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Sahu P, Barman A. Auditory Neuropathy Spectrum Disorder in Individuals with Sickle Cell Anemia: Case Study. Indian J Otolaryngol Head Neck Surg 2024; 76:2320-2325. [PMID: 38883506 PMCID: PMC11169182 DOI: 10.1007/s12070-024-04477-2] [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: 12/04/2023] [Accepted: 12/31/2023] [Indexed: 06/18/2024] Open
Abstract
The present study attempted to understand the association between Auditory neuropathy spectrum disorder (ANSD) and Sickle cell anemia (SCA) and to recognize possible causative factors for the presence of ANSD in SCA individuals. Two cases, 24 years male and 17years female with a laboratory-confirmed diagnosis of Sickle cell anemia underwent detailed audiological evaluation i.e., pure tone audiometry, speech audiometry, immittance audiometry, otoacoustic emission, and auditory brainstem responses. Audiological evaluation revealed a bilateral moderate low-frequency sensorineural hearing loss in male and bilateral moderately severe sensorineural Hearing loss in female case with elevated Speech Recognition Threshold and poor Speech Identification Scores. 'A' type tympanogram with the absence of Acoustic reflexes and the presence of Otoacoustic emission with no distinct and reproducible peak V in Auditory Brainstem Response (ABR) at 90 dBnHL with the presence of ringing cochlear microphonics on polarity reversal collectively indicating bilateral ANSD in both cases. ANSD and SCA are reported to have a genetic basis of etiology. There might be possibilities that one genetic condition may be common in manifesting both conditions or one genetic condition can cause the presence of another genetic condition or can exaggerate the evolution of another genetic condition. Also, abnormal ABR findings indicate the possibility of neuropathological involvement in isolation or in combination with genetic abnormalities that need detailed investigation to understand non-genetic causative factors. Thus, paved the path for further research in this line and might provide better rehabilitative options.
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Affiliation(s)
- Preeti Sahu
- Dept. of ENT & HNS Tatibandh, All India Institute of Medical Sciences (AIIMS), GE Road, Raipur, Chhattisgarh, 492099 India
| | - Animesh Barman
- Dept. of Audiology, All India Institute of Speech & Hearing (AIISH), Manasagangotri, Mysore, Karnataka, 570-006 India
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2
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Connes P, Nader E. Le globule rouge drépanocytaire : données fonctionnelles. Rev Med Interne 2023; 44:4S18-4S23. [PMID: 38049242 DOI: 10.1016/s0248-8663(23)01305-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Sickle cell anemia is a genetic disorder that affects hemoglobin leading to the production of an abnormal hemoglobin, called HbS. HbS has the property to polymerize under deoxygenated conditions, causing a mechanical distortion of red blood cells; a phenomenon called sickling. These sickle red blood cells are more fragile and rigid, leading to chronic hemolytic anemia and painful vaso-occlusive crises, as well as chronic vascular complications that can affect many organs. The abnormal functional properties of these sickle red blood cells are responsible for a wide range of clinical expression of the disease. HbS polymerization can be influenced by many factors, such as the hydration state of the red blood cells or the affinity of hemoglobin for oxygen. Moreover, the rheological characteristics of red blood cells, including their deformability and aggregation properties, are associated with specific clinical phenotypes. The pro-inflammatory and pro-oxidant state, as well as the repeated polymerization of HbS, accelerate the senescence of sickle red blood cells, promoting the release of microparticles and contributing to vascular dysfunction. Patients' red blood cells also have molecular characteristics that promote their adhesion to the endothelium and other circulating cells, contributing to the onset of vascular complications. Massive intravascular hemolysis, due to increased erythrocyte fragility, is also responsible for chronic vascular complications. These different alterations are privileged therapeutic targets, leading to the emergence of new specific treatments. © 2023 Société nationale française de médecine interne (SNFMI). Published by Elsevier Masson SAS. All rights reserved.
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Affiliation(s)
- P Connes
- Laboratoire LIBM EA7424, équipe « biologie vasculaire et du globule rouge », faculté de médecine Laennec, université Lyon 1, France; Laboratoire d'excellence sur le globule rouge (GR-Ex), Paris, France.
| | - E Nader
- Laboratoire LIBM EA7424, équipe « biologie vasculaire et du globule rouge », faculté de médecine Laennec, université Lyon 1, France; Laboratoire d'excellence sur le globule rouge (GR-Ex), Paris, France
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3
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Oyedeji CI, Hodulik KL, Telen MJ, Strouse JJ. Management of Older Adults with Sickle Cell Disease: Considerations for Current and Emerging Therapies. Drugs Aging 2023; 40:317-334. [PMID: 36853587 PMCID: PMC10979738 DOI: 10.1007/s40266-023-01014-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 03/01/2023]
Abstract
People with sickle cell disease (SCD) are living longer than ever before, with the median survival increasing from age 14 years in 1973, beyond age 40 years in the 1990s, and as high as 61 years in recent cohorts from academic centers. Improvements in survival have been attributed to initiatives, such as newborn screening, penicillin prophylaxis, vaccination against encapsulated organisms, better detection and treatment of splenic sequestration, and improved transfusion support. There are an estimated 100,000 people living with SCD in the United States and millions of people with SCD globally. Given that the number of older adults with SCD will likely continue to increase as survival improves, better evidence on how to manage this population is needed. When managing older adults with SCD (defined herein as age ≥ 40 years), healthcare providers should consider the potential pitfalls of extrapolating evidence from existing studies on current and emerging therapies that have typically been conducted with participants at mean ages far below 40 years. Older adults with SCD have historically had little to no representation in clinical trials; therefore, more guidance is needed on how to use current and emerging therapies in this population. This article summarizes the available evidence for managing older adults with SCD and discusses potential challenges to using approved and emerging drugs in this population.
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Affiliation(s)
- Charity I Oyedeji
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA.
- Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 315 Trent Dr., Suite 266, DUMC Box 3939, Durham, NC, 27710, USA.
| | - Kimberly L Hodulik
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Pharmacy, Duke University Hospital, Durham, NC, USA
| | - Marilyn J Telen
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - John J Strouse
- Division of Hematology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Duke Claude D. Pepper Older Americans Independence Center, Durham, NC, USA
- Department of Medicine, and Duke Comprehensive Sickle Cell Center, Duke University School of Medicine, 315 Trent Dr., Suite 266, DUMC Box 3939, Durham, NC, 27710, USA
- Division of Pediatric Hematology-Oncology, Duke University, Durham, NC, USA
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Roger C, Lionnet F, Mattioni S, Livrozet M, Steichen O, Letavernier E, Hammoudi N, Avellino V, Haymann J. Risk factors for CKD stage II onset in a prospective cohort of homozygous sickle cell adults. Am J Hematol 2021; 96:1147-1155. [PMID: 34111308 DOI: 10.1002/ajh.26264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/31/2021] [Accepted: 06/03/2021] [Indexed: 12/15/2022]
Abstract
Prevalence of renal impairment is increasing with aging in sickle cell anemia (SCA) patients, and is responsible for a high morbidity and mortality. However, sickle cell nephropathy's natural course remains mostly unknown. We conducted a prospective observational cohort study aimed to identify risk factors for CKD stage II in a cohort of SCA patients. Baseline clinical and biological parameters were collected. Renal parameters were updated at each visit. Risk factors were analyzed using the Cox model. Five-hundred and thirty-five SCA patients were included with a median follow-up of 5.33 (IQR:2.10-8.13) years. Median age was 22 (IQR:19-30) years old. Glomerular hyperfiltration was detected in 299 (55.9%) patients, microalbuminuria and macroalbuminuria in 180 (34%) and 67 (12.7%) patients respectively. During follow up, CKD stage II onset was detected in 39 patients (7.3%). Risk factors for CKD stage II after adjustment on baseline eGFR and age were macroalbuminuria HR: 3.89 [95% CI: 1.61;9.43], diastolic blood pressure (DBP) above 70 mm Hg HR: 2.02 [1.02-3.971], LDH (for 100 IU/L increase) HR: 1.28 [1.12;1.48] and tricuspid regurgitation velocity >2.5 m/sec HR: 2.89 [1.20-6.99]. Multivariate analysis also found age as a strong independent risk factor with HR: (per year increase) 1.13 [1.09;1.16] and a 13.3-fold increase above 30 years (p < 0.001). Our results show a high incidence of CKD stage II with aging, with a strong significant risk increase after 30-years-old, and pinpoint baseline DBP, macroalbuminuria and increased LDH as independent risk factors raising the issue of optimal blood pressure targets for SCA patients.
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Affiliation(s)
- Camille Roger
- Service de Néphrologie – CHRU de Lille Université de Lille Lille France
| | - Francois Lionnet
- Sorbonne Université, Department of Internal Medicine centre de référence de la drépanocytose (AP‐HP), Centre Hospitalier Universitaire Tenon, rue de la Chine Paris France
| | - Sarah Mattioni
- Sorbonne Université, Department of Internal Medicine centre de référence de la drépanocytose (AP‐HP), Centre Hospitalier Universitaire Tenon, rue de la Chine Paris France
| | - Marine Livrozet
- Service d'Explorations Fonctionnelles Multidisciplinaires Assistance Publique‐Hôpitaux de Paris (AP‐HP), Hôpital Tenon Paris France
- Sorbonne Université INSERM, UMR_S 1155, AP‐HP Paris France
| | - Olivier Steichen
- Sorbonne Université, Department of Internal Medicine centre de référence de la drépanocytose (AP‐HP), Centre Hospitalier Universitaire Tenon, rue de la Chine Paris France
| | - Emmanuel Letavernier
- Service d'Explorations Fonctionnelles Multidisciplinaires Assistance Publique‐Hôpitaux de Paris (AP‐HP), Hôpital Tenon Paris France
- Sorbonne Université INSERM, UMR_S 1155, AP‐HP Paris France
| | - Nadjib Hammoudi
- Sorbonne Université, Inserm, Institute of Cardiometabolism and Nutrition (ICAN), ACTION Study Group and Department of Cardiology Institute of Cardiology (AP‐HP), Hôpital Pitié‐Salpêtrière, Boulevard de l'hôpital Paris France
| | - Virginie Avellino
- Sorbonne Université, Department of Internal Medicine centre de référence de la drépanocytose (AP‐HP), Centre Hospitalier Universitaire Tenon, rue de la Chine Paris France
| | - Jean‐Philippe Haymann
- Service d'Explorations Fonctionnelles Multidisciplinaires Assistance Publique‐Hôpitaux de Paris (AP‐HP), Hôpital Tenon Paris France
- Sorbonne Université INSERM, UMR_S 1155, AP‐HP Paris France
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Inusa BPD, Liguoro I, Tayo B, Booth C, Turner C, Dalton NR. Reliability of different estimated glomerular filtration rate as measures of renal function in children with sickle cell disease. Blood Cells Mol Dis 2021; 91:102590. [PMID: 34256313 DOI: 10.1016/j.bcmd.2021.102590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/12/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There is no reliable marker for detecting early renal disease in early children with sickle cell disease (SCD). Estimation of glomerular filtration rate (eGFR) as derived from the height/plasma creatinine formula is dependent on the accuracy of the creatinine analytical method used. The aim of this study was to evaluate different equations for eGFR. METHODS Children aged 5-16 years recruited. mGFR was obtained using plasma disappearance of Inutest/Iohexol, serum creatinine (SCr) was measured either by standard laboratory method or by tandem mass spectrometry (MSMS). Estimated GFR was then calculated either by "Bedside Schwartz method" or by the full-age spectrum (FAS) equation. FINDINGS A total of 79 patients (mean age 9.8 ± 4.0 years). A revised eGFR constant was calculated for Schwartz equation from the slope of the plot of height/plasma creatinine versus mGFR. Mean values for mGFR (132.7 ± 32.1 ml/min/1.73m2) and eGFR methods compared: eGFR from standard SCr was significantly higher (144.2 ± 37.3 ml/min/1.73m2, p = 0.008). The MSMS eGFR showed the lowest SD (SD = 27.5), while both FAS eGFR and FAS-height eGFR showed the highest correlation coefficient (r = 0.67). INTERPRETATION eGFR calculation based on height and SCr determined with MSMS traceable creatinine is more reliable than Schwartz formula using jaffe/enzymatic methods in SCD children.
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Affiliation(s)
- Baba Psalm Duniya Inusa
- Paediatric Haematology, Evelina London Children's Hospital, Guy's & St Thomas' NHS Foundation Trust, London, UK.
| | - Ilaria Liguoro
- Department of Medicine, Division of Pediatrics, University of Udine, Italy
| | - Bamidele Tayo
- Department of Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, USA
| | - Caroline Booth
- Department of Nephrology, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, United Kingdom
| | - Charles Turner
- WellChild Laboratory, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, United Kingdom
| | - Neil R Dalton
- WellChild Laboratory, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, United Kingdom
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6
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Payán-Pernía S, Ruiz Llobet A, Remacha Sevilla ÁF, Egido J, Ballarín Castán JA, Moreno JA. Sickle cell nephropathy. Clinical manifestations and new mechanisms involved in kidney injury. Nefrologia 2021; 41:373-382. [PMID: 36165106 DOI: 10.1016/j.nefroe.2021.10.001] [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: 08/15/2020] [Accepted: 10/03/2020] [Indexed: 06/16/2023] Open
Abstract
Kidney problems are among the most common complications in sickle cell disease (SCD). They occur early in childhood and are one of the main factors related to mortality in these patients. The main underlying pathogenic mechanisms are vaso-occlusion and haemolysis. The renal medulla has ideal conditions for the sickling of red cells due to its low partial pressure of oxygen, high osmolarity and acidic pH. Initially, sickle-cell formation in the vasa recta of the renal medulla causes hyposthenuria. This is universal and appears in early childhood. Microscopic and macroscopic haematuria also occur, in part related to renal papillary necrosis when the infarcts are extensive. Release of prostaglandins in the renal medulla due to ischaemia leads to an increase in the glomerular filtration rate (GFR). Adaptively, sodium reabsorption in the proximal tubule increases, accompanied by increased creatinine secretion. Therefore, the GFR estimated from creatinine may be overestimated. Focal segmental glomerulosclerosis is the most common glomerular disease. Albuminuria is very common and reduction has been found in 72.8% of subjects treated with ACE inhibitors or ARB. Recent evidence suggests that free haemoglobin has harmful effects on podocytes, and may be a mechanism involved in impaired kidney function in these patients. These effects need to be better studied in SCD, as they could provide a therapeutic alternative in sickle cell nephropathy.
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Affiliation(s)
- Salvador Payán-Pernía
- Unidad de Eritropatología, Unidad de Gestión Clínica de Hematología, Hospital Universitario Virgen del Rocío, Instituto de Biomedicina de Sevilla (IBIS/CSIC), Sevilla, Spain.
| | - Anna Ruiz Llobet
- Servicios y Unidades de Referencia (CSUR) de Eritropatología Hereditaria, Hospital Sant Joan de Déu - Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Servicio de Hematología Pediátrica, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca, Fundació Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
| | - Ángel Francisco Remacha Sevilla
- Servicios y Unidades de Referencia (CSUR) de Eritropatología Hereditaria, Hospital Sant Joan de Déu - Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Servicio de Hematología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Egido
- Laboratorio de Enfermedades Renales, Vasculares y Diabetes, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | | | - Juan Antonio Moreno
- Departamento de Biología Celular, Fisiología e Inmunología, Universidad de Córdoba, Instituto Maimónides de Investigaciones Biomédicas de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Córdoba, Spain.
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7
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Abstract
Kidney problems are among the most common complications in sickle cell disease (SCD). They occur early in childhood and are one of the main factors related to mortality in these patients. The main underlying pathogenic mechanisms are vaso-occlusion and haemolysis. The renal medulla has ideal conditions for the sickling of red cells due to its low partial pressure of oxygen, high osmolarity and acidic pH. Initially, sickle-cell formation in the vasa recta of the renal medulla causes hyposthenuria. This is universal and appears in early childhood. Microscopic and macroscopic haematuria also occur, in part related to renal papillary necrosis when the infarcts are extensive. Release of prostaglandins in the renal medulla due to ischaemia leads to an increase in the glomerular filtration rate (GFR). Adaptively, sodium reabsorption in the proximal tubule increases, accompanied by increased creatinine secretion. Therefore, the GFR estimated from creatinine may be overestimated. Focal segmental glomerulosclerosis is the most common glomerular disease. Albuminuria is very common and reduction has been found in 72.8% of subjects treated with ACE inhibitors or ARB. Recent evidence suggests that free haemoglobin has harmful effects on podocytes, and may be a mechanism involved in impaired kidney function in these patients. These effects need to be better studied in SCD, as they could provide a therapeutic alternative in sickle cell nephropathy.
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8
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Thielen FW, Houwing ME, Cnossen MH, Al Hadithy-Irgiztseva IA, Hazelzet JA, Groot CAUD, de Pagter APJ, Blommestein HM. Cost of health care for paediatric patients with sickle cell disease: An analysis of resource use and costs in a European country. Pediatr Blood Cancer 2020; 67:e28588. [PMID: 32672889 DOI: 10.1002/pbc.28588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/28/2020] [Accepted: 06/23/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND While multiple studies have examined the cost of health care for one aspect of sickle cell disease care, few have focussed on the overall cost of comprehensive care for sickle cell disease. METHODS We conducted a retrospective cohort study of children with sickle cell disease treated in a comprehensive care centre from 1 January 2015 to 31 December 2016. Health care utilisation of included patients was based upon data from two main sources. The clinical practice guideline was used to determine the expected resource use of routine comprehensive care (planned elective care), and the financial claims database was used to estimate real-world resource use associated with acute and inpatient care (additional care). RESULTS A total of 125 children with sickle cell disease were analysed. Expenditures for these patients averaged €5049 [standard deviation (SD) €1634] per child per year. Total yearly costs per patient varied considerably, ranging from €669 to €84 010, and less than 15% of patients were responsible for 50% of the health care costs. The majority (37%) of costs was associated with inpatient hospital care, which increased by age group, 27% with diagnostics, 19% with treatment, 11% with outpatients' visits and 6% with emergency care. CONCLUSION We have described real-world resource use and expenditures for children with sickle cell disease in a European comprehensive care centre. It seems that costs of a comprehensive approach with effective management in the outpatient setting is favourable when compared to episodic health care.
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Affiliation(s)
- Frederick W Thielen
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - Maite E Houwing
- Department of Paediatric Haematology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marjon H Cnossen
- Department of Paediatric Haematology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ilona A Al Hadithy-Irgiztseva
- Department of Control and Compliance, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan A Hazelzet
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Carin A Uyl-de Groot
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.,Institute for Medical Technology Assessment, Rotterdam, The Netherlands
| | - Anne P J de Pagter
- Department of Paediatric Haematology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands.,Leiden University Medical Center-Willem Alexander Children's Hospital, Leiden, The Netherlands
| | - Hedwig M Blommestein
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
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9
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Outcomes following kidney transplantation in patients with sickle cell disease: The impact of automated exchange blood transfusion. PLoS One 2020; 15:e0236998. [PMID: 32790687 PMCID: PMC7425908 DOI: 10.1371/journal.pone.0236998] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 07/18/2020] [Indexed: 11/19/2022] Open
Abstract
There are over 12,000 people with sickle cell disease (SCD) in the UK, and 4-12% of patients who develop Sickle Cell Nephropathy (SCN) progress to End Stage Renal Disease (ESRD). Renal transplantation offers the best outcomes for these patients with but their access to transplantation is often limited. Regular automated exchange blood transfusions (EBT) reduce the complications of SCD and may improve outcomes. However, concerns over alloimmunisation limit its widespread implementation. In this retrospective multicenter study, data were collected on 34 SCD patients who received a kidney transplant across 6 London Hospitals between 1997 and 2017. 20/34 patients were on an EBT program, pre or post renal transplantation. Overall patient and graft survival were inferior to contemporaneous UK data in the ESRD population as a whole, a finding which is well-recognised. However, patient survival (CI 95%, p = 0.0032), graft survival and graft function were superior at all time-points in those who received EBT versus those who did not. 4/20 patients (20%) on EBT developed de novo donor specific antibodies (DSAs). 3/14 patients (21%) not on EBT developed de novo DSAs. The incidence of rejection in those on EBT was 5/18 (28%), as compared with 7/13 (54%) not on EBT. In conclusion, our data, while limited by an inevitably small sample size and differences in the date of transplantation, do suggest that long-term automated EBT post renal transplant is effective and safe, with improvement in graft and patient outcomes and no increase in antibody formation or graft rejection.
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10
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Howard J, Thein SL. Optimal disease management and health monitoring in adults with sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2019; 2019:505-512. [PMID: 31808832 PMCID: PMC6913450 DOI: 10.1182/hematology.2019000055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In countries with access to organized health care, survival of children with sickle cell disease (SCD) has greatly improved, resulting in a growing population of adults with SCD. Transition from pediatric to adult care presents many challenges for the patient, who now faces the reality of emerging complications in many organs that are cumulative, adding to other age-related nonsickle conditions that interact and add to the disease morbidity. We recommend regular comprehensive annual assessments, monitoring for early signs of organ damage and joint clinics with relevant specialists, if applicable. While maintaining a low threshold for intervention with disease-modifying therapies, we should always keep in mind that there is no single complication that is pathognomonic of SCD, and nonsickle comorbidities should always be excluded and treated if present. We need to reevaluate our approach to managing adults with SCD by putting a greater emphasis on multidisciplinary care while proactively considering curative options (hematopoietic stem cell transplant and gene therapy) and experimental pharmacological agents for adults with SCD of all ages before complications render the patients ineligible for these treatments.
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Affiliation(s)
- Jo Howard
- Department of Haematology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, United Kingdom; and
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung, and Blood Institute/National Institutes of Health, Bethesda, MD
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11
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Abstract
In countries with organized access to health care, survival of patients with sickle cell disease (SCD) has greatly improved, shifting the burden of care from a pediatrician to an internal medicine physician. As a consequence, cumulative disease complications related to chronic vasculopathy are becoming more apparent, adding to organ dysfunction from physiologic aging. The time has come for us to reevaluate the approach to managing the older adult with SCD by putting a greater emphasis on geriatric conditions while proactively considering curative options once previously offered only to younger patients, with comprehensive annual assessments and joint clinics with relevant specialists.
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Affiliation(s)
- Arun S Shet
- Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Building 10-CRC, 10 Center Drive, Bethesda, MD 20892, USA
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart Lung and Blood Institute, National Institutes of Health, Building 10-CRC, 10 Center Drive, Bethesda, MD 20892, USA.
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12
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How I treat the older adult with sickle cell disease. Blood 2018; 132:1750-1760. [PMID: 30206116 DOI: 10.1182/blood-2018-03-818161] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 06/21/2018] [Indexed: 12/31/2022] Open
Abstract
With increasing survival, cumulative complications of sickle cell disease (SCD), which develop insidiously over time, are becoming more apparent and common in older patients, particularly those in their fifth decade and beyond. The older patient is also more likely to develop other age-related nonsickle conditions that interact and add to the disease morbidity. A common misconception is that any symptom in a SCD patient is attributable to their SCD and this may lead to delays in diagnosis and appropriate intervention. We recommend regular comprehensive reviews and monitoring for early signs of organ damage and a low threshold for the use of hydroxyurea and blood transfusions as preventative measures for end-organ disease. Treatable comorbidities and acute deterioration should be managed aggressively. Although the primary goal in management of the older adult with SCD is improving anemia and minimizing organ damage, the time has come for us to be more proactive in considering curative therapies previously offered to the younger patient. Curative or experimental interventions should be discussed early, before complications render the patients ineligible for these treatments.
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13
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Abstract
In the 100 years since sickle cell anemia (SCA) was first described in the medical literature, studies of its molecular and pathophysiological basis have been at the vanguard of scientific discovery. By contrast, the translation of such knowledge into treatments that improve the lives of those affected has been much too slow. Recent years, however, have seen major advances on several fronts. A more detailed understanding of the switch from fetal to adult hemoglobin and the identification of regulators such as BCL11A provide hope that these findings will be translated into genomic-based approaches to the therapeutic reactivation of hemoglobin F production in patients with SCA. Meanwhile, an unprecedented number of new drugs aimed at both the treatment and prevention of end-organ damage are now in the pipeline, outcomes from potentially curative treatments such as allogeneic hematopoietic stem cell transplantation are improving, and great strides are being made in gene therapy, where methods employing both antisickling β-globin lentiviral vectors and gene editing are now entering clinical trials. Encouragingly, after a century of neglect, the profile of the vast majority of those with SCA in Africa and India is also finally improving.
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Affiliation(s)
- Thomas N Williams
- Department of Epidemiology and Demography, KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Medicine, Imperial College London, London W2 1NY, United Kingdom;
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland 20892-1589, USA;
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14
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Khan AB, Kesse-Adu R, Breen C, Murphy PB, Chambers J, Holmes P, Howard J. A descriptive study of the characteristics of older adults with sickle cell disease. Am J Hematol 2018; 93:E38-E40. [PMID: 29098717 DOI: 10.1002/ajh.24961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 10/28/2017] [Accepted: 10/31/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Anjum B. Khan
- Department of Haematology; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - Rachel Kesse-Adu
- Department of Haematology; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - Cormac Breen
- Department of Nephrology; Guy's and St Thomas’ NHS Foundation Trust; London UK
| | - Patrick B. Murphy
- Lane Fox Respiratory Unit; Guy's and St Thomas’ NHS Foundation Trust; London UK
- Division of Asthma Allergy and Lung Biology; King's College London School of Medical Education; London UK
| | - John Chambers
- Department of Cardiology; Guy's and St Thomas’ NHS Foundation Trust; London UK
- Cardiovascular Division; King's College London; UK
| | - Paul Holmes
- Department of Neurology; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Joanna Howard
- Department of Haematology; Guy's and St Thomas’ NHS Foundation Trust; London UK
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Naik RP, Derebail VK. The spectrum of sickle hemoglobin-related nephropathy: from sickle cell disease to sickle trait. Expert Rev Hematol 2017; 10:1087-1094. [PMID: 29048948 DOI: 10.1080/17474086.2017.1395279] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Renal dysfunction is among the most common complication of sickle cell disease (SCD), from hyposthenuria in children to progression to overt chronic kidney disease (CKD) in young adults. Emerging evidence now suggests that sickle hemoglobin-related nephropathy extends to individuals with sickle cell trait (SCT). Areas covered: This review will highlight the pathophysiology, epidemiology, and management recommendations for sickle hemoglobin-related nephropathy in both SCD and SCT. In addition, it will focus on the major demographic and genetic modifiers of renal disease in sickling hemoglobinopathies. Expert commentary: Studies have elucidated the course of renal disease in SCD; however, the scope and age of onset of renal dysfunction in SCT has yet to be determined. In SCD, several modifiers of renal disease - such as α-thalassemia, hemoglobin F, APOL1 and HMOX1 - have been described and provide an opportunity for a precision medicine approach to risk stratify patients who may benefit from early intervention. Extrapolating from this literature may also provide insight into the modifiers of renal disease in SCT. Further studies are needed to determine the optimal treatment for sickle hemoglobin-related nephropathy.
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Affiliation(s)
- Rakhi P Naik
- a Division of Hematology, Department of Medicine , Johns Hopkins University , Baltimore , MD , USA
| | - Vimal K Derebail
- b Division of Nephrology and Hypertension, Department of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
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Thein MS, Igbineweka NE, Thein SL. Sickle cell disease in the older adult. Pathology 2017; 49:1-9. [PMID: 27914684 PMCID: PMC10757825 DOI: 10.1016/j.pathol.2016.10.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 10/12/2016] [Accepted: 10/20/2016] [Indexed: 01/14/2023]
Abstract
Sickle cell disease (SCD) is an inherited haemoglobin disorder, associated with recurrent painful episodes, ongoing haemolytic anaemia and progressive multi-organ damage. Until the early 1990s, survival beyond the fourth decade for a patient with SCD was considered unusual and prompted case reports. Nowadays, in countries with developed health care systems, more than 90 percent of newborns with SCD survive into adulthood. Nevertheless, their life expectancy is still shortened by more than two decades compared to the general population. With an increasing life expectancy, SCD has now evolved into a debilitating disorder with substantial morbidity resulting from ongoing sickle cell vasculopathy and multi-organ damage. Limited data on health care issues of older adults with SCD poses multiple challenges to patients, their families and health care providers. In this review, we will address and discuss acute and chronic complications of SCD with a special focus on the older adult.
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Affiliation(s)
- Mya S Thein
- Sickle Cell Branch, National Heart Lung and Blood Institute, National Institute of Health, Bethesda, MD, USA
| | - Norris E Igbineweka
- Department of Haematology, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart Lung and Blood Institute, National Institute of Health, Bethesda, MD, USA.
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17
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Asnani M, Serjeant G, Royal-Thomas T, Reid M. Predictors of renal function progression in adults with homozygous sickle cell disease. Br J Haematol 2016; 173:461-8. [PMID: 27018388 DOI: 10.1111/bjh.13967] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 12/15/2015] [Indexed: 12/16/2022]
Abstract
Longitudinal studies of renal function may improve understanding of the pathophysiological mechanisms underlying sickle cell disease (SCD) nephropathy and may identify possible biological and clinical markers of renal function determined over time. Data from the Jamaica Sickle Cell Cohort Study (JSCCS) were extracted and the glomerular filtration rate (GFR) was estimated using the Chronic Kidney Disease Epidemiological and the SCD specific JSCCS-GFR equations from all adulthood serum creatinine measurements in homozygous SS patients. The other dataset consisted of measured GFR at two times about 13 years apart. Linear mixed model (LMM) regression analyses were conducted to determine predictors of GFR and serum creatinine over time. 191 individuals with SS disease had 867 GFR estimates available. Serum creatinine significantly increased from baseline whereas estimated GFR showed a significant decline. Serum creatinine showed positive association with increasing age, male gender, body mass index and sodium levels. Haemoglobin was a significant negative predictor of estimated GFR in age- and gender-adjusted models. A total of 24 females and 17 males had repeat measurements of their GFR. The mean annual decline in GFR was -3·2 ± 2·83 ml/min/1·73 m(2) . Haemoglobin was a significant positive predictor whereas serum creatinine, systolic blood pressure and urinary albumin: creatinine ratio were negative predictors of GFR.
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Affiliation(s)
- Monika Asnani
- Sickle Cell Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston 7, Jamaica (W.I.)
| | | | - Tamika Royal-Thomas
- Tropical Metabolism Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston 7, Jamaica (W.I.)
| | - Marvin Reid
- Tropical Metabolism Research Unit, Tropical Medicine Research Institute, The University of the West Indies, Kingston 7, Jamaica (W.I.)
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19
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Bartolucci P, Habibi A, Stehlé T, Di Liberto G, Rakotoson MG, Gellen-Dautremer J, Loric S, Moutereau S, Sahali D, Wagner-Ballon O, Remy P, Lang P, Grimbert P, Audureau E, Godeau B, Galacteros F, Audard V. Six Months of Hydroxyurea Reduces Albuminuria in Patients with Sickle Cell Disease. J Am Soc Nephrol 2015; 27:1847-53. [PMID: 26586692 DOI: 10.1681/asn.2014111126] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 09/07/2015] [Indexed: 12/22/2022] Open
Abstract
The earliest symptom of glomerular injury in patients with sickle cell disease (SCD) is microalbuminuria. The effect of hydroxyurea (HU) on urine albumin-to-creatinine ratio (ACR) is unclear and should be determined, because increasing numbers of patients with SCD take this drug to improve red blood cell function. In this cohort study of 58 SS-homozygous adults with SCD who initiated HU therapy, we evaluated ACR changes and relationships of these changes with demographic, clinical, and biologic parameters at HU initiation (baseline) and 6 months later (follow-up). Between baseline and follow-up, ACR declined significantly for the entire population (3.0-1.7 mg/mmol; P<0.01), but this was primarily driven by the ACR reduction in the microalbuminuria subgroup (8.1-2.3 mg/mmol; P=0.03; n=23). According to bivariate analyses on 39 patients who did not receive a blood transfusion during the study period, the baseline to follow-up ACR decline was strongly associated with decreases in levels of hemolysis markers, percentage of dense red blood cells, and systolic BP. Bivariate analysis also revealed a close association between the ACR decrease and high baseline levels of hemolysis markers and percentage of dense red blood cells. These results show that urine ACR decreased significantly after 6 months of HU and confirm a close relationship between ACR and hemolysis evolution in patients with SCD.
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Affiliation(s)
- Pablo Bartolucci
- Sickle Cell Referral Center, Department of Internal Medicine, Unité Institut National de la Santé Et de la Recherche Médicale (INSERM) U955, Equipe 2 and Laboratory of Excellence Globule Rouge Excellence (GR-Ex), Paris, France Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France;
| | - Anoosha Habibi
- Sickle Cell Referral Center, Department of Internal Medicine, Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France
| | - Thomas Stehlé
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Nephrology and Renal Transplantation
| | - Gaetana Di Liberto
- Unité Institut National de la Santé Et de la Recherche Médicale (INSERM) U955, Equipe 2 and Laboratory of Excellence Globule Rouge Excellence (GR-Ex), Paris, France Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France
| | - Marie Georgine Rakotoson
- Unité Institut National de la Santé Et de la Recherche Médicale (INSERM) U955, Equipe 2 and Laboratory of Excellence Globule Rouge Excellence (GR-Ex), Paris, France Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France
| | - Justine Gellen-Dautremer
- Sickle Cell Referral Center, Department of Internal Medicine, Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France
| | - Sylvain Loric
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Departement de Biochimie-Pharmacotoxicologie
| | - Stéphane Moutereau
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Departement de Biochimie-Pharmacotoxicologie
| | - Dil Sahali
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Nephrology and Renal Transplantation, Unité INSERM U955, Equipe 21, Idiopathic Nephrotic Syndrome Referral Center, Université Paris-Est Créteil, Creteil, France; and
| | - Orianne Wagner-Ballon
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Hematology and Immunology Biology, and
| | - Philippe Remy
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Nephrology and Renal Transplantation, Unité INSERM U955, Equipe 21, Idiopathic Nephrotic Syndrome Referral Center, Université Paris-Est Créteil, Creteil, France; and
| | - Philippe Lang
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Nephrology and Renal Transplantation, Unité INSERM U955, Equipe 21, Idiopathic Nephrotic Syndrome Referral Center, Université Paris-Est Créteil, Creteil, France; and
| | - Philippe Grimbert
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Nephrology and Renal Transplantation, Unité INSERM U955, Equipe 21, Idiopathic Nephrotic Syndrome Referral Center, Université Paris-Est Créteil, Creteil, France; and
| | - Etienne Audureau
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Public Health Unit EA (Equipe d'Accueil) 7376 CEpiA (Clinical Epidemiology And Ageing Unit, and
| | - Bertrand Godeau
- Department of Internal Medicine, Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France
| | - Frédéric Galacteros
- Sickle Cell Referral Center, Department of Internal Medicine, Unité Institut National de la Santé Et de la Recherche Médicale (INSERM) U955, Equipe 2 and Laboratory of Excellence Globule Rouge Excellence (GR-Ex), Paris, France Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France
| | - Vincent Audard
- Groupe Hospitalier Henri Mondor-Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Université Paris-Est Créteil, Creteil, France; Department of Nephrology and Renal Transplantation, Unité INSERM U955, Equipe 21, Idiopathic Nephrotic Syndrome Referral Center, Université Paris-Est Créteil, Creteil, France; and
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20
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Marsella M, Borgna-Pignatti C. Transfusional iron overload and iron chelation therapy in thalassemia major and sickle cell disease. Hematol Oncol Clin North Am 2015; 28:703-27, vi. [PMID: 25064709 DOI: 10.1016/j.hoc.2014.04.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Iron overload is an inevitable consequence of blood transfusions and is often accompanied by increased iron absorption from the gut. Chelation therapy is necessary to prevent the consequences of hemosiderosis. Three chelators, deferoxamine, deferiprone, and deferasirox, are presently available and a fourth is undergoing clinical trials. The efficacy of all 3 available chelators has been demonstrated. Also, many studies have shown the efficacy of the combination of deferoxamine plus deferiprone as an intensive treatment of severe iron overload. Alternating chelators can reduce adverse effects and improve compliance. Adherence to therapy is crucial for good results.
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Affiliation(s)
- Maria Marsella
- Department of Medical Sciences, University of Ferrara, Azienda Ospedale-Università Via Aldo Moro 8, Cona, Ferrara, Italy
| | - Caterina Borgna-Pignatti
- Department of Medical Sciences, University of Ferrara, Azienda Ospedale-Università Via Aldo Moro 8, Cona, Ferrara, Italy.
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21
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Ballas SK, Vichinsky EP. Is the medical home for adult patients with sickle cell disease a reality or an illusion? Hemoglobin 2015; 39:130-3. [PMID: 25806421 DOI: 10.3109/03630269.2015.1023312] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Recently, the patient-centered medical home (PCMH) emerged as a viable method to improve delivery of medical care. Due to all the promotion about the effectiveness of the PCMH, patients with sickle cell disease, their families and the community hoped that this could be a possible solution to the problems that arise in the treatment of adult patients with sickle cell disease. Review of the literature and review of the criteria for the establishment of a PCMH show that the PCMH is not an ideal model for patients with sickle cell disease because finding a personal physician, which is the first criteria of a functional PCMH, is a major problem in the process of transitioning the care of patients with sickle cell disease from pediatrics to adult care. Moreover, garnering hospital support to defray the initial costs to establish a PCMH for adults with sickle cell disease is unlikely given the already high costs of care for patients with sickle cell disease. Moreover, recent studies have shown insufficient evidence to determine the presumed beneficial effects of the PCMH, especially in patients with chronic disease.
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Affiliation(s)
- Samir K Ballas
- Department of Medicine, Cardeza Foundation, Jefferson Medical College, Thomas Jefferson University , Philadelphia, Pennsylvania , USA and
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22
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Galloway-Blake K, Reid M, Walters C, Jaggon J, Lee MG. Clinical Factors Associated with Morbidity and Mortality in Patients Admitted with Sickle Cell Disease. W INDIAN MED J 2014; 63:711-6. [PMID: 25867578 PMCID: PMC4668979 DOI: 10.7727/wimj.2014.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/28/2014] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the clinical factors associated with the length of hospitalization and mortality in patients with sickle cell disease (SCD). METHODS All patients with SCD admitted to the medical wards of the University Hospital of the West Indies, Jamaica, over a five-year period, January 1 to December 31, 2010, were reviewed. Data were extracted from hospital charts and comprised demographic and clinical information, investigations, interventions, duration of stay, pathological data and outcomes. RESULTS There were 105 patients reviewed; 84% were genotype Hb SS. Females accounted for 59% and males 41%. Overall mean age was 32.5 years (SD 13.7, range 12-66 years). The mean length of hospitalization was 10.2 days (SD 10.9, range 1-84 days). The main admission diagnoses were painful crisis, acute chest syndrome, severe anaemia, sepsis, hepatic sequestration, congestive cardiac failure and renal failure. The mean value for the following laboratory investigations were: haemoglobin 7.7 g/dL (SD 2.8), total white blood cell count 21.7 x 109/L (SD 14.2), platelet count 320 x 109/L (SD 191.9), blood urea 9.8 mmol/L (SD 11.9) and serum creatinine 198 umol/L (SD 267.9). Medical interventions included: blood transfusions in 20.9%, 55% received antibiotics and 74% received narcotic analgesia. There were 40 deaths with four autopsies done. The mortality rate for SCD was 38%. There were 189 repeat SCD admissions. CONCLUSION Sickle cell disease still carries a high morbidity and mortality in patients admitted to hospital. Recurrent admissions are a concern, as they impact on patient's morbidity and quality of life.
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Affiliation(s)
- K Galloway-Blake
- Department of Medicine, The University of the West Indies, Kingston 7, Jamaica, West Indies
| | - M Reid
- Tropical Medicine Research Institute (Sickle Cell Unit), The University of the West Indies, Kingston 7, Jamaica, West Indies
| | - C Walters
- Faculty of Medical Sciences, The University of the West Indies, Kingston 7, Jamaica, West Indies
| | - J Jaggon
- Department of Pathology, The University of the West Indies, Kingston 7, Jamaica, West Indies
| | - M G Lee
- Department of Medicine, The University of the West Indies, Kingston 7, Jamaica, West Indies.
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23
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Asnani MR, Reid ME. Renal function in adult Jamaicans with homozygous sickle cell disease. Hematology 2014; 20:422-8. [PMID: 25431929 DOI: 10.1179/1607845414y.0000000213] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Monika R. Asnani
- Sickle Cell UnitTropical Medicine Research Institute, University of the West Indies, Jamaica, WI, USA
| | - Marvin E. Reid
- Sickle Cell UnitTropical Medicine Research Institute, University of the West Indies, Jamaica, WI, USA
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24
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The ethics of a proposed study of hematopoietic stem cell transplant for children with “less severe” sickle cell disease. Blood 2014; 124:861-6. [DOI: 10.1182/blood-2014-05-575209] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Abstract
Hematopoietic stem cell transplant (HSCT) is the only cure for sickle cell disease (SCD). HSCT using an HLA-identical sibling donor is currently an acceptable treatment option for children with severe SCD, with expected HSCT survival >95% and event-free survival >85%. HSCT for children with less severe SCD (children who have not yet suffered overt disease complications or only had mild problems) is controversial. It is important to consider the ethical issues of a proposed study comparing HLA-identical sibling HSCT to best supportive care for children with less severe SCD. In evaluating the principles of nonmaleficence, respect for individual autonomy, and justice, we conclude that a study of HLA-identical sibling HSCT for all children with SCD, particularly hemoglobin SS and Sβ0-thalassemia disease, is ethically sound. Future work should explore the implementation of a large trial to help determine whether HSCT is a beneficial treatment of children with less severe SCD.
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Abstract
Abstract
Renal disease is one of the most frequent and severe complications experienced by patients with sickle cell disease; its prevalence is likely to increase as the patient population ages. We recommend regular monitoring for early signs of renal involvement and a low threshold for the use of hydroxyurea as preventative measures for end-stage renal disease. Once renal complications are detected, a careful assessment of the patient is required to rule out other causes of renal disease. Proteinuria and hypertension should be managed aggressively and the patient referred to a specialist nephrology center when progressive decline in renal function is noted. For the few patients who develop advanced chronic kidney disease, timely planning for dialysis and transplantation can significantly improve outcome, and we recommend an exchange blood transfusion policy for all patients on the transplant waiting list and for those with a functioning graft. Alongside the invasive treatment regimes, it is important to remember that renal failure in conjunction with sickle cell disease does carry a significant burden of morbidity and that focusing on symptom control has to be central to good patient care.
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26
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Prevalence and Progression of Chronic Kidney Disease in Adult Patients With Sickle Cell Disease. J Investig Med 2014; 62:804-7. [DOI: 10.1097/01.jim.0000446836.75352.72] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Loggetto SR. Sickle cell anemia: clinical diversity and beta S-globin haplotypes. Rev Bras Hematol Hemoter 2013; 35:155-7. [PMID: 23904799 PMCID: PMC3728122 DOI: 10.5581/1516-8484.20130048] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 04/17/2013] [Indexed: 11/27/2022] Open
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28
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Wilson NO, Ceesay FK, Hibbert JM, Driss A, Obed SA, Adjei AA, Gyasi RK, Anderson WA, Stiles JK. Pregnancy outcomes among patients with sickle cell disease at Korle-Bu Teaching Hospital, Accra, Ghana: retrospective cohort study. Am J Trop Med Hyg 2012; 86:936-42. [PMID: 22665597 DOI: 10.4269/ajtmh.2012.11-0625] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Pregnancy in sickle cell disease (SCD) patients is associated with increased risk of maternal and fetal mortality. This study determines pregnancy outcomes among women with SCD delivering at Korle-Bu Teaching Hospital, Accra, Ghana. Nine hundred sixty (960) medical records of pregnant women (131 HbSS, 112 HbSC, and 717 comparison group) from 2007 to 2008 were reviewed. The HbSS women were at increased risk of eclampsia (adjusted odds ratio [AOR] = 10.56, 95% confidence interval [CI] = 3.60-30.96, P < 0.001), intrauterine growth restriction (AOR = 4.00, 95% CI = 1.38-11.64, P = 0.011), and placenta previa (AOR = 22.03, 95% CI = 9.87-49.14, P < 0.001) compared with the comparison group. The HbSC women had increased risk for intrauterine fetal death (AOR = 3.38, 95% CI = 1.15-9.96, P = 0.027) and decreased risk of delivering low birth weight babies (AOR = 0.21, 95% CI = 0.06-0.73, P = 0.014). Women with SCD in Ghana are at a greater risk of morbidity and mortality in pregnancy compared with women without hemoglobinopathies. Improved maternal and fetal outcomes in Ghanaian women with SCD can be achieved through effective intervention by health care providers with thorough knowledge about predisposing factors toward adverse outcomes.
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Affiliation(s)
- Nana O Wilson
- Morehouse School of Medicine, Department of Microbiology, Biochemistry and Immunology, Atlanta, GA 30310, USA.
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Steinberg MH, Sebastiani P. Genetic modifiers of sickle cell disease. Am J Hematol 2012; 87:795-803. [PMID: 22641398 PMCID: PMC4562292 DOI: 10.1002/ajh.23232] [Citation(s) in RCA: 198] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Revised: 03/28/2012] [Accepted: 04/04/2012] [Indexed: 01/19/2023]
Abstract
Sickle cell anemia is associated with unusual clinical heterogeneity for a Mendelian disorder. Fetal hemoglobin concentration and coincident α thalassemia, both which directly affect the sickle erythrocyte, are the major modulators of the phenotype of disease. Understanding the genetics underlying the heritable subphenotypes of sickle cell anemia would be prognostically useful, could inform personalized therapeutics, and might help the discovery of new "druggable" pathophysiologic targets. Genotype-phenotype association studies have been used to identify novel genetic modifiers. In the future, whole genome sequencing with its promise of discovering hitherto unsuspected variants could add to our understanding of the genetic modifiers of this disease.
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Affiliation(s)
- Martin H. Steinberg
- Division of Hematology/Oncology, Department of Medicine, Boston University School of Medicine, Boston MA 02118 USA
| | - Paola Sebastiani
- Department of Biostatistics, Boston University School of Public Health, Boston, MA 02118, USA
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30
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Wood DK, Soriano A, Mahadevan L, Higgins JM, Bhatia SN. A biophysical indicator of vaso-occlusive risk in sickle cell disease. Sci Transl Med 2012; 4:123ra26. [PMID: 22378926 DOI: 10.1126/scitranslmed.3002738] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The search for predictive indicators of disease has largely focused on molecular markers. However, biophysical markers, which can integrate multiple pathways, may provide a more global picture of pathophysiology. Sickle cell disease affects millions of people worldwide and has been studied intensely at the molecular, cellular, tissue, and organismal level for a century, but there are still few, if any, markers quantifying the severity of this disease. Because the complications of sickle cell disease are largely due to vaso-occlusive events, we hypothesized that a physical metric characterizing the vaso-occlusive process could serve as an indicator of disease severity. Here, we use a microfluidic device to characterize the dynamics of "jamming," or vaso-occlusion, in physiologically relevant conditions, by measuring a biophysical parameter that quantifies the rate of change of the resistance to flow after a sudden deoxygenation event. Our studies show that this single biophysical parameter could be used to distinguish patients with poor outcomes from those with good outcomes, unlike existing laboratory tests. This biophysical indicator could therefore be used to guide the timing of clinical interventions, to monitor the progression of the disease, and to measure the efficacy of drugs, transfusion, and novel small molecules in an ex vivo setting.
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Affiliation(s)
- David K Wood
- Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA 02139, USA
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Abstract
Despite its apparently simple molecular aetiology, sickle cell disease (SCD) has long been known to have a remarkably variable clinical course, with complications involving many organs including the kidneys. Whilst many affected individuals show no evidence of renal involvement into late adulthood, others develop renal dysfunction in childhood or early adult life with a significant proportion eventually requiring renal replacement therapy. This review explores the pathophysiology and clinical manifestations of sickle cell nephropathy (SCN) and discusses how each complication can be investigated, monitored and managed in the outpatient setting. We summarize current knowledge of genetic modulation of sickle-related renal dysfunction. We outline the evidence for various treatment options and discuss others for which little evidence currently exists.
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Hassell KL. Population estimates of sickle cell disease in the U.S. Am J Prev Med 2010; 38:S512-21. [PMID: 20331952 DOI: 10.1016/j.amepre.2009.12.022] [Citation(s) in RCA: 814] [Impact Index Per Article: 58.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 12/17/2009] [Accepted: 12/22/2009] [Indexed: 12/13/2022]
Abstract
BACKGROUND The number of individuals with sickle cell disease (SCD) in the U.S. is unknown. Determination of burden of disease, healthcare issues, and policies is best served by representative estimations of the SCD population. PURPOSE To update SCD population estimates by using recent U.S. Census and birth-cohort SCD prevalence for at-risk populations as available through the centralized reporting of universal newborn screening for hemoglobinopathies, with an effort to demonstrate the potential effect of early mortality. METHODS National and state SCD populations were estimated based on the 2008 U.S. Census, using total, African-American, and Hispanic birth-cohort disease prevalence derived from the National Newborn Screening Information System. Estimates were corrected for early mortality for sickle cell anemia using data from the CDC's Compressed Mortality Report and published patient-cohort survival information. RESULTS National SCD population estimates ranged from 104,000 to 138,900, based on birth-cohort disease prevalence, but from 72,000 to 98,000 when corrected for early mortality. Several limitations were noted in the available data, particularly for SCD mortality in adults. CONCLUSIONS The number of individuals with SCD in the U.S. may approach 100,000, even when accounting for the effect of early mortality on estimations. A paucity of high-quality data limits appropriate estimation. State-to-state variability may preclude application of state-specific information to other states or to the nation as a whole. Standardized collection and centralized reporting, a surveillance system, will be necessary to assess the size and composition of the U.S. SCD population.
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Affiliation(s)
- Kathryn L Hassell
- Colorado Sickle Cell Treatment and Research Center, University of Colorado Denver Health Sciences Center, Aurora, CO 80045, USA.
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