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Bhatt S, Argueta DA, Gupta K, Kundu S. Red Blood Cells as Therapeutic Target to Treat Sickle Cell Disease. Antioxid Redox Signal 2024; 40:1025-1049. [PMID: 37975291 DOI: 10.1089/ars.2023.0348] [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] [Indexed: 11/19/2023]
Abstract
Significance: Sickle cell disease (SCD) is the most common inherited diathesis affecting mostly underserved populations globally. SCD is characterized by chronic pain and fatigue, severe acute painful crises requiring hospitalization and opioids, strokes, multiorgan damage, and a shortened life span. Symptoms may appear shortly after birth, and, in less developed countries, most children with SCD die before attaining age 5. Hematopoietic stem cell transplant and gene therapy offer a curative therapeutic approach, but, due to many challenges, are limited in their availability and effectiveness for a majority of persons with SCD. A critical unmet need is to develop safe and effective novel targeted therapies. A wide array of drugs currently undergoing clinical investigation hold promise for an expanded pharmacological armamentarium against SCD. Recent Advances: Hydroxyurea, the most widely used intervention for SCD management, has improved the survival in the Western world and more recently, voxelotor (R-state-stabilizer), l-glutamine, and crizanlizumab (anti-P-selectin antibody) have been approved by the Food and Drug Administration (FDA) for use in SCD. The recent FDA approval emphasizes the need to revisit the advances in understanding the core pathophysiology of SCD to accelerate novel evidence-based strategies to treat SCD. The biomechanical breakdown of erythrocytesis, the core pathophysiology of SCD, is associated with intrinsic factors, including the composition of hemoglobin, membrane integrity, cellular volume, hydration, andoxidative stress. Critical Issues and Future Directions: In this context, this review focuses on advances in emerging nongenetic interventions directed toward the therapeutic targets intrinsic to sickle red blood cells (RBCs), which can prevent impaired rheology of RBCs to impede disease progression and reduce the sequelae of comorbidities, including pain, vasculopathy, and organ damage. In addition, given the intricate pathophysiology of the disease, it is unlikely that a single pharmacotherapeutic intervention will comprehensively ameliorate the multifaceted complications associated with SCD. However, the availability of multiple drug options affords the opportunity for individualized therapeutic regimens tailored to specific SCD-related complications. Furthermore, it opens avenues for combination drug therapy, capitalizing on distinct mechanisms of action and profiles of adverse effects.
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Affiliation(s)
- Shruti Bhatt
- Department of Biochemistry, University of Delhi South Campus, New Delhi, India
| | - Donovan A Argueta
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, California, USA
| | - Kalpna Gupta
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, Irvine, California, USA
| | - Suman Kundu
- Department of Biochemistry, University of Delhi South Campus, New Delhi, India
- Department of Biological Sciences, Birla Institute of Technology and Science Pilani, KK Birla Goa Campus, Goa, India
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Ladu AI, Kadaura MU, Dauda M, Baba AS, Zango NG, Jeffery C, Farate A, Adekile A, Bates I. Malaria Infection in Patients with Sickle Cell Disease in Nigeria: Association with Markers of Hyposplenism. Hemoglobin 2024; 48:15-23. [PMID: 38247354 DOI: 10.1080/03630269.2023.2285881] [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: 05/19/2023] [Accepted: 11/15/2023] [Indexed: 01/23/2024]
Abstract
Malaria is considered an important cause of morbidity and mortality among people living with sickle cell disease (SCD). This has partly been attributed to the loss of splenic function that occurs early in the disease process. We conducted a cross-sectional study and determined the frequency of malaria infection among SCD patients and explored the association with spleen's presence on ultrasonography and spleen function assessed using the frequency of Howell-Jolly bodies (HJBs). A total of 395 participants consisting of 119 acutely-ill SCD patients, 168 steady-state SCD controls, and 108 healthy non-SCD controls were studied. The prevalence of Plasmodium falciparum parasitemia was 51.3% in acutely-ill SCD patients, 31.7% in steady-state SCD controls, and 11.0% in the healthy non-SCD controls; however, the mean parasite density was significantly higher in the non-SCD controls compared to both SCD groups (p = 0.0001). Among the acutely-ill SCD patients, the prevalence of clinical malaria and severe malaria anemia were highest in children <5 years of age. The prevalence of parasitemia (p = 0.540) and parasite density (p = 0.975) showed no association with spleen presence or absence on ultrasonography. Similarly, the frequency of HJB red cells was not associated with the presence of parasitemia (p = 0.183). Our study highlights the frequency and role of malaria infection in acutely-ill SCD patients, especially in those younger than five years. Although we have found no evidence of an increased risk of malaria parasitemia or parasite density with markers of hyposplenism, the role played by an underlying immunity to malaria among SCD patients in malaria-endemic region is not clear and needs further studies.
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Affiliation(s)
- Adama Isah Ladu
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Mairo Usman Kadaura
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Mohammed Dauda
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Abubakar Sadiq Baba
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Nasir Garba Zango
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Caroline Jeffery
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, UK
| | - Abubakar Farate
- Department of Radiology, Faculty of Clinical Sciences, University of Maiduguri, Maiduguri, Nigeria
| | - Adekunle Adekile
- Department of Paediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Imelda Bates
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
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de Oliveira Taques W, Bett GC, de Moraes BLB, Medeiros I, Fontes CJF, Godinho de Oliveira R. Factors Associated with Overt Stroke in Children and Adolescents with Sickle Cell Disease: A Retrospective Cohort Study. Hemoglobin 2024; 48:39-46. [PMID: 38263710 DOI: 10.1080/03630269.2023.2301490] [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: 01/20/2023] [Accepted: 12/21/2023] [Indexed: 01/25/2024]
Abstract
Sickle cell disease (SCD) is associated with a high occurrence of complications due to vaso-occlusive phenomenon such as stroke. This retrospective cohort study aimed to examine the clinical and laboratory characteristics of 120 children and adolescents with SCD and analyze the factors associated with overt stroke incidence. All relevant data were obtained from patient medical records. Survival analysis was used to compare the demographic, clinical, and laboratory characteristics between patients with and those without overt stroke. The patients were 52.5% female with a mean (SD) age of 11.2 (4.3) years. The incidence of overt stroke in this cohort was nine out of 956.7 patient-years, resulting in an incidence density of 0.94 cases/100 patient-years. Reports of greater than or equal to two previous attacks of dactylitis and greater than or equal to three episodes of acute chest syndrome (ACS)/pneumonia were associated with overt stroke and an increase in reticulocyte count and red blood cell distribution width (RDW). In conclusion, a history of a high number of dactylitis, ACS/pneumonia, increased RDW, and reticulocytosis was associated with overt stroke occurrence in children and adolescents with SCD. Future studies with a higher stroke incidence in the evaluated sample are necessary to confirm this hypothesis.
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Affiliation(s)
- Wolney de Oliveira Taques
- Júlio Müller University Hospital/EBSERH, Teaching and Research Management, Federal University of Mato Grosso - UFMT, Cuiabá, Brazil
- Medicine Course, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil
- Hematology Outpatient Clinic of MT-Hemocentro, State Health Department of MT - Mato Grosso, Cuiabá, Brazil
| | - Gabriele Curvo Bett
- Medicine Course, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil
| | | | - Iasmin Medeiros
- Medicine Course, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil
| | - Cor Jesus Fernandes Fontes
- Júlio Müller University Hospital/EBSERH, Teaching and Research Management, Federal University of Mato Grosso - UFMT, Cuiabá, Brazil
- Medicine Course, Várzea Grande University Center (UNIVAG), Várzea Grande, Brazil
| | - Ruberlei Godinho de Oliveira
- Júlio Müller University Hospital/EBSERH, Teaching and Research Management, Federal University of Mato Grosso - UFMT, Cuiabá, Brazil
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Ladu AI, Kadaura MU, Dauda M, Baba AS, Jeffery C, Farate A, Adekile A, Bates I, Dacombe R. Bacteraemia Among Patients with Sickle Cell Disease in Nigeria: Association with Spleen Size and Function. Mediterr J Hematol Infect Dis 2023; 15:e2023054. [PMID: 37705518 PMCID: PMC10497316 DOI: 10.4084/mjhid.2023.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/14/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Adama I Ladu
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Mairo U Kadaura
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Mohammed Dauda
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Abubakar Sadiq Baba
- Department of Microbiology, Faculty of Basic Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Caroline Jeffery
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Clinical Infection, Microbiology and Immunology, University of Liverpool, Liverpool, United Kingdom
| | - Abubakar Farate
- Department of Radiology, Faculty of Clinical Sciences, University of Maiduguri. Borno State, Nigeria
| | - Adekunle Adekile
- Department of Paediatrics, Faculty of Medicine, Kuwait University, Kuwait
| | - Imelda Bates
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Russell Dacombe
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Ata F, Rahhal A, Malkawi L, Iqbal P, Khamees I, Alhiyari M, Yousaf Z, Qasim H, Alshurafa A, Sardar S, Javed S, Fernyhough L, Yassin M. Genotypic and Phenotypic Composition of Sickle Cell Disease in the Arab Population - A Systematic Review. Pharmgenomics Pers Med 2023; 16:133-144. [PMID: 36851992 PMCID: PMC9961577 DOI: 10.2147/pgpm.s391394] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023] Open
Abstract
Sickle cell disease (SCD) is a genetic disease influenced by ethnicity and regional differences in its clinical course. Recent advances in the management of SCD with newer therapies are being introduced to the Western population. However, many of these treatments are yet to be used in the Arabic SCD population. Understanding the genetic variations of SCD regionally is essential to anticipate the utilization of new treatments. This systematic review's main objective is to pool the available data on the genetic composition of SCD in the Arabic population. Data for 44,034 patients was extracted from 184 studies (11 case reports, 8 case series, 56 retrospectives, 107 prospective observational studies, and 2 clinical trials) using PubMed, Scopus, and Google Scholar. Male (49%) and female (51%) patients were equally reported wherever gender was available (N=13105). Various SCD genotypes were reported in a total of 14,257 patients, including Hb SS (77%) Hb Sβ0 (9.9%), and Hb Sβ+ (7.2%), while the rest of the genotypes, including HbSC, HbSD, HbSE, HbSO Arab, Hb S/α-Thal, Hb Sβ0 + α-Thal, and HBS Oman were individually reported in <4% of the cases. Major SCD complications in the Arab population included pain crises (48.25%) followed by neurological complications (33.46%), hepatobiliary complications (25.53%), musculoskeletal complications (24.73%), and hemolytic anemia (23.57%). The treatments reported for SCD included hydroxyurea (20%), blood transfusion (14.32%), and Deferasirox (3.03%). We did not find the use of stem cell transplantation or newer treatments such as L-Glutamine, Voxelotor, Crizanlizumab, or gene therapy reported in any of the studies included in our review. This review highlights the genetic makeup of SCD in Arab countries and its common phenotypic manifestations and will help direct further research on SCD in this region, especially concerning genetic therapy. Systematic Review Registration The protocol has been registered in the International Prospective Register of Systematic Reviews(PROSPERO):CRD42020218,666. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=218666.
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Affiliation(s)
- Fateen Ata
- Department of Endocrinology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Alaa Rahhal
- Department of Clinical Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Lujain Malkawi
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Phool Iqbal
- Department of Internal Medicine, Metropolitan Hospital, New York, NY, USA
| | - Ibrahim Khamees
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mousa Alhiyari
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Department of Internal Medicine, Reading Hospital - Tower Health, West Reading, PA, USA
| | - Hana Qasim
- Department of Internal Medicine, UMKC School of medicine, Kansas, MO, USA
| | - Awni Alshurafa
- Department of Medical Oncology /Hematology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Sundus Sardar
- Department of Medicine, Division of Nephrology, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA, USA
| | - Saad Javed
- Department of Internal Medicine, Icahn school of medicine at Mount Sinai/Queens Hospital Center, New York, NY, USA
| | - Liam Fernyhough
- Department of Medical Oncology /Hematology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.,Department of Medical Education, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Mohamed Yassin
- Department of Medical Oncology /Hematology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Tennenbaum J, Volle G, Buffet P, Ranque B, Pouchot J, Arlet JB. [Splenic dysfunction in sickle cell disease: An update]. Rev Med Interne 2023:S0248-8663(23)00005-X. [PMID: 36710088 DOI: 10.1016/j.revmed.2023.01.005] [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: 10/18/2022] [Revised: 01/01/2023] [Accepted: 01/08/2023] [Indexed: 01/30/2023]
Abstract
The spleen filters blood cells and contributes to the immune defense. The red pulp clears the blood from altered red blood cells via its unique microcirculatory network ; while the white pulp is a secondary lymphoid organ, directly connected to the bloodstream, whose specificity is the defense against encapsulated bacteria through the production of "natural" IgM in the marginal zone. Various health conditions can cause acquired impairment of the splenic function (or hyposplenism) directly and/or through therapeutic splenectomy. Hypo/asplenia is complicated by an increased susceptibility to encapsulated germ infections, but an increased risk of thrombosis and pulmonary hypertension has also been reported after surgical splenectomy. Homozygous sickle cell disease is the most common disease associated with functional asplenia. The latter appears early in childhood likely through repeated ischemic alterations caused by the sickling of red blood cells. In addition, specific complications such as hypersplenism and acute splenic sequestration can occur and may be life-threatening. We provide here an update on the role and physiology of the spleen, which will allow a better understanding of the pathophysiology of spleen damage and its consequences in sickle cell disease.
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Affiliation(s)
- J Tennenbaum
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France.
| | - G Volle
- Service de médecine interne, Hôpital Henri-Mondor, Assistance publique-Hôpitaux de Paris, Créteil, France
| | - P Buffet
- Laboratoire d'Excellence GR-Ex, Biologie intégrée du globule rouge (BIGR), Université Paris Cité, Inserm, Paris, France
| | - B Ranque
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Laboratoire d'Excellence GR-Ex, Biologie intégrée du globule rouge (BIGR), Université Paris Cité, Inserm, Paris, France; Faculté de médecine Paris Cité, Paris, France
| | - J Pouchot
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Faculté de médecine Paris Cité, Paris, France
| | - J-B Arlet
- Service de médecine interne, Centre de référence national de la drépanocytose de l'adulte, Hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, Paris, France; Laboratoire d'Excellence GR-Ex, Biologie intégrée du globule rouge (BIGR), Université Paris Cité, Inserm, Paris, France; Faculté de médecine Paris Cité, Paris, France; Inserm U1163, CNRS 8254, Institut IMAGINE, Hôpital Necker, Assistance publique-Hôpitaux de Paris, Paris, France
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Ladu AI, Satumari NA, Abba AM, Abulfathi FA, Jeffery C, Adekile A, Bates I. Evaluation of two red cell inclusion staining methods for assessing spleen function among sickle cell disease patients in North-East Nigeria. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001552. [PMID: 37200242 DOI: 10.1371/journal.pgph.0001552] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/23/2023] [Indexed: 05/20/2023]
Abstract
The loss of splenic function is associated with an increased risk of infection in sickle cell disease (SCD); however, spleen function is rarely documented among SCD patients in Africa, due partly to the non-availability of sophisticated techniques such as scintigraphy. Methods of assessing splenic function which may be achievable in resource-poor settings include counting red blood cells (RBC) containing Howell Jolly Bodies (HJB) and RBC containing silver-staining (argyrophilic) inclusions (AI) using a light microscope. We evaluated the presence of HJB-and AI-containing RBC as markers of splenic dysfunction among SCD patients in Nigeria. We prospectively enrolled children and adults with SCD in steady state attending outpatient clinics at a tertiary hospital in North-East Nigeria. The percentages of HJB-and AI-containing red cells were estimated from peripheral blood smears and compared to normal controls. There were 182 SCD patients and 102 healthy controls. Both AI- and HJB-containing red cells could be easily identified in the participants blood smears. SCD patients had a significantly higher proportion of red cells containing HJB (1.5%; IQR 0.7%-3.1%) compared to controls (0.3%; IQR 0.1%-0.5%) (P <0.0001). The AI red cell counts were also higher among the SCD patients (47.4%; IQR 34.5%-66.0%) than the control group (7.1%; IQR 5.1%-8.7%) (P < 0.0001). The intra-observer reliability for assessment of HJB- (r = 0.92; r2 = 0.86) and AI- containing red cells (r = 0.90; r2 = 0.82) was high. The estimated intra-observer agreement was better with the HJB count method (95% limits of agreement, -4.5% to 4.3%; P = 0.579).We have demonstrated the utility of light microscopy in the assessment of red cells containing-HJB and AI inclusions as indices of splenic dysfunction in Nigerian SCD patients. These methods can be easily applied in the routine evaluation and care of patients with SCD to identify those at high risk of infection and initiate appropriate preventive measures.
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Affiliation(s)
- Adama I Ladu
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Ngamarju A Satumari
- Department of Medical Laboratory Science, Faculty of Allied Health Sciences, University of Maiduguri, Maiduguri, Borno state, Nigeria
| | - Aisha M Abba
- Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Fatima A Abulfathi
- Department of Haematology, Faculty of Basic Clinical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Caroline Jeffery
- Department of Clinical Infection, Microbiology and Immunology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, United Kingdom
- Department of Health Data Science, University of Liverpool, Liverpool, United Kingdom
| | - Adekunle Adekile
- Department of Paediatrics, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | - Imelda Bates
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Sickle Cell Trait, Clinical Manifestations and Outcomes: A Cross-Sectional Study in Colombia: Increasing Rate of Symptomatic Subjects Living in High Altitude. Mediterr J Hematol Infect Dis 2023; 15:e2023015. [PMID: 36908870 PMCID: PMC10000961 DOI: 10.4084/mjhid.2023.015] [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: 09/05/2022] [Accepted: 02/15/2023] [Indexed: 03/05/2023] Open
Abstract
Background Sickle cell trait (SCT) is an autosomal recessive blood disorder in which patients are heterozygous carriers for hemoglobin S (HbAS) and are usually asymptomatic. We performed a descriptive analysis of clinical manifestations and outcomes associated with SCT. Methods This was a descriptive, cross-sectional study that included patients with SCT from 2014 to 2020 at Hospital Militar Central, the reference center of the Military forces in Bogota, Colombia. Results Of 647 hemoglobin electrophoresis analyzed, we identified 51 patients with SCT, including 43 males (84.3%) and eight females (15.7%), with a median age of 22 years (IQR 15-36 years). Of these, 28 (54.8%) were Afro-Colombian, 23 (45.1%) were Colombian mestizos, and 31/51 (60.8%) of patients were active military members. Twenty-four patients (47.1%) were asymptomatic, and Twenty-seven patients (52.9%) were symptomatic (systemic complications); Most of the patients who presented symptoms were active military members of the Colombian military forces. Splenic complications were the most important (85.2%), p=0.0005, and there was a wide spectrum of splenic complications. In addition, we found significant elevations in leukocytes, bilirubin, LDH, and CRP. Eighteen patients (66.7%) received medical management, five (18.5%) required splenectomy, and only 5.9% of patients were sent for genetic counseling. Conclusions Military Personnel is a population with a high risk of developing symptoms, and splenic complications were the most relevant in symptomatic patients. Most patients received medical treatment, and 18.5% of patients required splenectomy. Our results reflect the absence of redirection of these patients to genetic counseling.
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Abstract
Asplenia (the congenital or acquired absence of the spleen) and hyposplenism (defective spleen function) are common causes of morbidity and mortality. The spleen is a secondary lymphoid organ that is responsible for the regulation of immune responses and blood filtration. Hence, asplenia or hyposplenism increases susceptibility to severe and invasive infections, especially those sustained by encapsulated bacteria (namely, Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae type b). Asplenia is predominantly due to splenectomy for either traumatic events or oncohaematological conditions. Hyposplenism can be caused by several conditions, including haematological, infectious, autoimmune and gastrointestinal disorders. Anatomical disruption of the spleen and depletion of immune cells, especially IgM memory B cells, seem to be predominantly responsible for the clinical manifestations. Early recognition of hyposplenism and proper management of asplenia are warranted to prevent overwhelming post-splenectomy infections through vaccination and antibiotic prophylaxis. Although recommendations are available, the implementation of vaccination strategies, including more effective and immunogenic vaccines, is needed. Additionally, screening programmes for early detection of hyposplenism in high-risk patients and improvement of patient education are warranted.
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Peretz S, Livshits L, Pretorius E, Makhro A, Bogdanova A, Gassmann M, Koren A, Levin C. The protective effect of the spleen in sickle cell patients. A comparative study between patients with asplenia/hyposplenism and hypersplenism. Front Physiol 2022; 13:796837. [PMID: 36105295 PMCID: PMC9465245 DOI: 10.3389/fphys.2022.796837] [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] [Received: 10/17/2021] [Accepted: 08/02/2022] [Indexed: 11/23/2022] Open
Abstract
Sickle cell disease (SCD) is caused by a point mutation in the beta-globin gene. SCD is characterized by chronic hemolytic anemia, vaso-occlusive events leading to tissue ischemia, and progressive organ failure. Chronic inflammatory state is part of the pathophysiology of SCD. Patients with SCD have extremely variable phenotypes, from mild disease to severe complications including early age death. The spleen is commonly injured in SCD. Early splenic dysfunction and progressive spleen atrophy are common. Splenomegaly and hypersplenism can also occur with the loss of the crucial splenic function. Acute, life-threatening spleen-related complications in SCD are well studied. The association of laboratory parameters with the spleen status including hyposplenism, asplenia, and splenomegaly/hypersplenism, and their implication in vaso-occlusive crisis and long-term complications in SCD remain to be determined. We evaluated the association between the spleen status with clinical and laboratory parameters in 31 SCD patients: Group a) Patients with asplenia/hyposplenism (N = 22) (including auto-splenectomy and splenectomized patients) vs. Group b) patients with splenomegaly and or hypersplenism (N = 9). Laboratory studies included: Complete Blood Count, reticulocyte count, iron metabolism parameters, C Reactive Protein (CRP), Hb variant distribution, and D-dimer. Metabolic and morphological red blood cell (RBC) studies included: density gradient (by Percoll), glucose consumption, lactate release, and K+ leakage, fetal RBC (F-Cells) and F-Reticulocytes, annexinV+, CD71+, oxidative stress measured by GSH presence in RBC and finally Howell Jolly Bodies count were all analyzed by Flow Cytometry. Scanning electron microscopy analysis of RBC was also performed. Patients with asplenia/hyposplenism showed significantly higher WBC, platelet, Hematocrit, hemoglobin S, CRP, D-dimer, Gamma Glutamyl Transferase (GGT), cholesterol, transferrin, annexin V+ RBCs, CD71+ RBCs, together with a markedly lower F Reticulocyte levels in comparison with splenomegaly/hypersplenism patients. In summary, important differences were also found between the groups in the studied RBCs parameters. Further studies are required to elucidate the effect of the spleen including hyper and hypo-splenia on laboratory parameters and in clinical manifestations, vascular pathology, and long-term complications of SCD. The benefits and risks of splenectomy compared to chronic transfusion need to be evaluated in clinical trials and the standard approach managing hypersplenism in SCD patients should be re-evaluated.
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Affiliation(s)
- Sari Peretz
- Pediatric Hematology Unit, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Leonid Livshits
- Pediatric Hematology Unit, Emek Medical Center, Afula, Israel
- Red Blood Cell Research Group, Vetsuisse Faculty, Institute of Veterinary Physiology, University of Zurich, Zürich, Switzerland
| | - Etheresia Pretorius
- Department of Physiological Sciences, Faculty of Science, Stellenbosch University, Stellenbosch, South Africa
| | - Asya Makhro
- Red Blood Cell Research Group, Vetsuisse Faculty, Institute of Veterinary Physiology, University of Zurich, Zürich, Switzerland
| | - Anna Bogdanova
- Red Blood Cell Research Group, Vetsuisse Faculty, Institute of Veterinary Physiology, University of Zurich, Zürich, Switzerland
- The Zurich Center for Integrative Human Physiology (ZIHP), Zürich, Switzerland
| | - Max Gassmann
- Red Blood Cell Research Group, Vetsuisse Faculty, Institute of Veterinary Physiology, University of Zurich, Zürich, Switzerland
| | - Ariel Koren
- Pediatric Hematology Unit, Emek Medical Center, Afula, Israel
| | - Carina Levin
- Pediatric Hematology Unit, Emek Medical Center, Afula, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- *Correspondence: Carina Levin, ,
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Abstract
In contrast to other lymphoid tissues making up the immune system, the spleen as its biggest organ is directly linked into the blood circulation. Beside its main task to filter out microorganism, proteins, and overaged or pathologically altered blood cells, also humoral and cellular immune responses are initiated in this organ. The spleen is not palpable during a physical examination in most but not all healthy patients. A correct diagnosis of splenomegaly in children and adolescents must take into account age-dependent size reference values. Ultrasound examination is nowadays used to measure the spleen size and to judge on reasons for morphological alterations in associated with an increase in organ size. An enormous amount of possible causes has to be put in consideration if splenomegaly is diagnosed. Among these are infectious agents, hematologic disorders, infiltrative diseases, hyperplasia of the white pulp, congestion, and changes in the composition and structure of the white pulp by immunologically mediated diseases. This review attempts to discuss a comprehensive list of differential diagnoses to be considered clinically in children and young adolescents.
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Affiliation(s)
- Meinolf Suttorp
- Pediatric Hemato-Oncology, Medical Faculty, Technical University Dresden, Dresden, Germany.,Division of Pediatric Oncology, Hematology and Palliative Medicine Section, Department of Pediatrics and Adolescent Medicine, University Medicine Rostock, Rostock, Germany
| | - Carl Friedrich Classen
- Division of Pediatric Oncology, Hematology and Palliative Medicine Section, Department of Pediatrics and Adolescent Medicine, University Medicine Rostock, Rostock, Germany
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