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Obeagu EI, Obeagu GU. Implications of climatic change on sickle cell anemia: A review. Medicine (Baltimore) 2024; 103:e37127. [PMID: 38335412 PMCID: PMC10860944 DOI: 10.1097/md.0000000000037127] [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: 11/30/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 02/12/2024] Open
Abstract
Sickle cell anemia (SCA) is a hereditary blood disorder characterized by abnormal hemoglobin, causing red blood cells to assume a sickle shape, leading to various complications. Climate change has emerged as a significant global challenge, influencing environmental conditions worldwide. This paper explores the implications of climatic variations on the prevalence, management, and outcomes of SCA. Climate change affects weather patterns, leading to altered temperatures, increased frequency of extreme weather events, and variations in humidity levels. These changes can have a profound impact on individuals living with SCA. High temperatures exacerbate the symptoms of SCA, potentially triggering painful vaso-occlusive crises due to dehydration and increased blood viscosity. Conversely, cold temperatures may induce vaso-occlusion by causing blood vessels to constrict. Changes in rainfall patterns might also affect water accessibility, which is crucial for maintaining adequate hydration, particularly in regions prone to droughts. The management of SCA is multifaceted, involving regular medical care, hydration, and avoiding triggers that could precipitate a crisis. Adverse weather events and natural disasters can disrupt healthcare infrastructure and access to essential medications and resources for SCA patients, especially in vulnerable communities. To mitigate the implications of climatic change on SCA, interdisciplinary strategies are essential. These strategies may include enhancing healthcare systems' resilience to climate-related disruptions, implementing adaptive measures to address changing environmental conditions, and promoting public awareness and education on managing SCA amidst climate variability. In conclusion, climatic variations pose significant challenges for individuals with SCA, affecting the prevalence, management, and outcomes of the disease.
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Alkindi S, Panjwani V, Al-Rahbi S, Al-Saidi K, Pathare AV. Iron Overload in Patients With Heavily Transfused Sickle Cell Disease-Correlation of Serum Ferritin With Cardiac T2 * MRI (CMRTools), Liver T2 * MRI, and R2-MRI (Ferriscan®). Front Med (Lausanne) 2021; 8:731102. [PMID: 34760898 PMCID: PMC8573209 DOI: 10.3389/fmed.2021.731102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/17/2021] [Indexed: 11/13/2022] Open
Abstract
The treatment of sickle cell disease (SCD) is mainly supportive, except for a minority, who receive bone marrow transplantation (BMT). Serum ferritin (SF) is routinely available but is notoriously unreliable as a tool for iron-overload assessment since it is an acute-phase reactant. Although blood transfusion is one of the most effective ways to deal with specific acute and chronic complications of SCD, this strategy is often associated with alloimmunization, iron overload, and hemolytic reactions. This study, thus, aims to evaluate iron overload in patients with SCD on chronic blood transfusions and specifically, correlate SF with the current standard of care of iron-overload assessment using MRI-based imaging techniques. Amongst a historic cohort of 58 chronically transfused patients with SCD, we were able to evaluate 44 patients who are currently alive and had multiple follow-up testing. Their mean age (±SD) was 35 (9) years and comprised of 68.2% of women. The studied iron-overload parameters included cardiac T2* MRI, liver iron concentration (LIC) by Liver T2* MRI, and serial SF levels. Additionally, in a smaller cohort, we also studied LIC by FerriScan© R2-MRI. Chronic blood transfusions were necessary for severe vaso-occlusive crisis (VOC) (38.6%), severe symptomatic anemia (38.6%), past history of stroke (15.9%), and recurrent acute chest syndrome (6.9%). About 14 (24%) patients among the original cohort died following SCD-related complications. Among the patients currently receiving chelation, 26 (96%) are on Deferasirox (DFX) [Jadenu® (24) or Exjade® (2)], with good compliance and tolerance. However, one patient is still receiving IV deferoxamine (DFO), in view of the significantly high systemic iron burden. In this evaluable cohort of 44 patients, the mean SF (±SD) reduced marginally from 4,311 to 4,230 ng/ml, mean Liver T2* MRI dropped from 12 to 10.3 mg/gm dry weight, while the mean cardiac T2*MRI improved from 36.8 to 39.5 ms. There was a mild to moderate correlation between the baseline and final values of SF ng/ml, r = 0.33, p = 0.01; Cardiac T2* MRI ms, r = 0.3, p = 0.02 and Liver T2* MRI mg/kg dry weight, r = 0.6, p < 0.001. Overall, there was a positive correlation between SF and Liver T2* MRI (Pearson's r = 0.78, p < 0.001). Cardiac T2*MRI increased with the decreasing SF concentration, showing a negative correlation which was statistically significant (Pearson's r = -0.6, p < 0.001). Furthermore, there was an excellent correlation between SF ng/ml and LIC by FerriScan© R2-MRI mg/g or mmol/kg (Spearmen's rho = -0.723, p < 0.008) in a small subset of patients (n = 14) who underwent the procedure. In conclusion, our study demonstrated a good correlation between serial SF and LIC by either Liver MRI T2* or by FerriScan© R2-MRI, even though SF is an acute-phase reactant. It also confirms the cardiac sparing effect in patients with SCD, even with the significant transfusion-related iron burden. About 14 (24%) patients of the original cohort died over the past 15 years, indicative of a negative impact of iron overload on disease morbidity and mortality.
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Affiliation(s)
- Salam Alkindi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman.,College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Vinodh Panjwani
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sarah Al-Rahbi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khalid Al-Saidi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Anil V Pathare
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
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Jang T, Poplawska M, Cimpeanu E, Mo G, Dutta D, Lim SH. Vaso-occlusive crisis in sickle cell disease: a vicious cycle of secondary events. J Transl Med 2021; 19:397. [PMID: 34544432 PMCID: PMC8454100 DOI: 10.1186/s12967-021-03074-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/08/2021] [Indexed: 12/18/2022] Open
Abstract
Painful vaso-occlusive crisis (VOC) remains the most common reason for presenting to the Emergency Department and hospitalization in patients with sickle cell disease (SCD). Although two new agents have been approved by the Food and Drug Administration for treating SCD, they both target to reduce the frequency of VOC. Results from studies investigating various approaches to treat and shorten VOC have so far been generally disappointing. In this paper, we will summarize the complex pathophysiology and downstream events of VOC and discuss the likely reasons for the disappointing results using monotherapy. We will put forward the rationale for exploring some of the currently available agents to either protect erythrocytes un-involved in the hemoglobin polymerization process from sickling induced by the secondary events, or a multipronged combination approach that targets the complex downstream pathways of VOC.
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Affiliation(s)
- Tim Jang
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC #20, Brooklyn, NY, 11203, USA
| | - Maria Poplawska
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC #20, Brooklyn, NY, 11203, USA
| | - Emanuela Cimpeanu
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC #20, Brooklyn, NY, 11203, USA
| | - George Mo
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC #20, Brooklyn, NY, 11203, USA
| | - Dibyendu Dutta
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC #20, Brooklyn, NY, 11203, USA
| | - Seah H Lim
- Division of Hematology and Oncology, Department of Medicine, SUNY Downstate Medical Center, SUNY Downstate Health Sciences University, 450 Clarkson Avenue, MSC #20, Brooklyn, NY, 11203, USA.
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Gaartman AE, Sayedi AK, Gerritsma JJ, de Back TR, van Tuijn CF, Tang MW, Heijboer H, de Heer K, Biemond BJ, Nur E. Fluid overload due to intravenous fluid therapy for vaso-occlusive crisis in sickle cell disease: incidence and risk factors. Br J Haematol 2021; 194:899-907. [PMID: 34263922 PMCID: PMC8456906 DOI: 10.1111/bjh.17696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 02/02/2023]
Abstract
Intravenous fluid therapy (IV‐FT) is routinely used in the treatment of vaso‐occlusive crises (VOCs), as dehydration possibly promotes and sustains erythrocyte sickling. Patients with sickle cell disease (SCD) are at risk of developing diastolic dysfunction and fluid overload due to IV‐FT. However, data on the adverse effects of IV‐FT for VOC is sparse. We aimed to evaluate the incidence and risk factors of fluid overload due to IV‐FT in patients with SCD. Consecutive hospitalisations for VOC treated with IV‐FT between September 2016 and September 2018 were retrospectively analysed. The median (interquartile range) age was 25·0 (18·3–33·8) years and 65% had a severe genotype (HbSS/HbSβ0‐thal). Fluid overload occurred in 21% of 100 patients. Hospital stay was longer in patients with fluid overload (6·0 vs. 4·0 days, P = 0·037). A positive history of fluid overload (P = 0·017), lactate dehydrogenase level (P = 0·011), and top‐up transfusion during admission (P = 0·005) were independently associated with fluid overload occurrence. IV‐FT was not reduced in 86% of patients despite a previous history of fluid overload. Fluid overload is frequently encountered during IV‐FT for VOC. IV‐FT is often not adjusted despite a positive history of fluid overload or when top‐up transfusion is indicated, emphasising the need for more awareness of this complication and a personalised approach.
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Affiliation(s)
- Aafke E Gaartman
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ajab K Sayedi
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Jorn J Gerritsma
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Tim R de Back
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
| | | | - Man Wai Tang
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Harriët Heijboer
- Department of Pediatric Hematology, Emma Children's Hospital, Amsterdam UMC, Amsterdam, The Netherlands
| | - Koen de Heer
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands.,Department of Internal Medicine, Flevo Hospital, Almere, The Netherlands
| | - Bart J Biemond
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Erfan Nur
- Department of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
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American Society of Hematology 2020 guidelines for sickle cell disease: management of acute and chronic pain. Blood Adv 2021; 4:2656-2701. [PMID: 32559294 DOI: 10.1182/bloodadvances.2020001851] [Citation(s) in RCA: 176] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/09/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The management of acute and chronic pain for individuals living with sickle cell disease (SCD) is a clinical challenge. This reflects the paucity of clinical SCD pain research and limited understanding of the complex biological differences between acute and chronic pain. These issues collectively create barriers to effective, targeted interventions. Optimal pain management requires interdisciplinary care. OBJECTIVE These evidence-based guidelines developed by the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in pain management decisions for children and adults with SCD. METHODS ASH formed a multidisciplinary panel, including 2 patient representatives, that was thoroughly vetted to minimize bias from conflicts of interest. The Mayo Evidence-Based Practice Research Program supported the guideline development process, including updating or performing systematic reviews. Clinical questions and outcomes were prioritized according to importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE evidence-to-decision frameworks, to assess evidence and make recommendations, which were subject to public comment. RESULTS The panel reached consensus on 18 recommendations specific to acute and chronic pain. The recommendations reflect a broad pain management approach, encompassing pharmacological and nonpharmacological interventions and analgesic delivery. CONCLUSIONS Because of low-certainty evidence and closely balanced benefits and harms, most recommendations are conditional. Patient preferences should drive clinical decisions. Policymaking, including that by payers, will require substantial debate and input from stakeholders. Randomized controlled trials and comparative-effectiveness studies are needed for chronic opioid therapy, nonopioid therapies, and nonpharmacological interventions.
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Purnell MC, Rayborn M. Novel hydration and nutritional strategies for sickle cell disease. EJHAEM 2020; 1:230-234. [PMID: 35847706 PMCID: PMC9175917 DOI: 10.1002/jha2.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 04/16/2020] [Indexed: 11/09/2022]
Abstract
Introduction Sickle cell disease and sickle cell trait affect over 300 million people worldwide. Vaso-occlusive crises (VOCs) are the most common reason that these patients seek medical care. Objectives Recently, a newly identified "trigger" (involving glucose and electrolytes) for a mechanism of abnormal actin polymerization may offer further understanding with regard to the sequence of events that cascade to complications such as VOCs in those with sickle cell disease (SCD) and as well as those with sickle cell trait. Methods A literature review to identify the current standard of care guidelines for hydration and nutritional strategies during VOCs in patients with SCD and sickle cell trait was conducted in PubMed, OVID, and Google Scholar. Results This review suggested that current rationales for hydration and nutritional strategies for these patients during periods of crisis are generally based on consensus and have remained largely undefined to date. Conclusion This new trigger, along with this literature review, suggests investigations related to serum glucose and cation (electrolyte) levels may help define novel strategies for the development of protocols/standard of care with regard to intravenous and oral hydration/nutritional guidelines in these patients during both clinical and perioperative management periods.
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Affiliation(s)
- Marcy C. Purnell
- School of Leadership and Advanced Nursing PracticeThe University of Southern MississippiHattiesburgMississippi
| | - Michong Rayborn
- School of Leadership and Advanced Nursing PracticeThe University of Southern MississippiHattiesburgMississippi
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Gaut D, Jones J, Chen C, Ghafouri S, Leng M, Quinn R. Outcomes related to intravenous fluid administration in sickle cell patients during vaso-occlusive crisis. Ann Hematol 2020; 99:1217-1223. [DOI: 10.1007/s00277-020-04050-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 04/20/2020] [Indexed: 12/29/2022]
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Carden MA, Brousseau DC, Ahmad FA, Bennett J, Bhatt S, Bogie A, Brown K, Casper TC, Chapman LL, Chumpitazi CE, Cohen D, Dampier C, Ellison AM, Grasemann H, Hickey RW, Hsu LL, Leibovich S, Powell E, Richards R, Sarnaik S, Weiner DL, Morris CR. Normal saline bolus use in pediatric emergency departments is associated with poorer pain control in children with sickle cell anemia and vaso-occlusive pain. Am J Hematol 2019; 94:689-696. [PMID: 30916794 DOI: 10.1002/ajh.25471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/24/2019] [Accepted: 03/25/2019] [Indexed: 11/07/2022]
Abstract
Vaso-occlusive pain events (VOE) are the leading cause of emergency department (ED) visits in sickle cell anemia (SCA). This study assessed the variability in use of intravenous fluids (IVFs), and the association of normal saline bolus (NSB), on pain and other clinical outcomes in children with SCA, presenting to pediatric emergency departments (PED) with VOE. Four-hundred charts of children age 3-21 years with SCA/VOE receiving parenteral opioids at 20 high-volume PEDs were evaluated in a retrospective study. Data on type and amount of IVFs used were collected. Patients were divided into two groups: those who received NSB and those who did not. The association of NSB use on change in pain scores and admission rates was evaluated. Among 400 children studied, 261 (65%) received a NSB. Mean age was 13.8 ± 4.9 years; 46% were male; 92% had hemoglobin-SS. The IVFs (bolus and/or maintenance) were used in 84% of patients. Eight different types of IVFs were utilized and IVF volume administered varied widely. Mean triage pain scores were similar between groups, but improvement in pain scores from presentation-to-ED-disposition was smaller in the NSB group (2.2 vs 3.0, P = .03), while admission rates were higher (71% vs 59%, P = .01). Use of NSB remained associated with poorer final pain scores and worse change in pain scores in our multivariable model. In conclusion, wide variations in practice utilizing IVFs are common. NSB is given to >50% of children with SCA/VOE, but is associated with poorer pain control; a controlled prospective trial is needed to determine causality.
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Affiliation(s)
- Marcus A. Carden
- Departments of Pediatrics and MedicineUniversity of North Carolina at Chapel Hill School of Medicine Chapel Hill North Carolina
| | - David C. Brousseau
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Medical College of Wisconsin Milwaukee Wisconsin
| | - Fahd A. Ahmad
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Washington University School of Medicine St. Louis Missouri
| | - Jonathan Bennett
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Alfred I. DuPont Hospital for Children Wilmington Delaware
| | - Seema Bhatt
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center Cincinnati Ohio
| | - Amanda Bogie
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Oklahoma Health Sciences Center Oklahoma City Oklahoma
| | - Kathleen Brown
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's National Medical Center Washington District of Columbia
| | - Theron Charles Casper
- Department of Pediatrics, Division of Pediatric Critical Care, University of Utah Salt Lake City Utah
| | | | - Corrie E. Chumpitazi
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Baylor College of Medicine Houston Texas
| | - Daniel Cohen
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Nationwide Children's Hospital Columbus Ohio
| | - Carlton Dampier
- Department of Pediatrics, Division of Hematology/OncologyEmory University School of Medicine Atlanta Georgia
- Department of Pediatrics, Division of Pediatric Emergency Medicine, The Aflac Cancer and Blood Disorders Center of Children's Healthcare Atlanta Georgia
| | - Angela M. Ellison
- Department of Pediatrics, Division of Pediatric Emergency Medicine, The Children's Hospital of Philadelphia Philadelphia Pennsylvania
| | - Hartmut Grasemann
- Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children Toronto Ontario Canada
| | - Robert W. Hickey
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Pittsburgh of UPMC Pittsburgh Pennsylvania
| | - Lewis L. Hsu
- Department of Pediatrics, Division of Pediatric Hematology and OncologyUniversity of Illinois at Chicago Chicago Illinois
| | - Sara Leibovich
- Department of Pediatrics, Division of Pediatric Emergency Medicine, UCSF‐Benioff Children's Hospital at Oakland Oakland California
| | - Elizabeth Powell
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago Chicago Illinois
| | - Rachel Richards
- Department of Pediatrics, Division of Pediatric Critical Care, University of Utah Salt Lake City Utah
| | - Syana Sarnaik
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Hospital of Michigan Detroit Michigan
| | - Debra L. Weiner
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Boston Children's Hospital Boston Massachusetts
| | - Claudia R. Morris
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
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Akinbami AA, Uche EI, Suleiman AM, Ogbenna AA, Olowoselu FO, Augustine B, Badiru MA, Bamiro RA, Kamson OR. On artherogenic index of plasma in sickle cell anaemia patients. Pan Afr Med J 2019; 32:141. [PMID: 31308859 PMCID: PMC6609855 DOI: 10.11604/pamj.2019.32.141.17166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2018] [Accepted: 02/26/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Sickle cell anaemia (SCA) is an inherited abnormality of haemoglobin associated with reduced life expectancy. Patients' complications include dyslipideamia. This study was aimed at determining the artherogenic index of plasma (AIP) in sickle cell anaemia patients and compares the value to HbAA controls value. A high AIP is strongly predictive of elevated cardiovascular risk. METHODS A comparative study was conducted among SCA patients attending the haematology clinic, Lagos State University Teaching Hospital (LASUTH) and HbAA Phenotype controls. A total of 304 participants were recruited consisting of equal numbers of SCA and HbAA controls. Single lipid profiles were done; logarithms of triglycerides/high density lipoprotein were calculated to obtain AIP and lipid profile ratios established for all participants. RESULTS There were lower mean values of Total Cholesterol (TC), High Density Lipoprotein(HDL) and Low Density Lipoprotein (LDL) amongst SCD participants than controls and higher mean values of triglycerides (TG) and Very Low Density Lipoprotein (VLDL) in SCD p < 0.05. The AIP in SCD ranges from -0.62 to 1.32 while that of controls ranges from -0.56 to 0.61.The mean AIP were 0.14 ± 0.29 and -0.009 ± 0.26 in SCD and controls respectively. P value = 0.002. CONCLUSION AIP value is higher in sickle cell anaemia than controls, the former have lower mean values of TC, HDL and LDL and higher mean values of TG and VLDL.
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Affiliation(s)
- Akinsegun Abduljaleel Akinbami
- Department of Haematology and Blood Transfusion, Lagos State University, College of Medicine PMB 21266, Ikeja, Lagos, Lagos State, Nigeria
| | - Ebele Ifeyinwa Uche
- Department of Haematology and Blood Transfusion, Lagos State University, College of Medicine PMB 21266, Ikeja, Lagos, Lagos State, Nigeria
| | - Aishatu Maude Suleiman
- Department of Haematology and Blood Transfusion, Faculty of Basic Clinical Sciences, College of Health Sciences, Ahmadu Bello University, Zaria
| | - Ann Abiola Ogbenna
- Department of Haematology and Blood Transfusion, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Nigeria
| | - Festus Olusola Olowoselu
- Department of Haematology and Blood Transfusion, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Nigeria
| | - Benjamin Augustine
- Department of Haematology and Blood Transfusion, Faculty of Basic Clinical Sciences, College of Health Sciences, Ahmadu Bello University, Zaria
| | - Mulikat Adesola Badiru
- Department of Hematology and Blood Transfusion, Lagos State University, Teaching Hospital, PMB 21266, Ikeja, Lagos State, Nigeria
| | - Rafat Abiodun Bamiro
- Department of Hematology and Blood Transfusion, Lagos State University, Teaching Hospital, PMB 21266, Ikeja, Lagos State, Nigeria
| | - Omolara Risqat Kamson
- Department of Hematology and Blood Transfusion, Lagos State University, Teaching Hospital, PMB 21266, Ikeja, Lagos State, Nigeria
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Nugent WH, Jubin R, Buontempo PJ, Kazo F, Song BK. Microvascular and systemic responses to novel PEGylated carboxyhaemoglobin-based oxygen carrier in a rat model of vaso-occlusive crisis. ARTIFICIAL CELLS NANOMEDICINE AND BIOTECHNOLOGY 2019; 47:95-103. [DOI: 10.1080/21691401.2018.1543197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | - Ronald Jubin
- Prolong Pharmaceuticals, South Plainfield, NJ, USA
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Carden MA, Fay M, Sakurai Y, McFarland B, Blanche S, DiPrete C, Joiner CH, Sulchek T, Lam WA. Normal saline is associated with increased sickle red cell stiffness and prolonged transit times in a microfluidic model of the capillary system. Microcirculation 2018; 24. [PMID: 28106307 DOI: 10.1111/micc.12353] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 01/16/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Vaso-occlusive crisis (VOC) is a complex process that occurs in patients with sickle cell disease (SCD) and is often associated with pain and urgent hospitalization. A major instigator of VOC is microvascular obstruction by pathologically stiffened sickle red blood cells (RBCs), and thus, therapy relies heavily on optimizing intravenous fluid (IVF) hydration to increase RBC deformability. However, no evidence-based guidelines regarding the choice of IVF currently exist. We therefore analyzed alterations in biomechanical properties of sickle RBCs isolated from patients with homozygous SCD (hemoglobin SS) after exposure to different osmolarities of clinical IVF formulations. METHODS Atomic force microscopy (AFM) was used to assess stiffness of RBCs after exposure to different IVFs. A microfluidic model of the human capillary system was used to assess transit time (TT) and propensity to occlusion after exposure to the different IVF formulations. RESULTS Sickle RBCs exposed to normal saline (NS) had increased stiffness, TTs, and propensity to microchannel occlusion compared to other osmolarities. CONCLUSION NS, an IVF formulation often used to treat patients with SCD during VOC, may induce localized microvascular obstruction due to alterations of sickle RBC biomechanical properties.
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Affiliation(s)
- Marcus A Carden
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Meredith Fay
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Yumiko Sakurai
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
| | - Brynn McFarland
- Georgia Tech School of Chemical & Biomolecular Engineering, Atlanta, GA, USA
| | - Sydney Blanche
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Caleb DiPrete
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA
| | - Clinton H Joiner
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Todd Sulchek
- Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Wilbur A Lam
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer Center and Blood Disorders Center of Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA.,The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Emory University, Atlanta, GA, USA.,Parker H. Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, USA.,Institute for Electronics and Nanotechnology, Georgia Institute of Technology, Atlanta, GA, USA
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Carden MA, Fay ME, Lu X, Mannino RG, Sakurai Y, Ciciliano JC, Hansen CE, Chonat S, Joiner CH, Wood DK, Lam WA. Extracellular fluid tonicity impacts sickle red blood cell deformability and adhesion. Blood 2017; 130:2654-2663. [PMID: 28978568 PMCID: PMC5731085 DOI: 10.1182/blood-2017-04-780635] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 09/24/2017] [Indexed: 01/04/2023] Open
Abstract
Abnormal sickle red blood cell (sRBC) biomechanics, including pathological deformability and adhesion, correlate with clinical severity in sickle cell disease (SCD). Clinical intravenous fluids (IVFs) of various tonicities are often used during treatment of vaso-occlusive pain episodes (VOE), the major cause of morbidity in SCD. However, evidence-based guidelines are lacking, and there is no consensus regarding which IVFs to use during VOE. Further, it is unknown how altering extracellular fluid tonicity with IVFs affects sRBC biomechanics in the microcirculation, where vaso-occlusion takes place. Here, we report how altering extracellular fluid tonicity with admixtures of clinical IVFs affects sRBC biomechanical properties by leveraging novel in vitro microfluidic models of the microcirculation, including 1 capable of deoxygenating the sRBC environment to monitor changes in microchannel occlusion risk and an "endothelialized" microvascular model that measures alterations in sRBC/endothelium adhesion under postcapillary venular conditions. Admixtures with higher tonicities (sodium = 141 mEq/L) affected sRBC biomechanics by decreasing sRBC deformability, increasing sRBC occlusion under normoxic and hypoxic conditions, and increasing sRBC adhesion in our microfluidic human microvasculature models. Admixtures with excessive hypotonicity (sodium = 103 mEq/L), in contrast, decreased sRBC adhesion, but overswelling prolonged sRBC transit times in capillary-sized microchannels. Admixtures with intermediate tonicities (sodium = 111-122 mEq/L) resulted in optimal changes in sRBC biomechanics, thereby reducing the risk for vaso-occlusion in our models. These results have significant translational implications for patients with SCD and warrant a large-scale prospective clinical study addressing optimal IVF management during VOE in SCD.
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Affiliation(s)
- Marcus A Carden
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA
| | - Meredith E Fay
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA
| | - Xinran Lu
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN
| | - Robert G Mannino
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA
| | - Yumiko Sakurai
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA
| | - Jordan C Ciciliano
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- Woodruff School of Mechanical Engineering, Petit Institute for Bioengineering and Bioscience, and
| | - Caroline E Hansen
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA
| | - Satheesh Chonat
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
| | - Clinton H Joiner
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
| | - David K Wood
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN
| | - Wilbur A Lam
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Aflac Cancer & Blood Disorders Center, Emory University School of Medicine, Atlanta, GA
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA
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Abstract
INTRODUCTION Under conditions of blood flow, selectins mediate the intercellular adhesion between erythrocytes, leukocytes, platelets and vascular endothelium that contribute to vaso-occlusion and tissue damage in sickle cell disease (SCD). Therefore, selectin antagonists have the potential to ameliorate SCD. AREAS COVERED In this review, the author discusses the cellular and molecular basis of vaso-occlusion in SCD, and presents evidence that selectin-mediated cell adhesion has clinical importance in this disorder. The author discusses molecular structure of human selectins and their physiological ligands and highlights clinical trials of selectin-targeted therapy of SCD. Herein, the author also assesses the benefits and limitations of the selectin antagonists that are currently under evaluation for SCD, and offers suggestions for the future. EXPERT OPINION In Phase I and II clinical trials, rivipansel and heparin demonstrated promising efficacy and safety in SCD. Although selectin blockade could potentially impair immune response, an increased incidence of infection was not reported in SCD patients treated with heparin (n = 127) or rivipansel (n = 111). The efficacy and safety findings from Phase I and II clinical studies are encouraging the commencement of Phase III studies to further evaluate selectin-targeted therapy in SCD.
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Affiliation(s)
- Iheanyi Okpala
- University of Nigeria, College of Medicine, Department of Haematology/Immunology , Enugu Campus , Nigeria
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Ojo OT, Shokunbi WA. CD4+ T Lymphocytes count in sickle cell anaemia patients attending a tertiary hospital. Niger Med J 2014; 55:242-5. [PMID: 25013257 PMCID: PMC4089054 DOI: 10.4103/0300-1652.132058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Sickle cell haemoglobin (HbS) is the commonest abnormal haemoglobin and it has a worldwide distribution. Reports have shown that patients with sickle cell anaemia (HbSS) have an increased susceptibility to infection leading to increased morbidity and mortality. Impaired leucocyte function and loss of both humoral and cell-mediated immunity are some of the mechanisms that have been reported to account for the immunocompromised state in patients with sickle cell disease. This study was carried out to determine the CD4+ T lymphocytes count in patients with sickle cell anaemia. MATERIALS AND METHODS A comparative cross-sectional study of 40 sickle cell anaemia patients in steady state (asymptomatic for at least 4 weeks) attending haematology clinic and 40 age and sex-matched healthy HbA control were recruited into the study. Both HbS patients and the controls were HIV negative. The blood samples obtained were analyzed for CD4+ T cell by Flow cytometry. RESULTS The study found that there was no significant difference in the number of CD4+ T lymphocyte count between individuals with sickle cell anaemia and HbA (1016 ± 513 cells/μL vs 920 ± 364cells/μL). CONCLUSION It is recommended that the functionality of CD4+ T lymphocyte should be considered rather than the number in further attempt to elucidate the cellular immune dysfunction in patients with sickle cell anaemia.
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Affiliation(s)
- Omotola Toyin Ojo
- Department of Haematology and Blood Transfusion, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun, Nigeria
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15
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Akinbami A, Dosunmu A, Adediran A, Oshinaike O, Adebola P, Arogundade O. Haematological values in homozygous sickle cell disease in steady state and haemoglobin phenotypes AA controls in Lagos, Nigeria. BMC Res Notes 2012; 5:396. [PMID: 22849350 PMCID: PMC3423074 DOI: 10.1186/1756-0500-5-396] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2012] [Accepted: 07/25/2012] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Sickle cell disease is a genetic abnormality involving the haemoglobin. Although, it is primarily a red cell disorders, the white blood cells and platelets are also affected by the mutation. The consequent haemoglobin S causes polymerization of haemoglobin resulting in haemolysis and anaemia. This study aims to provide baseline haematological values in sickle cell disease patients in steady state and compare the deviation from haemoglobin phenotype AA control values. METHODS A case-control study was conducted amongst homozygous sickle cell patients attending the sickle cell clinics of Lagos State University Teaching Hospital Ikeja and haemoglobin phenotype AA controls. About 4.5mls of blood sample was collected from each participant for full blood count analysis. All blood samples were screened for HIV and haemoglobin phenotypes confirmed using cellulose acetate haemoglobin electrophoresis at pH 8.6. RESULTS A total of 103 cases and 98 controls were enrolled. The overall mean haemoglobin concentration for cases was 7.93 ± 1.47 g/dl, packed cell volume 24.44 ± 4.68%, mean cell volume 81.52 ± 7.89 fl, and mean cell haemoglobin 26.50 ± 3.20 pg. While for controls, mean haemoglobin concentration was 13.83 ± 1.32 g/dl, packed cell volume 43.07 ± 3.95%, mean cell volume 86.90 ± 4.69 fl, and mean cell haemoglobin 28.50 ± 1.34 pg. The overall mean white blood cell counts for the cases was 10.27 ± 3.94 *103/μl and platelet counts of 412.71 ± 145.09*103/μl. While white blood cell count for the controls was 5.67 ± 1.59*103/μl and platelet counts of 222.82 ± 57.62*103/μl. CONCLUSION Homozygous sickle cell disease patients have lower values of red cell parameters, but higher values of white cell and platelets counts compared to haemoglobin phenotype AA controls.
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Affiliation(s)
- Akinsegun Akinbami
- Department of Haematology and Blood Transfusion, Lagos State University, College of Medicine, Lagos, Nigeria
| | - Adedoyin Dosunmu
- Department of Haematology and Blood Transfusion, Lagos State University, College of Medicine, Lagos, Nigeria
| | - Adewumi Adediran
- Department of Haematology and Blood Transfusion, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Olajumoke Oshinaike
- Department of Medicine, Lagos State University, College of Medicine, Lagos, Nigeria
| | - Phillip Adebola
- Department of Medicine, Lagos State University, College of Medicine, Lagos, Nigeria
| | - Olanrewaju Arogundade
- Department of Haematology and Blood Transfusion, Lagos State University, College of Medicine, Lagos, Nigeria
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16
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A randomized, controlled clinical trial of ketoprofen for sickle-cell disease vaso-occlusive crises in adults. Blood 2009; 114:3742-7. [DOI: 10.1182/blood-2009-06-227330] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Vaso-occlusive crisis (VOC) is the primary cause of hospitalization of patients with sickle-cell disease. Treatment mainly consists of intravenous morphine, which has many dose-related side effects. Nonsteroidal antiinflammatory drugs have been proposed to provide pain relief and decrease the need for opioids. Nevertheless, only a few underpowered trials of nonsteroidal antiinflammatory drugs for sickle-cell VOC have been conducted, and conflicting results were reported. We conducted a phase 3, double-blind, randomized, placebo-controlled trial with ketoprofen (300 mg/day for 5 days), a nonselective cyclooxygenase inhibitor, for severe VOC in adults. A total of 66 VOC episodes were included. The primary efficacy outcome was VOC duration. The secondary end points were morphine consumption, pain relief, and treatment failure. Seven VOC episodes in each group were excluded from the analysis because of treatment failures. No significant between-group differences were observed for the primary outcome or the secondary end points. Thus, although ketoprofen was well-tolerated, it had no significant efficacy as treatment of VOC requiring hospitalization. These findings argue against its systematic use in this setting.
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17
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Schettler V, Wieland E. A case report of darbepoetin treatment in a patient with sickle cell disease and chronic renal failure undergoing regular hemodialysis procedures that induce a dose-dependent extension of blood transfusion intervals. Ther Apher Dial 2009; 13:80-2. [PMID: 19379175 DOI: 10.1111/j.1744-9987.2009.00602.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In this case, a female Nigerian patient suffered from sickle cell disease (SCD, hemoglobin SS)-induced chronic renal failure and was undergoing hemodialysis treatment. Due to SCD crisis and renal anemia the patient received regular blood transfusions when the hemoglobin concentration fell below 5.0 g/L. Blood transfusion associated iron-overload was noticed. To reduce the iron-overload side effects, we started an erythropoietin therapy (darbepoetin) to extend the blood transfusion interval, using 30-150 microg/week. As a result of our investigation we observed that darbepoetin can significantly extend blood transfusion intervals without increasing SCD crisis. To substantiate our observation, further investigations are needed with more SCD patients undergoing regular hemodialysis treatment.
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18
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Ikefuna AN, Emodi IJ, Ocheni S. Clinical profile and home management of sickle cell-related pain: the Enugu (Nigeria) experience. Pediatr Hematol Oncol 2009; 26:309-12. [PMID: 19579076 DOI: 10.1080/08880010902754818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To document the pattern of and ability of sickle cell anemic patients to manage painful crises at home. SUBJECT AND METHODS Confirmed HbSS patients or caregivers attending the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria, were interviewed, using a questionnaire, on their last painful episode. RESULTS The limbs were involved in all ages, but involvement of the joints, ribs, and spine was uncommon in patients under 5 years old. Pain started between 6 pm and 12 midnight in 33.3%. Analgesics with or without massage or hydration was mostly used at home. 29% of subjects required hospitalization. CONCLUSION Patients need better access to more potent analgesics to reduce the burden on the health system.
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Affiliation(s)
- Anthony N Ikefuna
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu, Nigeria.
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19
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Charles KS, Osagie K, Battini RK. Hospital admissions for acute painful crisis in Trinidad and Tobago. Are the British Committee for Standards in Haematology (BCSH) guidelines applicable? CLINICAL AND LABORATORY HAEMATOLOGY 2006; 28:299-302. [PMID: 16999718 DOI: 10.1111/j.1365-2257.2006.00804.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
We observed consecutive hospital admissions for acute painful crisis (APC) among adults with Sickle Cell Disease (SCD) over a 6-month period in Trinidad and Tobago. Episodes (111) of APC resulted in 82 admissions of 59 patients. The most common site for pain was the trunk. Patients ranged in age from 17 to 53 years (median: 25). Median length of hospital stay was 4 days. Total dose of Pethidine given per admission ranged from 100 to 1650 mg (median: 525). The mean dose of morphine was 70 mg. Six (7%) of patients were readmitted within 10 days of discharge. Twenty-five (30%) of patients had chest pain at presentation of whom 10 (12%) had consolidation on chest X-ray, defining the acute chest syndrome (ACS). There was one death caused by biliary sepsis. The study revealed seemingly low opiate usage for in-hospital treatment of APC with acceptable rates of readmission. The BCSH 2003 guidelines seemed applicable apart for the choice and route of fluid for rehydration and opiate analgesia.
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Affiliation(s)
- K S Charles
- Haematology Department, General Hospital, Charlotte Street, Port of Spain, Trinidad and Tobago.
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20
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Ezeh C, Ugochukwu CC, Weinstein J, Okpala I. Hepcidin, haemoglobin and ferritin levels in sickle cell anaemia. Eur J Haematol 2005; 74:86-8. [PMID: 15613115 DOI: 10.1111/j.1600-0609.2004.00337.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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21
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Okpala I, Daniel Y, Haynes R, Odoemene D, Goldman J. Relationship between the clinical manifestations of sickle cell disease and the expression of adhesion molecules on white blood cells. Eur J Haematol 2002; 69:135-44. [PMID: 12406006 DOI: 10.1034/j.1600-0609.2002.02775.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The severity of sickle cell disease (SCD) increases with leukocyte count. The biological basis could be that leukocyte adherence to vascular endothelium mediated by adhesion molecules (AMs) facilitates vaso-occlusion, the basic pathological process in SCD. OBJECTIVE To find out if there is a relationship between expression of AMs by leukocytes and the clinical manifestations of SCD. METHODS Flow cytometry was used to study the relationship between leukocyte AM expression and disease manifestations in 100 patients with homozygous (HbSS) sickle cell disease and 34 genotype HbAA controls. The effect of hydroxyurea therapy on AM expression was also examined. We excluded HbSS patients with any other disease, pregnancy in the previous 3 months, or Haemogloben F (HbF) > or = 10%. RESULTS Patients with complications of SCD showed high expression of alphaMbeta integrin by the neutrophils; and l-selectin by lymphocytes and neutrophils (P < 0.03). CD18 was highly expressed by neutrophils in patients with sickle nephropathy (P = 0.018), and l-selectin by lymphocytes in those with stroke (P = 0.03). Monocyte l-selectin increased in sickle cell crisis relative to steady state (P = 0.04). Expression of alphaLbeta2 integrin by neutrophils, monocytes, and lymphocytes decreased within a month of hydroxyurea therapy (P < 0.05), with symptomatic improvement in the patients and no more than 3.3% rise in HbF level. CONCLUSIONS The findings suggest that in SCD (1): High steady-state expression of alphaMbeta2 integrin and l-selectin by leukocytes predisposes to severe manifestations. (2) Increased leukocyte AM expression above steady-state levels could be important in the genesis of crisis. (3) The early symptomatic improvement that follows hydroxyurea therapy is mediated via mechanisms independent of increased HbF, and may involve reduced AM expression in leukocytes. (4) Other treatment modalities that reduce leukocyte AM expression might also confer clinical benefit.
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Affiliation(s)
- Iheanyi Okpala
- Departments of Haematology, St. Thomas's Hospital, London, UK.
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22
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Okpala I, Westerdale N, Jegede T, Cheung B. Etilefrine for the prevention of priapism in adult sickle cell disease. Br J Haematol 2002; 118:918-21. [PMID: 12181066 DOI: 10.1046/j.1365-2141.2002.03691.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Priapism is a common complication of sickle cell disease (SCD) that could lead to erectile dysfunction and psychosocial problems. Treatment of established fulminant priapism is usually not satisfactory. It is therefore important to prevent this complication of SCD. The alpha-adrenergic agonist etilefrine (50-100 mg/d) produced a good clinical response in 13 of 18 (72%) adults who have recurrent priapism; 17 had SCD and one sickle cell trait. After a follow-up of 1-48 months, none of the 18 people on etilefrine developed hypertension or sexual dysfunction. Similar efficacy and safety profiles of the drug have been reported previously.
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Affiliation(s)
- Iheanyi Okpala
- Department of Haematology, St. Thomas' Hospital, London, UK.
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23
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Okpala I, Thomas V, Westerdale N, Jegede T, Raj K, Daley S, Costello-Binger H, Mullen J, Rochester-Peart C, Helps S, Tulloch E, Akpala M, Dick M, Bewley S, Davies M, Abbs I. The comprehensiveness care of sickle cell disease. Eur J Haematol 2002; 68:157-62. [PMID: 12068796 DOI: 10.1034/j.1600-0609.2002.01523.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Millions of people across the world have sickle cell disease (SCD). Although the true prevalence of SCD in Europe is not certain, London (UK) alone had an estimated 9000 people with the disorder in 1997. People affected by SCD are best managed by a multidisciplinary team of professionals who deliver comprehensive care: a model of healthcare based on interaction of medical and non-medical services with the affected persons. The components of comprehensive care include patient/parent information, genetic counselling, social services, prevention of infections, dietary advice and supplementation, psychotherapy, renal and other specialist medical care, maternal and child health, orthopaedic and general surgery, pain control, physiotherapy, dental and eye care, drug dependency services and specialist sickle cell nursing. The traditional role of haematologists remains to co-ordinate overall management and liase with other specialities as necessary. Co-operation from the affected persons is indispensable to the delivery of comprehensive care. Working in partnership with the hospital or community health service administration and voluntary agencies enhances the success of the multidisciplinary team. Holistic care improves the quality of life of people affected by SCD, and reduces the number as well as length of hospital admissions. Disease-related morbidity is reduced by early detection and treatment of chronic complications. Comprehensive care promotes awareness of SCD among affected persons who are encouraged to take greater control of their own lives, and achieves better patient management than the solo efforts of any single group of professionals. This cost-effective model of care is an option for taking haemoglobinopathy services forward in the new millennium.
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Affiliation(s)
- Iheanyi Okpala
- Department of Haematology, Guy's & St Thomas' Hospitals Trust, London, UK.
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McCarthy LJ, Vattuone J, Weidner J, Skipworth E, Fernandez C, Jackson L, Rothenberger S, Waxman D, Miraglia C, Porcu P, Danielson CF. Do automated red cell exchanges relieve priapism in patients with sickle cell anemia? THERAPEUTIC APHERESIS : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR APHERESIS AND THE JAPANESE SOCIETY FOR APHERESIS 2000; 4:256-8. [PMID: 10910030 DOI: 10.1046/j.1526-0968.2000.00222.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Priapism is a dramatic, painful complication for some men afflicted by sickle cell anemia. Although the natural history remains unclear, many believe replacing the patient's abnormal red blood cells (RBCs) with normal RBCs by apheresis is effective. However, no controlled trials have demonstrated its effectiveness. We exchanged 7 men after medical management failed. All procedures reduced sickle hemoglobin levels to < 30%. Two patients underwent emergency automated red cell exchanges without any detumescence or reduction of pain. The remaining 5 patients were exchanged non-emergently; 4 experienced no detumescence or relief of pain. One adult experienced resolution 8 h postexchange. However, he had a history of "stuttering" priapism. All required decompression procedures. Automated RBC exchanges were not effective in achieving detumescence or reducing pain.
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Affiliation(s)
- L J McCarthy
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine and Indiana University Hospital, Indianapolis 46202-5283, USA.
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Abstract
Examination of the genetic mechanisms underlying the thalassaemias has led to a clearer understanding of the control of eukaryotic genes in general. Inherited disorders of haemoglobin synthesis are an important cause worldwide of morbidity and mortality, and place a large burden on patients, families, and ultimately communities. The haemoglobin disorders can be controlled, by counselling and prenatal diagnosis. Treatment is usually symptomatic, though bone-marrow transplantation for beta-thalassaemia may be successful in suitable patients.
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Affiliation(s)
- D J Weatherall
- Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital, UK
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26
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Yale SH, Nagib N, Guthrie T. Acute chest syndrome in sickle cell disease. Crucial considerations in adolescents and adults. Postgrad Med 2000; 107:215-8, 221-2. [PMID: 10649675 DOI: 10.3810/pgm.2000.01.835] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Rapid recognition of acute chest syndrome is essential in patients with sickle cell disease. The condition can be particularly severe in adolescents and adults and often leads to death. In this article, the authors review the challenges of evaluating the syndrome and outline current treatment and supportive care.
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Affiliation(s)
- S H Yale
- Marshfield Clinic, Department of Internal Medicine, WI 54449, USA.
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27
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Anyaegbu CC, Okpala IE, Aken'ova AY, Salimonu LS. Complement haemolytic activity, circulating immune complexes and the morbidity of sickle cell anaemia. APMIS 1999; 107:699-702. [PMID: 10440069 DOI: 10.1111/j.1699-0463.1999.tb01463.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of this study was to find out if the number of crises and complications of sickle cell anaemia (SCA) relate to complement function, or the levels of circulating immune complexes (CIC), complement factor B (Bf), C3 and C4. In 73 steady-state HbSS patients and 50 HbAA control subjects, we determined the haemolytic activity of the alternative pathway of complement (AP50), of the classical pathway (CH50); and the serum concentrations of Bf, C3, C4 and CIC. By clinical examination of each patient and review of the medical records, we determined the number of complications of SCA which had occurred and the mean number of crises per year over a minimum period of 3 years. The mean+/-SD AP50 for the patients (14+/-2 U/ml) was significantly lower than the control value of 16+/-3 U/ml (p<0.001). AP50 had a significant inverse correlation with the number of crises (r=-0.30, p<0.02). Mean+/-SD CIC in patients (0.45+/-0.38 g/l) was significantly higher than in controls: 0.24+/-0.15 g/l (p<0.002). CIC showed a significant direct correlation with the number of complications of SCA (r=+/-0.28, p<0.02). Mean+/-SD Bf in SCA patients (0.19+/-0.09) was higher than in controls (0.17+/-0.05). The difference reached marginal statistical significance (p=0.049). SCA patients and controls had no significant differences in CH50, C3 and C4. These parameters and Bf did not correlate with either the number of crises or complications. The mechanisms underlying the correlations observed in this study are yet to be fully elucidated.
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Affiliation(s)
- C C Anyaegbu
- Department of Haematology, Nnamdi Azikiwe University Hospital, Nnewi, Anambra State, Nigeria
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