesic consumption between day (D)0, D7 and D30. Wound healing was assessed by variation in wound areas between D0 and D30. RESULTS Twenty-five patients with a median age range of 45.5years old were included, 68% were men, SS genotype was present in 96% of the cases. At D7, a significant decrease in VAS and consumption of analgesics of all classes was observed. At D30, only a significant decrease in VAS and consumption of mild opioids was present, as well as a significant reduction in wound surface area compared with D0. CONCLUSION Pinch grafts have a significant early analgesic effect in the management of patients with SCLU, and significantly notice reduction of wound surface area within one month.
Collapse
Affiliation(s)
- P Caboche-Salouhi
- Paris Cité University, Faculty of Medicine, Paris, France; Dermatology-Allergology and Vascular Medicine Department, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - A Le Seac'h
- Dermatology-Allergology and Vascular Medicine Department, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France; Sorbonne University, Faculty of Medicine, Paris, France
| | - F Lionnet
- Department of Internal Medicine, Sickle Cell Reference Center, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Santin
- Department of Internal Medicine, Sickle Cell Reference Center, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France
| | - S Mattioni
- Department of Internal Medicine, Sickle Cell Reference Center, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France
| | - F Tamboura
- Dermatology-Allergology and Vascular Medicine Department, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France
| | - O Steichen
- Sorbonne University, Faculty of Medicine, Paris, France; Department of Internal Medicine, Sickle Cell Reference Center, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France
| | - A Barbaud
- Dermatology-Allergology and Vascular Medicine Department, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France; Sorbonne University, Faculty of Medicine, Paris, France
| | - P Senet
- Dermatology-Allergology and Vascular Medicine Department, Hôpital Tenon, Assistance publique-Hôpitaux de Paris, Paris, France
| |
Collapse
|
6
|
Alshurafa A, Alkhatib M, Abu-Tineh M, Yassin MA. Sickle cell leg ulcer successfully managed by hyperbaric oxygen: a case report. Front Med (Lausanne) 2023; 10:1171971. [PMID: 37396892 PMCID: PMC10310543 DOI: 10.3389/fmed.2023.1171971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023] Open
Abstract
Sickle cell leg ulcers (SCLUs) are usually chronic, painful, and devastating complications of sickle cell disease. Skin vaso-occlusion with compromised blood flow, chronic inflammation, and endothelial dysfunction is thought to be the underlying mechanism. It is usually slow to heal, and it may become chronic and superinfected. The management of SCLUs is usually challenging and requires a multidisciplinary team. Multiple systemic and local therapies have been tried in SCLU treatment. However, the outcome is variable: currently, there are no official recommendations for the best effective treatment. Herein, we report a 34-year-old male patient with non-transfusion-dependent sickle cell disease who was suffering from a chronic left ankle ulcer and was successfully managed with hyperbaric oxygen therapy, resulting in a complete resolution of this devastating complication.
Collapse
Affiliation(s)
- Awni Alshurafa
- Hematology Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Alkhatib
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | | | | |
Collapse
|
7
|
Scientific and Clinical Abstracts From WOCNext® 2023: Las Vegas, Nevada ♦ June 4-7, 2023. J Wound Ostomy Continence Nurs 2023; 50:S1-S78. [PMID: 37632270 DOI: 10.1097/won.0000000000000980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
|
8
|
Oyedeji CI, Hodulik KL, Telen MJ, Strouse JJ. Management of Older Adults with Sickle Cell Disease: Considerations for Current and Emerging Therapies. Drugs Aging 2023; 40:317-334. [PMID: 36853587 PMCID: PMC10979738 DOI: 10.1007/s40266-023-01014-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
People with sickle cell disease (SCD) are living longer than ever before, with the median survival increasing from age 14 years in 1973, beyond age 40 years in the 1990s, and as high as 61 years in recent cohorts from academic centers. Improvements in survival have been attributed to initiatives, such as newborn screening, penicillin prophylaxis, vaccination against encapsulated organisms, better detection and treatment of splenic sequestration, and improved transfusion support. There are an estimated 100,000 people living with SCD in the United States and millions of people with SCD globally. Given that the number of older adults with SCD will likely continue to increase as survival improves, better evidence on how to manage this population is needed. When managing older adults with SCD (defined herein as age ≥ 40 years), healthcare providers should consider the potential pitfalls of extrapolating evidence from existing studies on current and emerging therapies that have typically been conducted with participants at mean ages far below 40 years. Older adults with SCD have historically had little to no representation in clinical trials; therefore, more guidance is needed on how to use current and emerging therapies in this population. This article summarizes the available evidence for managing older adults with SCD and discusses potential challenges to using approved and emerging drugs in this population.
Collapse
Affiliation(s)
- Charity I Oyedeji
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.
- Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 315 Trent Dr., Suite 266, DUMC Box 3939, Durham, NC, 27710, USA.
| | - Kimberly L Hodulik
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Pharmacy, Duke University Hospital, Durham, NC, USA
| | - Marilyn J Telen
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - John J Strouse
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA
- Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 315 Trent Dr., Suite 266, DUMC Box 3939, Durham, NC, 27710, USA
- Division of Pediatric Hematology-Oncology, Duke University, Durham, NC, USA
| |
Collapse
|
9
|
Asma S, Boğa B, Kaçmaz M. Sickle Cell Leg Ulcer Extending to the Achilles Tendon. Turk J Haematol 2023; 40:64-65. [PMID: 36458530 PMCID: PMC9979733 DOI: 10.4274/tjh.galenos.2022.2022.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Affiliation(s)
- Süheyl Asma
- Başkent University, Sickle Cell Unit, Adana, Türkiye
| | | | - Murat Kaçmaz
- Hatay Mustafa Kemal University, Department of Hematology, Hatay, Türkiye
| |
Collapse
|
10
|
Levy JA, Burnett AL, Minniti CP, Ennis W, Vittal A, Heller T, Kleiner D, Thein SL. Clinical Vignettes Part I. Hematol Oncol Clin North Am 2022; 36:1187-1199. [PMID: 36400538 DOI: 10.1016/j.hoc.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with sickle cell disease and/or (rarely) trait are at increased risk for developing recurrent episodes of priapism, also known as stuttering priapism, and major ischemic priapism. Treatment of acute ischemic priapism is reactive; whereas ideal management consists of preventative approaches to ultimately promote the best improvement in patient's quality of life. Leg ulcers in patients with sickle cell disease (SCD) are quite common, with ∼20 % of patients with HBSS reporting either having an active or a past ucler. They can be confused with venous ulcers, with lower extremity hyperpigmentation confounding further the diagnosis. Several factors believed to contribute to the development of leg ulcers in patients with SCD are discussed in this article. Sickle cell liver disease (SCLD) occurs because of a wide variety of insults to the liver that happen during the lifetime of these patients. SCLD includes a range of complications of the hepatobiliary system and is increasing in prevalence with the aging adult sickle population. Liver nodular regenerative hyperplasia (NRH) is more common than realized and underappreciated as a diagnosis and requires liver biopsy with reticulin staining. Undiagnosed, the insidious damage from liver NRH can lead to noncirrhotic portal hypertension or cirrhosis.
Collapse
|
11
|
Clinical Grade Human Pluripotent Stem Cell-Derived Engineered Skin Substitutes Promote Keratinocytes Wound Closure In Vitro. Cells 2022; 11:cells11071151. [PMID: 35406716 PMCID: PMC8998132 DOI: 10.3390/cells11071151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
Chronic wounds, such as leg ulcers associated with sickle cell disease, occur as a consequence of a prolonged inflammatory phase during the healing process. They are extremely hard to heal and persist as a significant health care problem due to the absence of effective treatment and the uprising number of patients. Indeed, there is a critical need to develop novel cell- and tissue-based therapies to treat these chronic wounds. Development in skin engineering leads to a small catalogue of available substitutes manufactured in Good Manufacturing Practices compliant (GMPc) conditions. Those substitutes are produced using primary cells that could limit their use due to restricted sourcing. Here, we propose GMPc protocols to produce functional populations of keratinocytes and fibroblasts derived from pluripotent stem cells to reconstruct the associated dermo-epidermal substitute with plasma-based fibrin matrix. In addition, this manufactured composite skin is biologically active and enhances in vitro wounding of keratinocytes. The proposed composite skin opens new perspectives for skin replacement using allogeneic substitute.
Collapse
|
12
|
Nascimento DCD, Garcia LR, Costa RN, Pozza R, Soares SSS, Souza NVDDO. O SENTIDO DO TRABALHO PARA HOMENS COM ANEMIA FALCIFORME E ÚLCERAS FALCÊMICAS. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0218pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
RESUMO Objetivo: analisar o sentido do trabalho para homens com anemia falciforme e úlceras falcêmicas e discutir os desafios que eles enfrentam para manterem-se no mundo do trabalho. Método: estudo qualitativo e descritivo, desenvolvido em dois cenários, um ambulatório de curativos de um hospital de grande porte e uma clínica de enfermagem em estomaterapia, ambos vinculados a uma universidade pública do Rio de Janeiro, Brasil. A coleta de dados ocorreu de agosto a novembro de 2019, por meio de entrevista semiestruturada, com 20 homens com úlceras falcêmicas. A análise lexical dos dados foi realizada a partir do software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados: verificou-se a penosidade física, social e psicológica que a ferida origina nos homens que atuam no mundo do trabalho. Além disso, constatou-se que o trabalho representa um valor importante para o homem, além de ser visto como refúgio para lidar com a dor imposta pela ferida. Conclusão: o trabalho representa utilidade e satisfação, pois possibilita prover materialmente o homem e suas famílias, reafirma sua virilidade e seu domínio nos contextos familiar e social, o faz sentir-se útil e produtivo. Mas, contraditoriamente, também produz sofrimento quando esses homens precisam se manter no trabalho com dor, cansaço, vergonha e frustração decorrentes de uma doença e de uma lesão que altera sua imagem corporal e sua produtividade, além de gerar sentimento de repulsa no seu coletivo profissional.
Collapse
|
13
|
Nascimento DCD, Garcia LR, Costa RN, Pozza R, Soares SSS, Souza NVDDO. THE MEANING OF WORK FOR MEN WITH SICKLE-CELL ANEMIA AND ULCERS. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2022-0218en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
ABSTRACT Objective: to analyze the meaning of work for men with sickle-cell anemia and ulcers and to discuss the challenges they face to remain in the world of work. Method: a qualitative and descriptive study developed in two settings: an outpatient service specialized in dressings of a large-sized hospital and a Stomatherapy Nursing clinic, both linked to a public university from Rio de Janeiro, Brazil. Data collection took place from August to November 2018 by means of semi-structured interviews with 20 men who had sickle-cell ulcers. Lexical data analysis was performed in the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software. Results: the physical, social and psychological hardships caused by the wounds in men who are active in the world of work were verified. In addition to that, it was found that work is of important value for men, in addition to considering it as a shelter to deal with the pain imposed by the wounds. Conclusion: work represents usefulness and satisfaction, as it makes it possible to materially provide for men and their families and it reasserts their virility and their dominance in the family and social contexts, in addition to making them feel useful and productive. However, on the other hand, it also produces distress when these men need to stay at work with pain, tiredness, shame and frustration arising from a disease and an injury that alter their body image and productivity, in addition to generating feelings of disgust in their professional collective.
Collapse
|
14
|
Mehta V, Kirubarajan A, Sabouhanian A, Jayawardena SM, Chandrakumaran P, Thangavelu N, Cader R, Mettananda S, Bandara D, Khan S, Weatherall DJ, Allen A, Premawardhena AP, Olivieri NF. Leg Ulcers: A Report in Patients with Hemoglobin E Beta Thalassemia and Review of the Literature in Severe Beta Thalassemia. Acta Haematol 2021; 145:334-343. [PMID: 34753145 DOI: 10.1159/000520731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/05/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Leg ulcers are a frequent complication in patients with the inherited hemoglobin disorders. In thalassemia, the literature is limited, and factors associated with the development of leg ulcers in hemoglobin E (HbE) beta thalassemia, the most common form of severe beta-thalassemia worldwide, have not previously been reported. METHODS We reviewed all available medical records of patients with HbE beta thalassemia to document the onset of leg ulcers at the 2 largest treatment centers in Sri Lanka. We reviewed the literature to identify studies reporting outcomes of interventions for ulcers in severe thalassemia. RESULTS Of a total of 255 actively registered patients with HbE thalassemia in the 2 centers, 196 patient charts were evaluable. A leg ulcer with a documented date of onset was recorded in 45 (22%) of 196 evaluable patients, aged (mean ± SEM) 22.2 ± 1.4 years. Most had been irregularly transfused; steady-state hemoglobin was 6.4 ± 0.2 g/dL. Treatment achieving healing in 17 patients included transfusions, antibiotics, oral zinc, wound toileting, and skin grafting. CONCLUSION Leg ulcers may be more common in HbE beta thalassemia than in other forms of thalassemia. A systematic approach to treatment will be needed to document the prevalence and factors placing such patients at risk for leg ulcers. Controlled trials to evaluate the optimal treatment of this common complication are indicated.
Collapse
Affiliation(s)
- Vikita Mehta
- Arts and Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Amir Sabouhanian
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Nila Thangavelu
- Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Refai Cader
- Policy Analysis and Development, Ministry of Health, Colombo, Sri Lanka
| | - Sachith Mettananda
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | - Dayananda Bandara
- National Thalassaemia Centre, Kurunegala, Sri Lanka
- Teaching Hospital Kurunegala, Kurunegala, Sri Lanka
| | - Shawn Khan
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David J Weatherall
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | - Angela Allen
- MRC Weatherall Institute of Molecular Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Nancy F Olivieri
- Pediatrics, Medicine and Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Klingelhöller C, Schneider SW. Differentialdiagnose Ulcus cruris, Ursachen und Therapie. PHLEBOLOGIE 2021. [DOI: 10.1055/a-1584-5841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
ZusammenfassungDie ätiologisch korrekte Diagnose eines Ulcus cruris zu stellen ist nicht immer einfach und sollte insbesondere bei chronischen progredienten Wunden differenzialdiagnostisch gut überlegt sein. Neben den häufigsten Ursachen des Ulcus cruris, den Gefäßerkrankungen, sind auch z.B. autoimmunologische, infektiöse, metabolische, exogene und neoplastische Ursachen in die differenzialdiagnostischen Überlegungen mit einzubeziehen. Für eine erfolgreiche Behandlung der Patienten mit chronischen Wunden mit gleichzeitiger, deutlich reduzierter Lebensqualität ist eine kausale Therapie zwingend notwendig.
Collapse
Affiliation(s)
- Carmen Klingelhöller
- Klinik und Poliklinik für Dermatologie, Andrologie und Venerologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| | - Stefan W. Schneider
- Klinik und Poliklinik für Dermatologie, Andrologie und Venerologie, Universitätsklinikum Hamburg Eppendorf, Hamburg, Deutschland
| |
Collapse
|
16
|
Flattau A, Vinces G, You S, Crouch AS, Minniti CP. Colocating Wound Care for Patients with Sickle Cell Ulcers in a Hematology Clinic. Adv Skin Wound Care 2021; 34:539-541. [PMID: 34546205 DOI: 10.1097/01.asw.0000790476.13111.5f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Leg ulcers affect 15% of people with sickle cell disease. However, wound centers typically treat few people with this condition, which makes it difficult to concentrate clinical expertise or support the scientific study of this orphan disease. This article describes an initiative to increase engagement in care through a partnership between wound healing and hematology leadership that led to colocating wound services within a sickle cell clinic. METHODS Via a retrospective chart review, the authors collected records of all adult patients with sickle cell disease who received wound care in the last decade, including 7 years of wound center data and 3 years of data from the colocated services. Patient and visit characteristics were analyzed using descriptive analytics. RESULTS The general wound center had previously treated 35 patients with sickle cell ulcers over 7 years. In contrast, colocated services engaged 56 patients within 3 years, including 20 who transferred care and 36 new patients. The majority of patients at the colocated site were women, unlike at the wound center (58% vs 47%, P = .07). Results indicated that 36% of patients healed initial wounds, and 45% had new wound occurrences. CONCLUSIONS Colocation successfully increases the number of patients with sickle cell ulcers who will engage in wound care at a single site, laying the foundation for clinical studies to improve the evidence base for this difficult-to-treat condition.
Collapse
Affiliation(s)
- Anna Flattau
- At the Albert Einstein College of Medicine and Montefiore Health System, Bronx, New York, Anna Flattau, MD, MS, MSc, is Associate Professor and Vice Chair, Department of Family and Social Medicine; Giacomo Vinces, DO, is Assistant Professor, Department of Family and Social Medicine; Shuo You, MD, is Research Coordinator, Division of Hematology, Department of Medicine; Andrew S. Crouch, BA, is Research Coordinator, Division of Hematology, Department of Medicine; and Caterina P. Minniti, MD, is Professor, Division of Hematology, Department of Medicine. Acknowledgment: This work was partially supported by a grant from the FDA (R01FD005729). The authors have disclosed no other financial relationships related to this article. Submitted October 29, 2020; accepted in revised form November 23, 2020
| | | | | | | | | |
Collapse
|
17
|
Byeon J, Blizinsky KD, Persaud A, Findley K, Lee J, Buscetta AJ, You S, Bittinger K, Minniti CP, Bonham VL, Grice EA. Insights into the skin microbiome of sickle cell disease leg ulcers. Wound Repair Regen 2021; 29:801-809. [PMID: 33964094 PMCID: PMC8410641 DOI: 10.1111/wrr.12924] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/10/2021] [Accepted: 04/14/2021] [Indexed: 01/04/2023]
Abstract
Leg ulcers are estimated to occur in 1%-10% of North American patients with sickle cell disease (SCD). Their pathophysiology remains poorly defined, but as with other chronic wounds, it is hypothesised that the microbial milieu, or microbiome, contributes to their healing and clinical outcomes. This study utilises 16S ribosomal RNA (rRNA) gene sequencing to describe, for the first time, the microbiome of the SCD leg ulcer and its association with clinical factors. In a cross-sectional analysis of 42 ulcers, we recovered microbial profiles similar to other chronic wounds in the predominance of anaerobic bacteria and opportunistic pathogens including Staphylococcus, Corynebacterium, and Finegoldia. Ulcers separated into two clusters: one defined by predominance of Staphylococcus and smaller surface area, and the other displaying a greater diversity of taxa and larger surface area. We also find that the relative abundance of Porphyromonas is negatively associated with haemoglobin levels, a key clinical severity indicator for SCD, and that Finegoldia relative abundance is negatively associated with CD19+ B cell count. Finally, ratios of Corynebacterium:Lactobacillus and Staphylococcus:Lactobacillus are elevated in the intact skin of individuals with a history of SCD leg ulcers, while the ratio of Lactobacillus:Bacillus is elevated in that of individuals without a history of ulcers. Investigations of the skin microbiome in relation to SCD ulcer pathophysiology can inform clinical guidelines for this poorly understood chronic wound, as well as enhance broader understanding about the role of the skin microbiome in delayed wound healing.
Collapse
Affiliation(s)
- Julia Byeon
- Social and Behavioral Research BranchNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Katherine D. Blizinsky
- All of Us Research ProgramNational Institutes of HealthBethesdaMarylandUSA
- NeurologyRush Alzheimer's Disease Center, Rush Medical CollegeChicagoIllinoisUSA
| | - Anitra Persaud
- Social and Behavioral Research BranchNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Keisha Findley
- Social and Behavioral Research BranchNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Jung‐Jin Lee
- The Children's Hospital of PhiladelphiaMicrobiome Center Roberts Center for Pediatric ResearchPhiladelphiaPennsylvaniaUSA
| | - Ashley J. Buscetta
- Social and Behavioral Research BranchNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Shuo You
- Department of Medicine, Division of HematologyMontefiore Medical Center, Albert Einstein College of MedicineBronxNew YorkUSA
| | - Kyle Bittinger
- The Children's Hospital of PhiladelphiaMicrobiome Center Roberts Center for Pediatric ResearchPhiladelphiaPennsylvaniaUSA
| | - Caterina P. Minniti
- Albert Einstein College of Medicine, Center for Sickle Cell Disease ResearchMontefiore Medical CenterBronxNew YorkUSA
| | - Vence L. Bonham
- Social and Behavioral Research BranchNational Human Genome Research Institute, National Institutes of HealthBethesdaMarylandUSA
| | - Elizabeth A. Grice
- Department of Dermatology and MicrobiologyUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| |
Collapse
|
18
|
Sahu T, Verma HK, Ganguly S, Sinha M, Sinha R. Common, But Neglected: A Comprehensive Review of Leg Ulcers in Sickle Cell Disease. Adv Skin Wound Care 2021; 34:423-431. [PMID: 34260420 DOI: 10.1097/01.asw.0000755924.12513.40] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To compile available evidence to better understand the management of leg ulcers in sickle cell disease (SCD), as well as describe potential therapeutic steps that may be required to improve the quality of life of patients with SCD leg ulcers. DATA SOURCES MEDLINE, PubMed, EMBASE, and Web of Science databases. STUDY SELECTION A comprehensive search was conducted to retrieve relevant studies using the keywords "sickle cell disease and leg ulcer," "ulcer treatments, diagnosis and sickle cell," and "wound sickle cell." Studies published through July 2020 were included. DATA EXTRACTION Two independent authors selected all studies that assessed the relationship between leg ulcer and SCD identified from online databases. DATA SYNTHESIS The authors have summarized updated information on pathophysiology (vasculopathy linked to chronic hemolysis and endothelial dysfunction), diagnosis, and available treatment options to unravel the dermohematologic connection between leg ulcers and SCD. CONCLUSIONS It is the authors' hope that this detailed discussion of the information available on leg ulcers and SCD will lead to a better appreciation of this clinical problem by the clinicians and researchers and in turn have a long-term positive effect on the quality of life of patients with SCD. Researchers should design new trials considering these insights and potential therapeutic approaches based on current knowledge.
Collapse
Affiliation(s)
- Tarun Sahu
- Tarun Sahu, PhD, is Research Fellow, Department of Physiology, All India Institute of Medical Sciences, Raipur, India. Henu Kumar Verma, PhD, is Researcher, Stem Cell Laboratory, Institute of Experimental Endocrinology and Oncology, National Research Council, Naples, Italy. At the All India Institute of Medical Sciences, Satyaki Ganguly, MD, DNB, is Associate Professor, Department of Dermatology; Meenakshi Sinha, PhD, is Associate Professor, Department of Physiology; and Ramanjan Sinha, PhD, is Professor and Head, Department of Physiology. The authors have disclosed no financial relationships related to this article. Submitted August 26, 2020; accepted in revised form October 22, 2020
| | | | | | | | | |
Collapse
|
19
|
Livshits L, Barshtein G, Arbell D, Gural A, Levin C, Guizouarn H. Do We Store Packed Red Blood Cells under "Quasi-Diabetic" Conditions? Biomolecules 2021; 11:biom11070992. [PMID: 34356616 PMCID: PMC8301930 DOI: 10.3390/biom11070992] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/21/2021] [Accepted: 07/01/2021] [Indexed: 01/28/2023] Open
Abstract
Red blood cell (RBC) transfusion is one of the most common therapeutic procedures in modern medicine. Although frequently lifesaving, it often has deleterious side effects. RBC quality is one of the critical factors for transfusion efficacy and safety. The role of various factors in the cells’ ability to maintain their functionality during storage is widely discussed in professional literature. Thus, the extra- and intracellular factors inducing an accelerated RBC aging need to be identified and therapeutically modified. Despite the extensively studied in vivo effect of chronic hyperglycemia on RBC hemodynamic and metabolic properties, as well as on their lifespan, only limited attention has been directed at the high sugar concentration in RBCs storage media, a possible cause of damage to red blood cells. This mini-review aims to compare the biophysical and biochemical changes observed in the red blood cells during cold storage and in patients with non-insulin-dependent diabetes mellitus (NIDDM). Given the well-described corresponding RBC alterations in NIDDM and during cold storage, we may regard the stored (especially long-stored) RBCs as “quasi-diabetic”. Keeping in mind that these RBC modifications may be crucial for the initial steps of microvascular pathogenesis, suitable preventive care for the transfused patients should be considered. We hope that our hypothesis will stimulate targeted experimental research to establish a relationship between a high sugar concentration in a storage medium and a deterioration in cells’ functional properties during storage.
Collapse
Affiliation(s)
- Leonid Livshits
- Red Blood Cell Research Group, Institute of Veterinary Physiology, Vetsuisse Faculty, University of Zürich, CH-8057 Zurich, Switzerland;
| | - Gregory Barshtein
- Biochemistry Department, The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 91905, Israel
- Correspondence: ; Tel.: +972-2-6758309
| | - Dan Arbell
- Pediatric Surgery Department, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Alexander Gural
- Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Carina Levin
- Pediatric Hematology Unit, Emek Medical Center, Afula 1834111, Israel;
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 32000, Israel
| | - Hélène Guizouarn
- Institut de Biologie Valrose, Université Côte d’Azur, CNRS, Inserm, 28 Av. Valrose, 06100 Nice, France;
| |
Collapse
|
20
|
Andrade PG, Spira JAO, Borges EL, Gomes MDL. PROFILE OF WOMEN WITH LEG ULCERS DUE TO SICKLE CELL DISEASE. ESTIMA 2021. [DOI: 10.30886/estima.v19.993_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective: to characterize the profile of women with leg ulcers resulting from sickle cell disease treated at a public health institution in Brazil. Method: historical cohort study conducted in the outpatient sector with a sample of women with sickle cell disease and leg ulcer, followed from 1998 to 2014. The data were extracted from the medical record and included sociodemographic, clinical and ulcer-related variables, and underwent descriptive statistical analysis. Results: of the 17 women, 64.7% were cured, 58.8% were aged between 30 and 39 years, 64.7% declared themselves brown, 70.6% were without partners, 41.2% had incomplete elementary education, 52, 9% had an income of 2 to 3 minimum wages, 70.6% were eutrophic and 82.4% used vitamin supplements. Women had a total of 29 ulcers, 52.9% had a single ulcer, 41.4% were located in the malleolar region, 55.17% were between 2 and 36 months, all classified as stage 3. The treatment was with coverings and Unna’s boot. Conclusion: the women received care from specialist nurses and most were cured with up to eight months of follow-up, which required a nursing consultation, including clinical evaluation, topical treatment and application of compression therapy.
Collapse
|
21
|
Andrade PG, Spira JAO, Borges EL, Gomes MDL. PERFIL DE MULHERES COM ÚLCERAS DA PERNA DECORRENTES DE DOENÇA FALCIFORME. ESTIMA 2021. [DOI: 10.30886/estima.v19.993_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objetivo:caracterizar o perfil de mulheres com úlceras da perna decorrentes da doença falciforme atendidas em uma instituição pública de saúde do Brasil. Método: estudo de coorte histórica realizado no setor ambulatorial com amostra de mulheres com doença falciforme e úlcera da perna, acompanhadas de 1998 a 2014. Os dados foram extraídos do prontuário e contemplaram variáveis sociodemográficas, clínicas e relacionadas à úlcera, e passaram por análise estatística descritiva. Resultados: das 17 mulheres, 64,7% obtiveram cura, 58,8% tinham idade entre 30 e 39 anos, 64,7% se autodeclaram pardas, 70,6% estavam sem parceiros, 41,2% possuíam ensino fundamental incompleto, 52,9% tinham renda de 2 a 3 salários mínimos, 70,6% eram eutróficas e 82,4% faziam uso de suplementos vitamínicos. As mulheres apresentaram o total de 29 úlceras, 52,9% tinham úlcera única, 41,4% localizadas na região maleolar, 55,17% com existência entre 2 e 36 meses, todas classificadas em estágio 3. O tratamento foi com coberturas e bota de Unna. Conclusão: as mulheres receberam cuidados de enfermeiros especialistas e a maioria obteve a cura com até oito meses de acompanhamento que demandou a consulta de enfermagem, contemplando a avaliação clínica, o tratamento tópico e aplicação da terapia de compressão.
Collapse
|
22
|
Martí-Carvajal AJ, Knight-Madden JM, Martinez-Zapata MJ. Interventions for treating leg ulcers in people with sickle cell disease. Cochrane Database Syst Rev 2021; 1:CD008394. [PMID: 34559425 PMCID: PMC8407242 DOI: 10.1002/14651858.cd008394.pub4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The frequency of skin ulceration makes an important contributor to the morbidity burden in people with sickle cell disease. Many treatment options are available to the healthcare professional, although it is uncertain which treatments have been assessed for effectiveness in people with sickle cell disease. This is an update of a previously published Cochrane Review. OBJECTIVES To assess the clinical effectiveness and harms of interventions for treating leg ulcers in people with sickle cell disease. SEARCH METHODS We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register. We searched LILACS (1982 to January 2020), ISI Web of Knowledge (1985 to January 2020), and the Clinical Trials Search Portal of the World Health Organization (January 2020). We checked the reference lists of all the trials identified. We also contacted those groups or individuals who may have completed relevant randomised trials in this area. Date of the last search of the Cochrane Cystic Fibrosis and Genetic Disorders Group's Haemoglobinopathies Trials Register: 13 January 2020; date of the last search of the Cochrane Wounds Group Trials Register: 17 February 2017. SELECTION CRITERIA Randomised controlled trials of interventions for treating leg ulcers in people with sickle cell disease compared to placebo or an alternative treatment. DATA COLLECTION AND ANALYSIS Two authors independently selected studies for inclusion. All three authors independently assessed the risk of bias of the included studies and extracted data. We used GRADE to assess the quality of the evidence. MAIN RESULTS Six studies met the inclusion criteria (198 participants with 250 ulcers). Each trial investigated a different intervention and within this review we have grouped these as systemic pharmaceutical interventions (L-cartinine, arginine butyrate, isoxsuprine) and topical pharmaceutical interventions (Solcoseryl® cream, arginine-glycine-aspartic acid (RGD) peptide dressing and topical antibiotics). No trials on non-pharmaceutical interventions were included in the review. All trials had an overall unclear or high risk of bias, and drug companies sponsored four of them. We were unable to pool findings due to the heterogeneity in outcome definitions, and inconsistency between the units of randomisation and analysis. Three interventions reported on the change in ulcer size (arginine butyrate, RGD peptide, L-cartinine). Of these, only arginine butyrate showed a reduction of ulcer size compared with a control group, mean reduction -5.10 cm² (95% CI -9.65 to -0.55), but we are uncertain whether this reduces ulcer size compared to standard care alone as the certainty of the evidence has been assessed as very low. Three trials reported on complete leg ulcer closure (isoxsuprine, arginine butyrate, RGD peptide matrix; very low quality of evidence). None reported a clinical benefit. No trial reported on: the time to complete ulcer healing; ulcer-free survival following treatment for sickle cell leg ulcers; quality of life measures; incidence of amputation or harms. AUTHORS' CONCLUSIONS Given the very low quality of the evidence identified in this updated Cochrane Review we are uncertain whether any of the assessed pharmaceutical interventions reduce ulcer size or result in leg ulcer closure in treated participants compared to controls. However, this intervention was assessed as having a high risk of bias due to inadequacies in the single trial report. Other included studies were also assessed as having an unclear or high risk of bias. The harm profile of the all interventions remains inconclusive.
Collapse
Affiliation(s)
- Arturo J Martí-Carvajal
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad UTE (Cochrane Ecuador), Quito, Ecuador
- School of Medicine, Universidad Francisco de Vitoria (Cochrane Madrid), Madrid, Spain
| | | | - Maria José Martinez-Zapata
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| |
Collapse
|
23
|
Sackey D, Dei-Adomakoh Y, Olayemi E. Enhanced Hypercoagulability in Sickle Cell Anaemia Patients with Chronic Leg Ulcers. Adv Hematol 2020; 2020:5157031. [PMID: 33299420 PMCID: PMC7704197 DOI: 10.1155/2020/5157031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 11/18/2022] Open
Abstract
Sickle Cell Anaemia (SCA) is associated with a hypercoagulable state resulting in a predisposition to venous thromboembolism. With improvements in the quality of care, more patients with SCA survive into adulthood with an associated increase in the frequency of end-organ damage and chronic complications such as chronic leg ulcers (CLUs). These ulcers rarely occur in the first decade of life and are recurrent, painful, and slow-to-heal. This study tested the hypothesis that coagulation is enhanced in SCA patients with CLU. 145 participants (50 SCA with CLU, 50 SCA without CLU, and 45 with haemoglobin AA) were assessed to determine their coagulation profile using selected tests of coagulation. The SCA with the CLU group had the lowest mean haemoglobin (Hb) concentration. SCA patients with and without CLUs had elevated mean platelet counts, shorter mean aPTT, and marginally prolonged mean PT compared to HbAA patients. SCA with CLUs patients had a significantly shortened aPTT than those without CLUs (p = 0.035) and HbAA (p = 0.009). There were significant differences in the mean PT between SCA with CLUs patients and HbAA (p = 0.017); SCA without CLU and HbAA (p = 0.014). SCA with and without CLUs patients had higher mean D-dimer levels compared to HbAA. There was a negative correlation between Hb concentration and duration of CLU (r = -0.331, p = 0.021). In conclusion, our study demonstrates a heightened hypercoagulability in SCA patients with CLUs. We did not test for platelet activation, and it is not clear what role, if any, the enhanced hypercoagulability plays in the pathogenesis of CLUs in SCA. It will be useful to ascertain if antiplatelet agents or/and anticoagulants quicken the healing of CLUs in SCA patients.
Collapse
Affiliation(s)
- David Sackey
- Haematology Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Edeghonghon Olayemi
- Department of Haematology, University of Ghana Medical School, Accra, Ghana
- Ghana Institute of Clinical Genetics, Korle Bu, Accra, Ghana
| |
Collapse
|