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Evangelidis P, Venou TM, Fani B, Vlachaki E, Gavriilaki E. Endocrinopathies in Hemoglobinopathies: What Is the Role of Iron? Int J Mol Sci 2023; 24:16263. [PMID: 38003451 PMCID: PMC10671246 DOI: 10.3390/ijms242216263] [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: 10/16/2023] [Revised: 11/07/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Hemoglobinopathies, including β-thalassemia and sickle cell disease (SCD), are common genetic blood disorders. Endocrine disorders are frequent manifestations of organ damage observed mainly in patients with β-thalassemia and rarely in SCD. Iron overload, oxidative stress-induced cellular damage, chronic anemia, and HCV infection contribute to the development of endocrinopathies in β-thalassemia. The above factors, combined with vaso-occlusive events and microcirculation defects, are crucial for endocrine dysfunction in SCD patients. These endocrinopathies include diabetes mellitus, hypothyroidism, parathyroid dysfunction, gonadal and growth failure, osteoporosis, and adrenal insufficiency, affecting the quality of life of these patients. Thus, we aim to provide current knowledge and data about the epidemiology, pathogenesis, diagnosis, and management of endocrine disorders in β-thalassemia and SCD. We conducted a comprehensive review of the literature and examined the available data, mostly using the PubMed and Medline search engines for original articles. In the era of precision medicine, more studies investigating the potential role of genetic modifiers in the development of endocrinopathies in hemoglobinopathies are essential.
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Affiliation(s)
- Paschalis Evangelidis
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
| | - Theodora-Maria Venou
- Adult Thalassemia Unit, 2nd Department of Internal Medicine, Aristotle University of Thessaloniki, Hippocration General Hospital, 54642 Thessaloniki, Greece; (T.-M.V.); (E.V.)
| | | | - Efthymia Vlachaki
- Adult Thalassemia Unit, 2nd Department of Internal Medicine, Aristotle University of Thessaloniki, Hippocration General Hospital, 54642 Thessaloniki, Greece; (T.-M.V.); (E.V.)
| | - Eleni Gavriilaki
- Second Propedeutic Department of Internal Medicine, Hippocration Hospital, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece;
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Abu-Shaheen A, Dahan D, Henaa H, Nofal A, Abdelmoety DA, Riaz M, AlSheef M, Almatary A, AlFayyad I. Sickle cell disease in Gulf Cooperation Council countries: a systematic review. Expert Rev Hematol 2022; 15:893-909. [PMID: 36217841 DOI: 10.1080/17474086.2022.2132225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Evidence related to the national burden of Sickle Cell Disease (SCD) in Gulf Cooperation Council (GCC) largely fragmented. Thus, the aim of this study is to systemically review studies from GCC countries to assess the epidemiological profile of SCD. AREAS COVERED We searched combinations of key terms in MEDLINE/PubMed, CINAHL, and EMBASE. We selected relevant observational studies reporting the frequency, incidence, prevalence, risk factors, mortality rate, and complications of SCD among the GCC population. Studies restricted to laboratory diagnostic tests, experimental and animal studies, review articles, case reports and series, and conference proceedings and editorials were excluded. A total of 1,347 articles were retrieved, out of which 98 articles were found to be eligible and included in the study. The total number of participants from all the included studies was 3496447. The prevalence of SCD ranged from 0.24%-5.8% across the GCC and from 1.02%-45.8% for the sickle cell trait. Consanguineous marriage was a risk factor for likely giving children affected with hemoglobinopathies. EXPERT OPINION The prevalence of SCD and its complications vary among GCC. Because of the high prevalence of SCD and its complications, health authorities should focus on more rigorous prevention and treatment strategies.
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Affiliation(s)
| | - Doaa Dahan
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Humariya Henaa
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdullah Nofal
- Emergency Medicine Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Doaa A Abdelmoety
- Clinical Research Holy Management Department, Executive Administration of Research, King Abdullah Medical City in Capital, Makkah, Saudi Arabia
| | - Muhammad Riaz
- Department of Statistics, University of Malakand, Pakistan
| | - Mohammed AlSheef
- Internal Medicine Consultant, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman Almatary
- Neonatal Intensive Care Unit, King Fahad Medical City, Children specialized hospital. Riyadh, Saudi Arabia
| | - Isamme AlFayyad
- Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
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Batte A, Kasirye P, Baluku R, Kiguli S, Kalyesubula R, John CC, Schwaderer AL, Imel EA, Conroy AL. Mineral bone disorders and kidney disease in hospitalized children with sickle cell anemia. Front Pediatr 2022; 10:1078853. [PMID: 36819194 PMCID: PMC9932899 DOI: 10.3389/fped.2022.1078853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Mineral bone disorders (MBD) are common in sickle cell anemia (SCA). Frequent vaso-occlusive crises (VOC) further impact MBD in children with SCA. We evaluated the prevalence of markers of SCA-related MBD (sMBD) in hospitalized children and assessed the relationship between sMBD and individual mineral abnormalities with kidney disease. METHODS We prospectively recruited 185 children with SCA hospitalized with a VOC. Serum measures of mineral bone metabolism (calcium, phosphate, parathyroid hormone, 25-hydroxy vitamin D, FGF23, osteopontin) were measured at enrollment. The primary outcome was markers of sMBD defined as a composite of hypocalcemia, hyperphosphatemia, hyperparathyroidism, or deficiency in 25-OH vitamin D. Secondary outcomes included individual abnormalities in mineral metabolism. The Kidney Disease: Improving Global Outcomes (KDIGO) guidelines were used to define SCA-associated acute kidney injury (AKI). AKI was further assessed using urine NGAL as a marker of tubular injury. Acute kidney disease (AKD) was defined as a composite of AKI, an eGFR < 90 ml/min per 1.73 m2 using the Cystatin C GFR equation, or evidence of structural injury (positive biomarker test or albuminuria). RESULTS The mean age of children was 8.9 years and 41.6% were female. The prevalence of sMBD was 47.6%, with hypocalcemia the most frequent abnormality (29.9%, 55/184) followed by hyperphosphatemia (20.7%, 38/184), hyperparathyroidism (8.7%, 16/185), and vitamin D deficiency (5.4%, 10/185). There was no association between sMBD and sKDIGO-defined AKI using serial changes in creatinine or when incorporating biomarkers to define AKI. However, the presence of AKD was associated with a 2.01-fold increased odds of sMBD (95% CI 1.05 to 3.83) and was driven by a decrease in eGFR (OR, 2.90 95% CI: 1.59 to 5.29). When evaluating individual mineral abnormalities, hypocalcemia was associated with AKD and low eGFR while hyperparathyroidism was associated with low eGFR, AKI and structural injury. Vitamin D deficiency was associated with structural kidney injury. Vitamin D deficiency, hyperparathryoidism, and increases in FGF23 and osteopontin predicted mortality (p < 0.05 for all). CONCLUSION MBD is common among children with SCA hospitalized with VOC. Biomarkers of kidney injury and bone health may help risk stratify children at risk of sMBD. Routine evaluation of sMBD in children with SCA may improve long-term bone health.
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Affiliation(s)
- Anthony Batte
- Child Health and Development Centre, Makerere University College of Health Sciences, Kampala, Uganda
| | - Philip Kasirye
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Reagan Baluku
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sarah Kiguli
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Kalyesubula
- Department of Physiology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chandy C John
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Ryan White Center for Pediatric Infectious Diseases and Global Health, Indianapolis, IN, United States
| | - Andrew L Schwaderer
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Erik A Imel
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Andrea L Conroy
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Ryan White Center for Pediatric Infectious Diseases and Global Health, Indianapolis, IN, United States
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Khan EA, Cheddani L, Saint-Jacques C, Vargas-Poussou R, Frochot V, Chieze R, Letavernier E, Avellino V, Lionnet F, Haymann JP. Primary Hyperparathyroidism in Homozygous Sickle Cell Patients: A Hemolysis-Mediated Hypocalciuric Hypercalcemia Phenotype? J Clin Med 2021; 10:jcm10215179. [PMID: 34768698 PMCID: PMC8584729 DOI: 10.3390/jcm10215179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 09/21/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
Primary hyperparathyroidism (pHPT) has been reported to have a higher prevalence in sickle cell disease (SCD) patients, including a high rate of recurrence following surgery. However, most patients are asymptomatic at the time of diagnosis, with surprisingly infrequent hypercalciuria, raising the issue of renal calcium handling in SCD patients. We conducted a retrospective study including (1) 64 hypercalcemic pHPT non-SCD patients; (2) 177 SCD patients, divided into two groups of 12 hypercalcemic pHPT and 165 non-pHPT; (3) eight patients with a diagnosis of familial hypocalciuric hypercalcemia (FHH). Demographic and biological parameters at the time of diagnosis were collected and compared between the different groups. Determinants of fasting fractional excretion of calcium (FeCa2+) were also analyzed in non-pHPT SCD patients. Compared to non-SCD pHPT patients, our data show a similar ionized calcium and PTH concentration, with a lower plasmatic calcitriol concentration and a lower daily urinary calcium excretion in pHPT SCD patients (p < 0.0001 in both cases). Fasting FeCa2+ is also surprisingly low in pHPT SCD patients, and thus inadequate to be considered hypercalcemia, recalling the FHH phenotype. FeCa2+ is also low in the non-pHPT SCD control group, and negatively associated with PTH and hemolytic biomarkers such as LDH and low hemoglobin. Our data suggest that the pHPT biochemical phenotype in SCD patients resembles the FHH phenotype, and the fasting FeCa2+ association with chronic hemolysis biomarkers strengthens the view of a potential pharmacological link between hemolytic by-products and calcium reabsorption, potentially through a decreased calcium-sensing receptor (CaSR) activity.
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Affiliation(s)
- Edmat Akhtar Khan
- Service de Néphrologie, Université de Lorraine, CHRU-Nancy, 54500 Vandœuvre-lès-Nancy, France;
| | - Lynda Cheddani
- Unité HTA, Prévention et Thérapeutique Cardiovasculaires, Assistance Publique—Hôpitaux de Paris, Hôpital Hôtel Dieu, 75004 Paris, France;
- Centre de Diagnostic et de Thérapeutique, Hôtel-Dieu, Université de Paris, 75006 Paris, France
| | - Camille Saint-Jacques
- Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (C.S.-J.); (V.F.); (R.C.); (E.L.)
- Unité Mixte de Recherche (UMR) S 1155, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Hôpital Tenon, 75020 Paris, France
| | - Rosa Vargas-Poussou
- Centre d’Investigation Clinique, Centre de Référence des Maladies Rénales Héréditaires de l’Enfant et de l’Adulte, Assistance Publique—Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015 Paris, France;
| | - Vincent Frochot
- Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (C.S.-J.); (V.F.); (R.C.); (E.L.)
- Unité Mixte de Recherche (UMR) S 1155, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Hôpital Tenon, 75020 Paris, France
| | - Remi Chieze
- Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (C.S.-J.); (V.F.); (R.C.); (E.L.)
- Unité Mixte de Recherche (UMR) S 1155, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Hôpital Tenon, 75020 Paris, France
| | - Emmanuel Letavernier
- Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (C.S.-J.); (V.F.); (R.C.); (E.L.)
- Unité Mixte de Recherche (UMR) S 1155, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Hôpital Tenon, 75020 Paris, France
| | - Virginie Avellino
- Service de Médecine Interne, Centre de Référence de la Drépanocytose, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (V.A.); (F.L.)
| | - Francois Lionnet
- Service de Médecine Interne, Centre de Référence de la Drépanocytose, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (V.A.); (F.L.)
| | - Jean-Philippe Haymann
- Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique—Hôpitaux de Paris, Hôpital Tenon, 75020 Paris, France; (C.S.-J.); (V.F.); (R.C.); (E.L.)
- Unité Mixte de Recherche (UMR) S 1155, Institut National de la Santé et de la Recherche Médicale, Sorbonne Université, Hôpital Tenon, 75020 Paris, France
- Correspondence: ; Tel.: +33-1-5601-6771; Fax: +33-1-5601-7003
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Adekunle MO, Dada AO, Njokanma FO, Solarin AU, Animasahun BA, Lamina MO. Comparative Effectiveness of a Six-Week Treatment Course of Vitamin D 2 and D 3 in Children With Sickle Cell Anemia in Steady State With Hypovitaminosis D: A Randomized Clinical Trial. J Hematol 2021; 10:114-122. [PMID: 34267848 PMCID: PMC8256915 DOI: 10.14740/jh817] [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: 03/14/2021] [Accepted: 04/06/2021] [Indexed: 11/11/2022] Open
Abstract
Background Correction of vitamin D deficiency through administration of either vitamin D2 or D3 has been shown to reduce chronic bone pains and frequency of acute bone pains, increase bone density as well as improve growth stature in children with sickle cell anemia (SCA). Findings vary on the effectiveness of the two forms of the vitamin. The current study was carried out to compare the effectiveness of a 6-week treatment course of vitamin D2 and D3 in the correction of hypovitaminosis D (vitamin D insufficiency and deficiency) as well as evaluate treatment response to derangement of serum calcium and alkaline phosphatase (ALP) in children with SCA in steady state. Methods The study was a randomized, double-blind clinical trial of 174 children with SCA aged 1 - 18 years. Subjects with hypovitaminosis D (baseline serum 25-hydroxyvitamin D (25(OH)D) below 75 nmol/L) were randomized into two treatment arms. Each arm treated either of the two forms of vitamin D had a once weekly dose of 50,000 IU for a period of 6 weeks. Results Median rise in serum 25(OH)D after 6 weeks of oral vitamin D2 or D3 was similar between the two groups (median rise in 25(OH)D of 17.8 nmol/L in D2, 15.3 nmol/L in D3 groups). Also, there was no significant difference in the proportion of subjects that improved in their vitamin D status in both treatment arms (P = 0.409). Treatment was significantly associated with increase in proportion of subjects with normal serum calcium (P ≤ 0.001) and decrease in proportion of subjects with elevated serum ALP (P ≤ 0.001). Conclusion Once weekly dose (50,000 IU) of either vitamin D supplement has equal effectiveness in correction of hypovitaminosis D. However, vitamin D3 may be cost-effective because it is cheaper.
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Affiliation(s)
| | - Adeyemi Oluwaseun Dada
- Department of Chemical Pathology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Fidelis Olisamedua Njokanma
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Adaobi Uzoamaka Solarin
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Barakat Adeola Animasahun
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Moriam Omolola Lamina
- Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
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Abstract
STUDY DESIGN Sickle cell disease (SCD) is a relatively common blood disorder that has profound implications on the musculoskeletal system and particularly the spine; however, there is a paucity of data in the literature discussing this important topic. OBJECTIVES (1) To elucidate common spinal pathologies affecting patients with SCD, as well as the medical and surgical treatments available for these patients. (2) To discuss indications for surgical management of spinal complications of SCD and important for orthopedic surgeons when taking patients with SCD to the operating room. METHODS A narrative review of the literature was performed. RESULTS Patients with SCD have a significantly higher risk of developing spinal pathologies including vertebral osteomyelitis, compression fracture, vertebral vaso-occlusive crises, and osteoporosis, among others. In addition, patients with sickle cell disease are particularly susceptible to developing perioperative and post-operative complications including surgical site infection, implant malfunction, and vertebral body compression fracture. Postoperatively patients with SCD are prone to developing complications and adequate hydration is necessary in order to reduce complications of SCD. CONCLUSIONS Several spinal pathologies may arise secondary to SCD and distinguishing these pathologies from one another may be challenging due to similarities in symptoms and inflammatory markers. Although most patients with SCD can benefit from conservative treatment involving rest, symptomatic therapy, antibiotic therapy, and/or orthosis, surgical intervention may be indicated in certain cases. It is preferable to avoid surgery in patients with SCD due to an increased risk of complications such as wound infection and vaso-occlusive crisis.
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Affiliation(s)
- Hayeem L. Rudy
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY,
USA
| | - David Yang
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY,
USA
| | - Andrew D. Nam
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY,
USA
| | - Woojin Cho
- Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY,
USA,Woojin Cho, Department of Orthopaedic Surgery,
Albert Einstein College of Medicine/Montefiore Medical Center, 3400 Bainbridge Avenue, 6th
Floor, Bronx, NY 10467, USA.
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Tavakoli S, Xiao L. Depletion of Intestinal Microbiome Partially Rescues Bone Loss in Sickle Cell Disease Male Mice. Sci Rep 2019; 9:8659. [PMID: 31209247 PMCID: PMC6572770 DOI: 10.1038/s41598-019-45270-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 05/29/2019] [Indexed: 12/17/2022] Open
Abstract
Osteoporosis or osteopenia are common clinical manifestations of sickle cell disease (SCD) with unclear mechanisms. Since senescence of circulating neutrophil can be modulated by signals derived from intestinal microbiome and neutrophils are abundant in bone marrow and can regulate osteoblasts and osteoclasts, we examined whether gut microbiome contributes to bone loss in SCD mice. SCD and their littermates control mice were treated with antibiotics to deplete gut microbiome. At the end of 7 weeks treatment, serum was collected for biochemistry marker measurements. Bone mass and remodeling were evaluated by dual beam X-ray absorptiometry, micro-computed tomography, and histomorphometry. Bone-related genes in tibia and barrier marker genes in the small intestine were analyzed by quantitative PCR. Antibiotic treatment rescued increased intestinal inflammatory cytokine marker genes (Tnfα, IL17, Ifnγ) expression, rescued decreased intestinal barrier marker genes (claudin 3 and claudin 15) expression, and rescued increased serum cytokines (IFNγ, IL27, IL10) in SCD mice. Antibiotic significantly improved decreased bone mass in SCD mice mainly through enhanced osteoblast function and increased osteoblast-related genes (Runx2 and Igf1) expression in SCD mice. Our findings support that increased bacteria load augments antigenic load traversing the impaired intestinal barrier through inflammation, leading to increased inflammatory cytokines, impaired osteoblast function, and bone loss in SCD mice.
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Affiliation(s)
- Sara Tavakoli
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA
| | - Liping Xiao
- Department of Medicine, UConn Health, Farmington, CT, 06030, USA. .,Department of Psychiatry, UConn Health, Farmington, CT, 06030, USA.
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Hamdy M, Salama N, Maher G, Elrefaee A. Vitamin D and Nonskeletal Complications among Egyptian Sickle Cell Disease Patients. Adv Hematol 2018; 2018:3867283. [PMID: 30305813 PMCID: PMC6164208 DOI: 10.1155/2018/3867283] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/15/2018] [Indexed: 12/15/2022] Open
Abstract
Lower levels of vitamin D have been documented in many patients with sickle cell disease (SCD), but data are still inconclusive regarding the association between vitamin D deficiency (VDD) and the occurrence or the severity of various SCD complications. Our study aimed to detect the prevalence of vitamin D deficiency among Egyptian patients with SCD and to associate it with the clinical course of the disease. We measured the level of 25-hydroxy vitamin D in 140 children (age from 4.3 to 15.5years), 80 patients with SCD and 60 controls using enzyme-linked immunosorbent assay. Vitamin D was deficient in 60% of SCD compared to 26.7% of controls. Severe VDD was significantly higher in SCD patients than controls. Patients were divided into 2 groups; Normal group (32 patients) and Deficient group (48 patients). There were statistically significant differences between the 2 groups regarding their age, height percentile, the presence of clinical jaundice, and osseous changes (P values 0.043, 0.024, 0.001, and 0.015, respectively). Hemoglobin and hematocrit values were significantly lower in Deficient group (P values 0.022 and 0.004, respectively) while the levels of aspartate aminotransferase, lactate dehydrogenase, and total and indirect bilirubin were significantly higher in the same group (P values 0.006, 0.001, 0.038, and 0.016, respectively). The frequency of blood transfusions, hospitalization, and vasoocclusive crisis previous year as well as the history of bone fracture and recurrent infections proved to be significantly higher in Deficient group. These findings suggest that VDD may play a role in the pathogenesis of hemolysis and other complication of SCD. Vitamin D monitoring and supplementation in patients with SCD should be implemented as a standard of care to potentially improve health outcomes in these affected patients.
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Affiliation(s)
- Mona Hamdy
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Niveen Salama
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ghada Maher
- Department of Chemical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amira Elrefaee
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
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AlJama A, AlKhalifah M, Al-Dabbous IA, Alqudaihi G. Vitamin D deficiency in sickle cell disease patients in the Eastern Province of Saudi Arabia. Ann Saudi Med 2018; 38:130-136. [PMID: 29620547 PMCID: PMC6074368 DOI: 10.5144/0256-4947.2018.130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Vitamin D deficiency (VDD) is a major global health problem. In sickle cell disease (SCD), VDD is highly prevalent, reaching up to 96% of populations. VDD may contribute to many of the complications of SCD. OBJECTIVE Estimate the 25-hydroxyvitamin D [25(OH)D] level and the frequency of VDD and insufficiency among among SCD patients by age group and disease status. DESIGN Analytical cross-sectional. SETTING Ministry of Health (MOH) secondary care hospital. PATIENTS AND METHODS Non-probability purposive sampling was used to select SCD patients, aged 12 years and older, of both sexes, who had visited the hospital during a period of 5 years (2010-2014). Blood samples were processed by electrochemiluminescence technology. MAIN OUTCOME MEASURE(S) 25(OH)D levels by demographic data, and disease activity. SAMPLE SIZE 640 patients. RESULTS Of those, 82% (n=523) had suboptimal 25(OH)D (0-<30 ng/ mL), and 67% were deficient (0-<20 ng/mL). Patients with any SCD crisis (20.7%, 144/694) had lower 25(OH)D (median, IQR: 10.1 ng/mL [8.6] ng/mL) compared to patients without crisis (71.0%, 493/694) (15.7 ng/ mL [18.2] ng/mL) (P<.001). Deficiency was more common in the young.er age groups and in sickle cell anemia patients with crisis. CONCLUSIONS VDD is highly prevalent in this population. Established vitamin D screening is a necessity, so that affected patients can be treated. LIMITATIONS Presence of residual confounders such as nutritional status, physical activity, lack of sun exposure, medications that alleviate SCD crises (such as hydroxyurea), and comorbid illnesses. The relationship between sickle cell disease genotype and vitamin D level was not analyzed. CONFLICT OF INTEREST None.
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Affiliation(s)
- Ali AlJama
- Ali AlJama Department of Internal Medicine, Qatif Central Hosptal, PO Box 627, Qatif 31911, Saudi Arabia, T: 966.13-855-5927, , ORCID: http://orcid.org/0000.0002-9985-7666
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10
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Garadah TS, Jaradat AA, Alalawi ME, Hassan AB. Hormonal and echocardiographic abnormalities in adult patients with sickle-cell anemia in Bahrain. J Blood Med 2016; 7:283-289. [PMID: 28008293 PMCID: PMC5167463 DOI: 10.2147/jbm.s124426] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Adrenal, thyroid, and parathyroid gland hormonal changes are recognized in children with homozygous (HbSS) sickle-cell anemia (SCA), but are not clear in adult patients with SCA. AIM To assess the metabolic and endocrine abnormalities in adult patients with SCA and evaluate left ventricular (LV) systolic and diastolic functions compared with patients with no SCA and further study the relationship between serum levels of cortisol, free thyroxine (T4), and testosterone with serum ferritin. MATERIALS AND METHODS The study was conducted on 82 patients with adult HbSS SCA compared with a sex- and age-matched control group. The serum levels of cortisol, parathyroid hormone (PTH), testosterone, thyroid-stimulating hormone (TSH), and free T4 were compared. Blood levels of hemoglobin, reticulocyte count, lactate dehydrogenase (LDH), calcium, alkaline phosphatase (ALP), vitamin D3, and ferritin were also compared. Pulsed Doppler echo was performed to evaluate the LV mass, wall thickness, and cavity dimensions with diastolic filling velocities of early (E) and atria (A) waves. Biometric data were analyzed as mean ± standard deviation between the two groups. Multiple regression analysis was performed between serum levels of ferritin as independent variable and testosterone, cortisol, and thyroid hormones. RESULTS A total of 82 adult patients with HbSS SCA were enrolled who had a mean age of 21±5.7 years, with 51 males (62%). Patients with SCA compared with the control group had significantly lower hemoglobin, body mass index, cortisol, vitamin D3, testosterone, and T4. Furthermore, there were significantly high levels of reticulocyte count, PTH, TSH, ferritin, LDH, ALP, and uric acid. The incidence of subclinical hypothyroidism and adrenal insufficiency was 7% and 4.8%, respectively, with hypogonadism 9.8% and vitamin D3 deficiency 61%. There were inverse relationships between ferritin as independent variable and serum levels of testosterone, T4, and cortisol, with regression coefficients of -0.49 (P<0.001), -0.33 (P<0.001), and -0.11 (P<0.92), respectively. CONCLUSION Patients with adult SCA had a high prevalence of in vivo hypoadrenialism (4.8%), hypogonadism (9.8%), and hypothyroidism (7%). There were significant inverse relationships between serum ferritin as independent variable and cortisol, testosterone, and T4. Pulsed Doppler echocardiography showed increased LV mass, with a restrictive LV diastolic pattern suggestive of diastolic dysfunction.
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Affiliation(s)
- Taysir S Garadah
- Cardiac Unit, Salmaniya Medical Complex, Ministry of Health; Department of Internal Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama
| | - Ahmed A Jaradat
- Department of Family and Community Medicine, Arabian Gulf University, Manama, Bahrain
| | | | - Adla B Hassan
- Department of Internal Medicine, College of Medicine and Medical Sciences, Arabian Gulf University, Manama
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Martyres DJ, Vijenthira A, Barrowman N, Harris-Janz S, Chretien C, Klaassen RJ. Nutrient Insufficiencies/Deficiencies in Children With Sickle Cell Disease and Its Association With Increased Disease Severity. Pediatr Blood Cancer 2016; 63:1060-4. [PMID: 26855061 DOI: 10.1002/pbc.25940] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 01/11/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Sickle cell disease (SCD) is characteristically described as a disease of hemolytic anemia and vaso-occlusive crises (VOCs). However, patients suffer from a multitude of other problems including impaired development, chronic pain, and increased susceptibility to infection. Nutritional deficiency has been implicated as a contributor to these issues. PROCEDURE We reported the nutrition status with respect to vitamin D, zinc, B6, B12, folate, and homocysteine serum levels in Canadian children with SCD (n = 91). We also tested for associations between nutrients and markers of disease severity and growth. RESULTS Almost half the sample (42%) had multiple nutrient insufficiencies/deficiencies, and a further 27% had a single insufficiency/deficiency. The most common insufficiency/deficiency was zinc in 57% followed by calcidiol (25 dihydroxyvitamin D (25(OH)D)) (52%). Sixteen percent of patients had low vitamin B6 levels, while folate, calcitriol (1,25(OH)D), and homocysteine levels were normal. Increased number of vitamin insufficiencies/deficiencies was associated with increasing disease severity (P = 0.018). Zinc insufficiency/deficiency was significantly associated with an increased number of home pain crises (P = 0.001) and an increased incidence of hospitalizations for VOCs (P = 0.01). CONCLUSIONS Our findings show that patients with SCD commonly have multiple nutrient insufficiencies/deficiencies and support the growing evidence for the link between low zinc and increased VOC. It also indicates that increased nutrient insufficiencies/deficiencies are associated with increased disease severity in SCD. Prospective studies with larger samples are needed to further elucidate the relationship between nutrient deficiencies and SCD, and to determine whether nutrient supplementation can improve the disease course.
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Affiliation(s)
- David J Martyres
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Abi Vijenthira
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nick Barrowman
- Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sydney Harris-Janz
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Christine Chretien
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Robert J Klaassen
- Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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12
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Nolan VG, Nottage KA, Cole EW, Hankins JS, Gurney JG. Prevalence of vitamin D deficiency in sickle cell disease: a systematic review. PLoS One 2015; 10:e0119908. [PMID: 25734582 PMCID: PMC4347975 DOI: 10.1371/journal.pone.0119908] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/03/2015] [Indexed: 11/19/2022] Open
Abstract
Vitamin D deficiency has emerged as a public health focus in recent years and patients with sickle cell disease (SCD) reportedly have a high prevalence of the condition. Our objectives were to summarize definitions of vitamin D deficiency and insufficiency used in the literature, and to determine the prevalence and magnitude of each in patients with SCD through a systematic review conducted according to PRISMA guidelines. From a PubMed search, 34 potential articles were identified and 15 met eligibility criteria for inclusion. Definitions of deficiency and insufficiency varied greatly across studies making direct comparisons difficult. This review provides evidence to suggest that suboptimal vitamin D levels are highly prevalent among those with SCD, far more so than in comparable non-SCD patients or matched control populations. Defining deficiency as vitamin D < 20 ng/mL, prevalence estimates in SCD populations range from 56.4% to 96.4%. When compared with results from the population-based National Health and Nutrition Examination Survey, however, the general African American population appeared to have a similarly high prevalence of vitamin D deficiency. African American patients with and without SCD were both substantially higher than that of Caucasians. What remains to be determined is whether there are adverse health effects for patients with SCD because of concurrent vitamin D deficiency.
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Affiliation(s)
- Vikki G. Nolan
- Departments of Hematology, Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis, School of Public Health, Memphis, TN, United States of America
| | - Kerri A. Nottage
- Epidemiology and Cancer Control, Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis, School of Public Health, Memphis, TN, United States of America
| | - Elliott W. Cole
- Departments of Hematology, Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis, School of Public Health, Memphis, TN, United States of America
| | - Jane S. Hankins
- Epidemiology and Cancer Control, Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis, School of Public Health, Memphis, TN, United States of America
| | - James G. Gurney
- Departments of Hematology, Division of Epidemiology, Biostatistics and Environmental Health, University of Memphis, School of Public Health, Memphis, TN, United States of America
- St. Jude Children’s Research Hospital, Memphis, TN, United States of America
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13
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Hussain AN, Alkhenizan AH, El Shaker M, Raef H, Gabr A. Increasing trends and significance of hypovitaminosis D: a population-based study in the Kingdom of Saudi Arabia. Arch Osteoporos 2014; 9:190. [PMID: 25213798 DOI: 10.1007/s11657-014-0190-3] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 07/28/2014] [Indexed: 02/03/2023]
Abstract
UNLABELLED Vitamin D deficiency is highly prevalent in Saudi Arabia, particularly among young women and is emerging as public health threat of epidemic proportions. Prevalence of severe hypovitaminosis D is expected to rise exponentially without primary intervention. This largest study encompasses extent of vitamin D deficiency and recommendations to reduce significant health care burden. INTRODUCTION The aim of the study was to determine the prevalence and significance of vitamin D deficiency in Saudi population and to help develop national consensus for its prevention, screening, and management. METHODS This was a retrospective observational study which involved 10,709 patients, recruited from the Department of Family Medicine and Polyclinic, King Faisal Specialist Hospital and Research Center (KFSH&RC), Saudi Arabia, over a period of 5 years. The endpoints included overall status of vitamin D level and severity of vitamin D deficiency. Serum measurements included 25 hydroxyvitamin D (25(OH)D), parathormone, calcium, phosphate, alkaline phosphatase, albumin levels, eGFR levels, bone mineral density. RESULTS A total of 10,709 patients were analyzed; 31.4 % were males and 68.6 % were females, with a preponderance of Saudis (68.5 %) compared to non-Saudis (31.5 %). The prevalence of vitamin D deficiency was 83.6 % (31.9 % severe, 32.0 % moderate, and 19.7 % mild), when cut points of less than 25, 50, and 75 nmol/l, respectively, were used. Mean serum 25(OH)D was 44.58 ± 34.80 standard deviation (SD) nmol/l. There was significant difference in severity of vitamin D deficiency stratified by age, gender, and nationality. More females had severe 25(OH)D deficiency compared to males (35.6 vs. 23.7 %, p < 0.000). Severe 25(OH)D deficiency was markedly high among adolescents as compared to other age groups (49.2 vs. 30.9 %, p < 0.000). More Saudis were found to be vitamin D deficient compared to non-Saudis (37.2 vs. 20.3 %, p < 0.000). CONCLUSION The prevalence of hypovitaminosis D is significantly high among Saudi population, especially among women, despite abundant sunshine. It is a major public health concern and requires a robust health policy for vitamin D supplementation and implementation of dietary public health measures. Vitamin D screening is strongly recommended at an earlier age especially among women and children.
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Affiliation(s)
- Aneela N Hussain
- Department of Family Medicine and Polyclinic, King Faisal Specialist Hospital & Research Center, P.O. Box 3354, MBC-62, Riyadh, 11211, Saudi Arabia,
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14
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Shams T, Al Wadani H, El-Masry R, Zakaria O. Effect of prophylactic vitamin D on anesthetic outcome in children with sickle cell disease. J Anaesthesiol Clin Pharmacol 2014; 30:20-4. [PMID: 24574588 PMCID: PMC3927286 DOI: 10.4103/0970-9185.125692] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background: Few previous studies proved that complications related to sickle cell disease (SCD) were common with regional anesthesia compared with general anesthesia while others reported no differences. This study was carried out to evaluate the role of prophylactic vitamin D on anesthetic outcome among male children with SCD undergoing circumcision. Materials and Methods: A comparative study was carried out on 58 children undergoing circumcision with the regional block under light general anesthesia. The study sample was classified into two groups: one group received daily 400 IU vitamin D for 6 months before surgery while the other group without vitamin D. All patients were followed regarding the post-operative analgesia and the incidence of post-operative SCD related complications (acute chest syndrome, painful crisis and cerebrovascular accident). Data were analyzed with Statistical Package for Social Sciences version 13, produced by IBM SPSS, Inc. in Chicago, Illinois, USA. Results: There was a highly significant difference between the two groups (P < 0.001) regarding first analgesic request and total analgesic consumption per day: there was delayed analgesic request and less total analgesic consumption per day in vitamin D group. Comparison of post-operative sedation scores showed highly significant difference (P < 0.001) between the two groups, Sedation scores was increased significantly in vitamin D group. This study also reported that the administration of vitamin D was associated with less noticeable post-operative SCD complications. Conclusion: The use of prophylactic vitamin D in SCD will result in delayed post-operative analgesic request and less total analgesic requirement. Administration of vitamin D was also associated with less post-operative complications.
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Affiliation(s)
- Tarek Shams
- Department of Anesthesia and ICU, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hamed Al Wadani
- Department of Surgery, King Faisal University, Kingdom of Saudi Arabia
| | - Ragaa El-Masry
- Public Health, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ossama Zakaria
- Department of Surgery, King Faisal University, Kingdom of Saudi Arabia
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15
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Adewoye AH, Chen TC, Ma Q, McMahon L, Mathieu J, Malabanan A, Steinberg MH, Holick MF. Sickle cell bone disease: response to vitamin D and calcium. Am J Hematol 2008; 83:271-4. [PMID: 17924548 DOI: 10.1002/ajh.21085] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Bone disease with osteoporosis and osteomalacia are common in sickle cell disease (SCD). Some patients have vitamin D deficiency and low bone mineral density (BMD). The role of vitamin D and calcium supplementation to restore bone health in SCD has not been well studied. In 14 adults with SCD, we measured 25(OH)D (25-hydroxyvitamin D) and BMD at the femoral neck, lumbar spine, and distal third of the ulna plus radius, along with markers of bone resorption (CTx; C-terminal component of pro-collagen type I) and bone formation (osteocalcin) before and after 12 months of vitamin D(2) and calcium carbonate treatment. Pretreatment, all patients were vitamin D deficient with a mean 25(OH)D level of 11.6 [corrected] +/- 4 [corrected] ng/ml, had low BMD at the lumbar spine (L-spine), 0.87 +/- 0.11 g/cm(2) (mean Z-score of -2.6 3 +/- 0.71 SD and T score of -2.31 +/- 0.75 SD), femoral neck, 0.8 +/- 0.18 g/cm(2) (mean Z-score -1.36 +/- 0.84, T-score -1.14 +/- 0.75), and the distal radius and ulna, 0.6 +/- 0.17 g/cm(2) (mean Z-score -1.18 +/- 0.79, T-score -1.01 +/- 0.74) and had elevated CTx (0.87 +/- 0.5 ng/ml) and osteocalcin levels (12.3 +/- 3.7 ng/mul). After treatment, all patients corrected their 25(OH)D level (34.6 [corrected] +/- 11 [corrected] ng/ml) (P < 0.001) with a 3.6% +/- 3.9% increase in BMD at the L-spine (P = 0.009), 4.6% +/- 8.5% increase at the femoral neck (P = 0.05) and 6.5% +/- 12.6% increase at the distal radius plus ulna (P = 0.09). CTx, osteocalcin, and PTH(i) levels were unchanged. Treatment of adult SCD with vitamin D and calcium can restore 25(OH)D levels to normal and improve BMD, but, markers of bone resorption remained unchanged. Screening for vitamin D deficiency and BMD in SCD patients seems warranted.
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Affiliation(s)
- Adeboye H Adewoye
- The Center of Excellence in Sickle Cell Disease and the Vitamin D, Skin and Bone Research Laboratories, Boston University School of Medicine, Boston, MA 02118, USA.
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16
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Kassab-Chekir A, Laradi S, Ferchichi S, Haj Khelil A, Feki M, Amri F, Selmi H, Bejaoui M, Miled A. Oxidant, antioxidant status and metabolic data in patients with beta-thalassemia. Clin Chim Acta 2003; 338:79-86. [PMID: 14637270 DOI: 10.1016/j.cccn.2003.07.010] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In beta-thalassemia major impaired biosynthesis of beta globin leads to accumulation of unpaired alpha globin chain. An iron overload, usually observed, generates oxygen-free radicals and peroxidative tissue injury. AIM To investigate hematological parameters, oxidative stress and the antioxidant capacity in beta-thalassemia patients compared to control subjects in order to determine their impact in several organs functions. METHODS This study was conducted on 56 beta-thalassemia major patients compared to 51 healthy subjects. We determined metabolic parameters (glycaemia, lipid parameters, electrolytes, iron indices, hepatic, renal and heart functions tests), plasmatic thiobarbituric acid reactive substances (TBARS), plasmatic peroxyl radical trapping potential (TRAP), plasmatic superoxide dismutase (SOD), erythrocyte gluthathione peroxidase (GPX), plasmatic vitamin E, vitamin A and trace elements. RESULTS Except triglycerides, lipid fractions were significantly decreased in beta-thalassemia compared to controls. Serum ferritin, iron, TBARS concentrations, SOD and GPX activities were significantly increased. But TRAP, vitamin E and zinc concentrations were significantly decreased. CONCLUSION Our findings confirm the peroxidative status generated by iron overload in beta-thalassemia major patients and highlight the rapid formation of marked amounts of TBARS and the increase of SOD and GPX activity. Our study suggested that in beta-thalassemia the first organ impaired is the liver.
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Affiliation(s)
- Asma Kassab-Chekir
- Laboratoire de Biochimie et de Toxicologie, CHU Farhat Hached, Sousse 4000, Tunisia.
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17
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Affiliation(s)
- K A Madani
- Biochemistry Department, Faculty of Science, King Abdulaziz University, Jeddah, S. Arabia
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18
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Soliman AT, el Banna N, alSalmi I, De Silva V, Craig A, Asfour M. Growth hormone secretion and circulating insulin-like growth factor-I (IGF-I) and IGF binding protein-3 concentrations in children with sickle cell disease. Metabolism 1997; 46:1241-5. [PMID: 9361679 DOI: 10.1016/s0026-0495(97)90224-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Impaired growth involving both height and weight accompanying sickle cell disease (SCD) poses diagnostic and therapeutic problems. We undertook this study to test the hypothesis that this impaired growth is associated with abnormalities of the growth hormone (GH)/insulin-like growth factor-I (IGF-I)/IGF binding protein-3 (IGFBP-3) axis in 21 children with SCD and that SCD is associated with GH resistance. Nine of 21 children with SCD had a defective GH response to both clonidine and glucagon provocation (peak < 10 micrograms/L); these children differed from the 12 others in having slower linear growth velocity (GV and GVSDS), lower circulating concentrations of IGF-I and IGFBP-3, and either partial or complete empty sellae in computed tomographic scans of the hypothalamic-pituitary area. In this group of patients with SCD, it appears that defective GH secretion and consequent low IGF-I production are the major etiological factors causing the slow growth. The two groups with SCD did not differ significantly in dietary intake, body mass index (BMI), midarm circumferences, skinfold thickness, serum albumin concentration, or intestinal absorption of D-xylose. A single injection of GH produced a smaller increase in circulating IGF-I in children with SCD with or without defective GH secretion versus 10 age-matched children with idiopathic short stature (ISS) and 11 children with isolated GH deficiency (GHD), suggesting partial GH resistance in the SCD group. The presence of defective GH secretion, decreased IGF-I synthesis, and partial resistance to GH in short children with SCD suggests that treatment with IGF-I may be superior to GH therapy for improving growth.
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Affiliation(s)
- A T Soliman
- Department of Pediatrics, Royal Hospital, Muscat, Oman
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19
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van der Dijs FP, van der Klis FR, Muskiet FD, Muskiet FA. Serum calcium and vitamin D status of patients with sickle cell disease in Curaçao. Ann Clin Biochem 1997; 34 ( Pt 2):170-2. [PMID: 9133251 DOI: 10.1177/000456329703400207] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We measured parameters of calcium homeostasis and vitamin D status in HbSS patients (median age 8 years, range 3-19; 8 females, 10 males) and matched HbAA controls living in the tropical island of Curaçao. Serum calcium concentration in HbSS patients [2.32(0.07)mmol/L] was lower (ANCOVA, P = 0.002) than that of HbAA controls [2.44(0.14)]. None of the subjects had hypocalcaemia. There were no differences in serum concentrations of phosphate, total protein, albumin, intact parathyroid hormone (PTH), 25-hydroxyvitamin D [87(27) nmol/L in patients, 86(15) nmol/L in controls) and 1,25-dihydroxyvitamin D. There were no significant relations between PTH and 25(OH)D. We conclude that vitamin D status of HbSS patients in Curaçao is adequate.
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Affiliation(s)
- F P van der Dijs
- Central Laboratory for Clinical Chemistry, University Hospital, Groningen, The Netherlands
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20
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Abstract
ESRD is a major complication in young adults with sickle cell anemia. As more patients with sickle cell anemia reach the third and fourth decades of life, the incidence of clinically apparent renal insufficiency will increase. As we understand the pathophysiology of renal damage and the effects of various therapies on the sickle renal vasculature, we can tailor specific management without further compromising already impaired renal function. Diagnostic clues must be recognized prior to the onset of irreversible damage, with appropriate intervention initiated at each age group. Bone marrow transplantation (BMT) is the only available cure for SCA at the present time. The demonstration that several distinct haplotypes of the beta s gene cluster on chromosome 11 influence the clinical expression of sickle cell anemia may be useful in delineating children who are at high risk for severe disease, and hence candidates for such hazardous therapeutic interventions as BMT prior to onset of clinically discernable disease. Current BMT preparative regimens can produce renal cortical and pulmonary toxicity, posing a patient selection problem in those cases in which the vasculopathy of the major organs is at an early stage and might be potentially repairable. Gene therapy without toxic preparative regimens is the ultimate answer. The challenge for the near future is the development of effective early therapeutic intervention during childhood and young adulthood.
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Affiliation(s)
- W Y Wong
- Department of Pediatrics, University of Southern California School of Medicine, Los Angeles, USA
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21
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Nduka N, Kazem Y, Saleh B. Variation in serum electrolytes and enzyme concentrations in patients with sickle cell disease. J Clin Pathol 1995; 48:648-51. [PMID: 7560173 PMCID: PMC502717 DOI: 10.1136/jcp.48.7.648] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
AIM To assess levels of some biochemical variables in sickle cell disease patients from eastern Saudi Arabia during steady state and in crises states, with a view to comparing biochemical and clinical manifestations of the disease with those in other geographical locations. METHODS Serum calcium, uric acid, total bilirubin, lactate dehydrogenase, hydroxybutyrate dehydrogenase, and haemoglobin were measured in 110 sickle cell patients when in steady state. The same variables were measured on 30 of the patients when they went into crisis. RESULTS Serum calcium tended to be lower in sickle cell patients than in healthy controls, while uric acid tended to be in the high normal range. Crises did not make any difference to serum calcium but they increased the uric acid level significantly. All the other variables measured were significantly abnormal and more so during crises. CONCLUSIONS Although the abnormal levels obtained for these biochemical variables in patients with sickle cell disease from eastern Saudi Arabia were similar to those from other geographical locations, there were noticeable differences in the severity of the abnormalities, which probably explains the differences in the clinical manifestations of the disease between geographical locations. Values of some of these variables could be adapted for use to monitor crises.
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Affiliation(s)
- N Nduka
- Department of Clinical Biochemistry, Qatif Central Hospital, Al Jeshi, Saudi Arabia
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