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Kaponda A, Muya K, Panda J, Koto KK, Bonnechère B. Unraveling the Complexity of Vaso-Occlusive Crises in Sickle Cell Disease: Insights from a Resource-Limited Setting. J Clin Med 2024; 13:2528. [PMID: 38731057 PMCID: PMC11084179 DOI: 10.3390/jcm13092528] [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: 04/05/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Background/Objectives: This study investigated vaso-occlusive crises (VOCs) in sickle cell disease in Lubumbashi, Democratic Republic of Congo, aiming to understand the disease complexities amidst limited resources. With sickle cell hemoglobinopathies on the rise in sub-Saharan Africa, this nine-year study explored factors associated with VOCs and hematological components. Methods: This study comprised 838 patients, analyzing VOCs and hematological changes over time. Demographic characteristics and blood composition changes were carefully categorized. A total of 2910 crises were observed and managed, with analyses conducted on severity, localization, and age groups using statistical methods. Results: The majority of crises were mild or moderate, primarily affecting osteoarticular regions. Statistical analysis revealed significant disparities in crisis intensity based on location and age. The association between blood samples and the number of comorbidities was investigated. Significant positive associations were found for all parameters, except monocytes, indicating a potential link between blood variables and complication burden. Survival analysis using Cox regression was performed to predict the probability of experiencing a second crisis. No significant effects of medication or localization were observed. However, intensity (p < 0.001), age (p < 0.001), and gender (p < 0.001) showed significant effects. Adjusted Hazard Ratios indicated increased risk with age and male gender and reduced risk with mild or severe crisis intensity compared to light. Conclusions: This research sheds light on the complexities of VOCs in resource-limited settings where sickle cell disease is prevalent. The intricate interplay between clinical, laboratory, and treatment factors is highlighted, offering insights for improved patient care. It aims to raise awareness of patient challenges and provide valuable information for targeted interventions to alleviate their burden.
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Affiliation(s)
- Ali Kaponda
- Reference Centre for Sickle Cell Disease of Lubumbashi, Institut de Recherche en Science de la Santé, Lubumbashi 1825, Democratic Republic of the Congo; (A.K.); (J.P.)
- Department of Clinical Biology, Faculty of Pharmaceutical Sciences, University of Lubumbashi, Lubumbashi 1825, Democratic Republic of the Congo
| | - Kalunga Muya
- Department of Pharmacology, Faculty of Pharmaceutical Sciences, University of Lubumbashi, Lubumbashi 1825, Democratic Republic of the Congo;
| | - Jules Panda
- Reference Centre for Sickle Cell Disease of Lubumbashi, Institut de Recherche en Science de la Santé, Lubumbashi 1825, Democratic Republic of the Congo; (A.K.); (J.P.)
- Department of Surgery, Faculty of Medicine, University of Lubumbashi, Lubumbashi 1825, Democratic Republic of the Congo
| | - Kodondi Kule Koto
- Department of Clinical Biology, Faculty of Pharmaceutical Sciences, University of Kinshasa, Kinshasa 2212, Democratic Republic of the Congo;
| | - Bruno Bonnechère
- REVAL, Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, 3590 Hasselt, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, University of Hasselt, 3590 Hasselt, Belgium
- Department of PXL—Healthcare, PXL University of Applied Sciences and Arts, 3500 Hasselt, Belgium
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Zakaria O, Buhalim RA, Almulhim F, Al Jabr FA, Alrashid A, Almutairi M. Clinical and Laboratory Predictors of Painful Vaso-Occlusive Crisis Among Sickle Cell Disease Patients: A Single-Center Study in Saudi Arabia. Cureus 2021; 13:e14980. [PMID: 34123674 PMCID: PMC8194373 DOI: 10.7759/cureus.14980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Vaso-occlusive crisis (VOC) episodes are considered to be the cause of 95% of hospitalizations for sickle cell disease (SCD) patients. The frequency of VOC is significantly associated with higher or lower lactate dehydrogenase levels, higher hemoglobin concentration, higher white blood cell, and neutrophil count, and lower platelet counts. In this study, we highlighted the association and predictors of VOC episodes in Saudi Arabia. Methods This is a retrospective observational study that was conducted in a period from January 2018 to December 2019 which included patients who were admitted and treated as sickle cell disease patients were included in this study. Retrieved data included patients' age, sex, and other demographic data items as well as the clinical history of SCD. The patients were divided into two groups. Those patients who developed one or two VOC episodes in the period between 2018-2019 were considered mild in severity and patients who developed three or more VOC episodes in the period between 2018-2019 were categorized as moderate to severe. Results A total of ninety-four patients (58 males and 36 females) with a male to female ratio of 1.6 were included in this study. The prevalence of patients who had severe vaso-occlusive crisis was 39.4% while mild-moderate were detected among 60.6% of the patients. It was found that there was no significant difference between the frequency of vaso-occlusive crisis and all the hematological parameters (all p>0.05). It was found that the risk of having vaso-occlusive crisis for those patients who were admitted more than three times was 30 times higher than those patients who were admitted by three times or less [adjusted odds ratio (AOR) = 30.081; 95% confidence interval (CI) = 8.204 - 110.3; p<0.001)]. Conclusion It was found that those patients who had three times VOC episodes in our studied period are more liable to have frequent episodes in the future which might necessitate urgent intervention for these patients.
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Affiliation(s)
- Ossama Zakaria
- Department of Surgery, College of Medicine, Al-Ahsa, SAU
| | | | - Fahad Almulhim
- College of Medicine, King Faisal University, Al-Ahsa, SAU
| | | | - Aqeel Alrashid
- College of Medicine, King Faisal University, Al-Ahsa, SAU
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Anea CB, Lyon M, Lee IA, Gonzales JN, Adeyemi A, Falls G, Kutlar A, Brittain JE. Pulmonary platelet thrombi and vascular pathology in acute chest syndrome in patients with sickle cell disease. Am J Hematol 2016; 91:173-8. [PMID: 26492581 PMCID: PMC4724297 DOI: 10.1002/ajh.24224] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 10/16/2015] [Accepted: 10/19/2015] [Indexed: 12/26/2022]
Abstract
A growing body of evidence suggests a role for platelets in sickle cell disease (SCD). Despite the proinflammatory, occlusive nature of platelets, a role for platelets in acute chest syndrome (ACS), however, remains understudied. To provide evidence and potentially describe contributory factors for a putative link between ACS and platelets, we performed an autopsy study of 20 SCD cases—10 of whom died from ACS and 10 whose deaths were not ACS‐related. Pulmonary histopathology and case history were collected. We discovered that disseminated pulmonary platelet thrombi were present in 3 out of 10 of cases with ACS, but none of the matched cases without ACS. Those cases with detected thrombi were associated with significant deposition of endothelial vWF and detection of large vWF aggregates adhered to endothelium. Potential clinical risk factors were younger age and higher platelet count at presentation. However, we also noted a sharp and significant decline in platelet count prior to death in each case with platelet thrombi in the lungs. In this study, neither hydroxyurea use nor perimortem transfusion was associated with platelet thrombi. Surprisingly, in all cases, there was profound pulmonary artery remodeling with both thrombotic and proliferative pulmonary plexiform lesions. The severity of remodeling was not associated with a severe history of ACS, or hydroxyurea use, but was inversely correlated with age. We thus provide evidence of undocumented presence of platelet thrombi in cases of fatal ACS and describe clinical correlates. We also provide novel correlates of pulmonary remodeling in SCD. Am. J. Hematol. 91:173–178, 2016. © 2015 The Authors. American Journal of Hematology Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Ciprian B. Anea
- Vascular Biology Center, Georgia Regents UniversityAugusta Georgia
| | - Matthew Lyon
- Department of Emergency MedicineGeorgia Regents UniversityAugusta Georgia
| | - Itia A. Lee
- Vascular Biology Center, Georgia Regents UniversityAugusta Georgia
| | - Joyce N. Gonzales
- Vascular Biology Center, Georgia Regents UniversityAugusta Georgia
- Department of MedicineDivision of Pulmonary/Critical Care, Georgia Regents UniversityAugusta GA
| | - Amidat Adeyemi
- Vascular Biology Center, Georgia Regents UniversityAugusta Georgia
| | - Greer Falls
- Department of PathologyGeorgia Regents UniversityAugusta Georgia
| | - Abdullah Kutlar
- Department of Medicine, Division of Hematology/OncologyAugusta Georgia
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Chirico EN, Martin C, Faës C, Féasson L, Oyono-Enguéllé S, Aufradet E, Dubouchaud H, Francina A, Canet-Soulas E, Thiriet P, Messonnier L, Pialoux V. Exercise training blunts oxidative stress in sickle cell trait carriers. J Appl Physiol (1985) 2012; 112:1445-53. [DOI: 10.1152/japplphysiol.01452.2011] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to analyze the effects of exercise training on oxidative stress in sickle cell trait carriers. Plasma levels of oxidative stress [advanced oxidation protein products (AOPP), protein carbonyl, malondialdehyde (MDA), and nitrotyrosine], antioxidant markers [catalase, glutathione peroxidase (GPX), and superoxide dismutase (SOD)], and nitrite and nitrate (NOx) were assessed at baseline, immediately following a maximal exercise test (Tex), and during recovery (T1h, T2h, T24h) in trained (T: 8 h/wk minimum) and untrained (U: no regular physical activity) sickle cell trait (SCT) carriers or control (CON) subjects (T-SCT, n = 10; U-SCT, n = 8; T-CON, n = 11; and U-CON, n = 11; age: 23.5 ± 2.2 yr). The trained subjects had higher SOD activities (7.6 ± 5.4 vs. 5.2 ± 2.1 U/ml, P = 0.016) and lower levels of AOPP (142 ± 102 vs. 177 ± 102 μM, P = 0.028) and protein carbonyl (82.1 ± 26.0 vs. 107.3 ± 30.6 nm/ml, P = 0.010) than the untrained subjects in response to exercise. In response to exercise, U-SCT had a higher level of AOPP (224 ± 130 vs. 174 ± 121 μM, P = 0.012), nitrotyrosine (127 ± 29.1 vs.70.6 ± 46.6 nM, P = 0.003), and protein carbonyl (114 ± 34.0 vs. 86.9 ± 26.8 nm/ml, P = 0.006) compared with T-SCT. T-SCT had a higher SOD activity (8.50 ± 7.2 vs. 4.30 ± 2.5 U/ml, P = 0.002) and NOx (28.8 ± 11.4 vs. 14.6 ± 7.0 μmol·l−1·min−1, P = 0.003) in response to exercise than U-SCT. Our data indicate that the overall oxidative stress and nitric oxide response is improved in exercise-trained SCT carriers compared with their untrained counterparts. These results suggest that physical activity could be a viable method of controlling the oxidative stress. This could have a beneficial impact because of its involvement in endothelial dysfunction and subsequent vascular impairment in hemoglobin S carriers.
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Affiliation(s)
- Erica N. Chirico
- Center of Research and Innovation on Sports, University Claude Bernard Lyon 1, University of Lyon, Villeurbanne
- CarMeN, INSERM, University Claude Bernard Lyon 1, Faculty of Medicine Lyon Sud, Oullins
| | - Cyril Martin
- Center of Research and Innovation on Sports, University Claude Bernard Lyon 1, University of Lyon, Villeurbanne
| | - Camille Faës
- Center of Research and Innovation on Sports, University Claude Bernard Lyon 1, University of Lyon, Villeurbanne
| | - Léonard Féasson
- Laboratory of Exercise Physiology, University of Savoie and University of Saint-Etienne, Le Bourget du Lac and Saint-Etienne, France
- Unit of Myology, University Hospital Center of Saint Etienne, France
| | - Samuel Oyono-Enguéllé
- Laboratory of Physiology, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | - Emeline Aufradet
- Center of Research and Innovation on Sports, University Claude Bernard Lyon 1, University of Lyon, Villeurbanne
| | - Hervé Dubouchaud
- Laboratoire de Bioénergétique Fondamentale et Appliquée, INSERM, University Joseph Fourier, Grenoble; and
| | - Alain Francina
- Unité de Pathologie Moléculaire de l'Hémoglobine, Hospices Civils de Lyon, Lyon, France
| | | | - Patrice Thiriet
- Center of Research and Innovation on Sports, University Claude Bernard Lyon 1, University of Lyon, Villeurbanne
| | - Laurent Messonnier
- Laboratory of Exercise Physiology, University of Savoie and University of Saint-Etienne, Le Bourget du Lac and Saint-Etienne, France
| | - Vincent Pialoux
- Center of Research and Innovation on Sports, University Claude Bernard Lyon 1, University of Lyon, Villeurbanne
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