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Cregan M, Puri L, Kang G, Anghelescu D. Prevalence of neuropathic pain in adolescents with sickle cell disease: A single-center experience. Pediatr Blood Cancer 2022; 69:e29583. [PMID: 35147289 PMCID: PMC8860881 DOI: 10.1002/pbc.29583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/22/2021] [Accepted: 01/07/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND Neuropathic pain (NP) has been previously explored in adolescents with sickle cell disease (SCD). This study aims to describe the prevalence of NP in adolescents with SCD at a single institution and to explore associated risk factors. PROCEDURE We used the painDETECT questionnaire, one of the few pain phenotyping questionnaires validated for adolescents. We also evaluated the relationships between painDETECT scores and frequency of acute care visits and admissions for pain in the previous 12 months, and age, respectively. Patients 12-18 years old were surveyed from June to July 2019. A retrospective approach was used to answer the remaining research questions. RESULTS Eighty-one and seven surveys were completed in the outpatient and inpatient settings, respectively. PainDETECT scores suggestive of NP were more prevalent in inpatient surveys than in outpatient surveys. The difference between the mean painDETECT scores of each group was significant when using a general linear mixed model. Most inpatients surveyed had ≥3 pain events in the previous 12 months. Further, older age and increased number of pain events in the previous 12 months were independently associated with higher painDETECT scores. CONCLUSIONS Overall, in our opinion, NP is not being evaluated for and treated sufficiently in pediatric SCD, especially in the setting of inpatient acute vaso-occlusive crisis. Age and number of acute pain events/admissions in the previous 12 months can be used to identify patients likely to be at risk for NP. It is important to continue to identify NP and develop NP-targeting treatment plans.
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Affiliation(s)
- Melissa Cregan
- St. Jude Children’s Research Hospital, Memphis, TN, USA, Ohio University Heritage College of Osteopathic Medicine, Athens, OH, USA
| | | | - Guolian Kang
- St. Jude Children’s Research Hospital, Memphis, TN, USA
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2
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Puri L, Nottage K, Hankins JS, Wang WC, McGregor O, Gossett JM, Kang G, Anghelescu DL. Gabapentin for acute pain in sickle cell disease: A randomized double-blinded placebo-controlled phase II clinical trial. EJHAEM 2021; 2:327-334. [PMID: 35844692 PMCID: PMC9175868 DOI: 10.1002/jha2.188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 06/15/2023]
Abstract
Pain in sickle cell disease (SCD) can have a neuropathic component. This randomized phase II double-blinded placebo-controlled study evaluated the efficacy of gabapentin in reducing pain and opioid consumption (morphine-equivalent dose [MED]) during acute vaso-occlusive crisis (VOC). Of 90 patients aged 1-18 years with VOC pain, 45 were randomized to a single gabapentin dose (15 mg/kg) and 45 to placebo, in addition to standard treatment; 42 and 44 patients were evaluable in the gabapentin and placebo arms, respectively. A decrease in pain of ≥33% was reported in 68% of patients in the gabapentin arm and 60% of those in the placebo arm (one-sided p = 0.23). The median MED (mg/kg) in the gabapentin (0.12) and placebo arms (0.13) was similar (p = 0.9). However, in the subset of patients with the HbSS genotype (n = 45), the mean (SD) absolute pain score decrease by the time of discharge was significantly greater in the gabapentin arm (5.9 [3.5]) than in the placebo arm (3.6 [3.3]) (p = 0.032). Pain scores in the overall study population were not significantly reduced when gabapentin was added to standard treatment; however, gabapentin benefited individuals with the more severe genotype, HbSS, during acute VOC. Larger, prospective studies are needed to confirm these findings.
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Affiliation(s)
- Latika Puri
- Department of HematologySt. Jude Children's Research HospitalMemphisTennesseeUSA
- Division of Pediatric Hematology/OncologyDepartment of PediatricsLoma Linda University Children's HospitalLoma LindaCaliforniaUSA
| | - Kerri Nottage
- Janssen Research and DevelopmentRaritanNew JerseyUSA
| | - Jane S. Hankins
- Department of HematologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Winfred C. Wang
- Department of HematologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Olivia McGregor
- Department of HematologySt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Jeffrey M. Gossett
- Department of BiostatisticsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Guolian Kang
- Department of BiostatisticsSt. Jude Children's Research HospitalMemphisTennesseeUSA
| | - Doralina L. Anghelescu
- Division of AnesthesiaDepartment of Pediatric MedicineSt. Jude Children's Research HospitalMemphisTennesseeUSA
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3
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Ketamine and lidocaine infusions decrease opioid consumption during vaso-occlusive crisis in adolescents with sickle cell disease. Curr Opin Support Palliat Care 2020; 13:402-407. [PMID: 31157658 DOI: 10.1097/spc.0000000000000437] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Recurrent exposure to opioids can lead to development of opioid tolerance and opioid-induced hyperalgesia through activation of N-methyl-D-aspartate receptors. N-methyl-D-aspartate receptor antagonists ketamine and lidocaine can modulate development of opioid tolerance and OIH. This study evaluated the utility of ketamine and/or lidocaine in decreasing opioid consumption during acute pain episodes in adolescents with sickle cell disease. There has been an increased effort to promote opioid-sparing pain relieving methods given the ongoing opioid epidemic. RECENT FINDINGS There have been six studies published over the past decade that highlight the ability of ketamine to reduce opioid consumption in the management of sickle cell disease-related pain, primarily in adult patients. There has been one study (2015) that demonstrated a similar benefit with lidocaine, however this was also in adult patients. SUMMARY We retrospectively evaluated treatment with ketamine and/or lidocaine infusions in adolescents hospitalized for vaso-occlusive crisis (VOC). Patients served as self-controls using a comparison with a previous control admission for VOC. The use of ketamine and/or lidocaine as adjuncts to opioids resulted in lower daily opioid consumption in three of four patients. Our study suggests that ketamine and/or lidocaine infusions may be useful adjuncts in reducing opioid exposure during VOC pain.
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4
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Do chronic pain and comorbidities affect brain function in sickle cell patients? A systematic review of neuroimaging and treatment approaches. Pain 2020; 160:1933-1945. [PMID: 31045749 DOI: 10.1097/j.pain.0000000000001591] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sickle cell disease (SCD) is a medical condition in which chronic pain is common and negatively impacts psychosocial function and quality of life. Although the brain mechanisms underlying chronic pain are well studied in other painful conditions, the brain mechanisms underlying chronic pain and the associated psychosocial comorbidities are not well established in SCD. A growing literature demonstrates the effect of treatment of chronic pain, including pharmacological and nonpharmacological treatments, on brain function. The present systematic review aimed to (1) determine the effects of chronic pain and psychosocial comorbidities on brain function of patients with SCD; (2) summarize pharmacological and nonpharmacological approaches to treat these symptoms; and (3) identify areas for further investigation of potential beneficial effects of treatments on brain function. Titles were screened using predefined criteria, including SCD, and abstracts and full texts were reviewed by 2 independent reviewers. A total of 1167 SCD articles were identified, and 86 full articles were included covering 3 sections: chronic pain (4 studies), psychosocial comorbidities (11 studies), and pharmacological and nonpharmacological treatments (71 studies). Neuroimaging evidence demonstrates aberrant neural processing related to chronic pain and psychosocial comorbidities in SCD beyond ischemic stroke and cerebral hemorrhage. Although neuroimaging studies show an important role for psychological factors, pain management is nearly exclusively based on opioids. Behavior therapy seems useful to improve psychological symptoms as well as chronic pain and quality of life. Further investigation is required with larger cohorts, matched controls, and examination of treatment-related neural mechanisms.
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5
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Orhurhu MS, Chu R, Claus L, Roberts J, Salisu B, Urits I, Orhurhu E, Viswanath O, Kaye AD, Kaye AJ, Orhurhu V. Neuropathic Pain and Sickle Cell Disease: a Review of Pharmacologic Management. Curr Pain Headache Rep 2020; 24:52. [PMID: 32705357 DOI: 10.1007/s11916-020-00885-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Sickle cell disease (SCD) remains among the most common and severe monogenic disorders present in the world today. Although sickle cell pain has been traditionally characterized as nociceptive, a significant portion of sickle cell patients has reported neuropathic pain symptoms. Our review article will discuss clinical aspects of SCD-related neuropathic pain, epidemiology of neuropathic pain among individuals with SCD, pain mechanisms, and current and future potential pharmacological interventions. RECENT FINDINGS Neuropathic pain in SCD is a complicated condition that often has a lifelong and significant negative impact on life; therefore, improved pain management is considered a significant and unmet need. Neuropathic pain mechanisms are heterogeneous, and the difficulty in determining their individual contribution to specific pain types may contribute to poor treatment outcomes in this population. Our review article outlines several pharmacological modalities which may be employed to treat neuropathic pain in SCD patients.
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Affiliation(s)
- Mariam Salisu Orhurhu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Chu
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Lauren Claus
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jacob Roberts
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02215, USA
| | - Ejovwoke Orhurhu
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
| | - Omar Viswanath
- Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.,Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Alan D Kaye
- Valley Anesthesiology and Pain Consultants, Phoenix, AZ, USA.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA.,Department of Anesthesiology, Creighton University School of Medicine, Omaha, NE, USA.,Department of Anesthesiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Aaron J Kaye
- Department of Anesthesiology, Medical University South Carolina, Charleston, SC, USA
| | - Vwaire Orhurhu
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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6
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Mathioudakis AG, Sivapalan P, Papi A, Vestbo J. The DisEntangling Chronic Obstructive pulmonary Disease Exacerbations clinical trials NETwork (DECODE-NET): rationale and vision. Eur Respir J 2020; 56:56/1/2000627. [PMID: 32616552 DOI: 10.1183/13993003.00627-2020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 05/13/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK.,The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Pradeesh Sivapalan
- Section of Respiratory Medicine, Dept of Internal Medicine, Herlev-Gentofte Hospital, Hellerup, Denmark.,Dept of Internal Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Alberto Papi
- Research Center on Asthma and COPD, Dept of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Jørgen Vestbo
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK .,The North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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7
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Abstract
Introduction: Acute pain from episodic vaso-occlusion (VOC) spans the lifespan of almost everyone with sickle cell disease (SCD), while additional chronic pain develops in susceptible individuals in early adolescences. Frequent acute pain with chronic pain causes significant physical and psychological morbidity, and frequent health-care utilization. Available pharmacologic therapies reduce acute pain frequency but few evidence-based therapies are available for chronic pain. Areas covered: An extensive PubMed literature search was performed with appropriate search criteria. The pathophysiology of acute pain from VOC in SCD is very complex with many events subsequent to sickle polymer formation. Sensitization of pain pathways and alterations of brain networks contributes to the experience of chronic pain. Numerous therapies targeting putative VOC mechanisms are in clinical trials, and show considerable promise. Alternative analgesic treatments for acute and chronic pain have been examined in small patient cohorts, but formal clinical trials are lacking. Expert opinion: Childhood is likely a critical window for prevention of acute and later chronic pain. New multimodal analgesic therapies are needed, particularly for chronic pain, and should be examined in clinical trials. Given the multifactorial nature of both pain and VOC, simultaneously targeting multiple mechanisms may be the optimal approach for effective preventive therapies.
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Affiliation(s)
- Carlton Dampier
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta , Atlanta , GA , USA
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8
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Moerdler S, Manwani D. New insights into the pathophysiology and development of novel therapies for sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2018; 2018:493-506. [PMID: 30504350 PMCID: PMC6245971 DOI: 10.1182/asheducation-2018.1.493] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Although the seminal event in sickle cell disease is the polymerization of abnormal hemoglobin, the downstream pathophysiology of vasoocclusion results from heterotypic interactions between the altered, adhesive sickle cell red blood cells, neutrophils, endothelium, and platelets. Ischemia reperfusion injury, hemolysis, and oxidant damage all contribute to heightened inflammation and activation of the hemostatic system. These various pathways are the focus of emerging treatments with potential to ameliorate disease manifestations. This review summarizes the considerable progress in development of these agents despite challenges in selection of study end points and complex pathophysiology.
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Affiliation(s)
- Scott Moerdler
- Children’s Hospital, Montefiore Medical Center, Bronx, NY; and
- Department of Microbiology and Immunology and
| | - Deepa Manwani
- Children’s Hospital, Montefiore Medical Center, Bronx, NY; and
- Division of Pediatric Hematology, Oncology, Marrow and Blood Cell Transplantation, Albert Einstein College of Medicine, Bronx, NY
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9
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Rousseau V, Morelle M, Arriuberge C, Darnis S, Chabaud S, Launay V, Thouvenin S, Roumenoff-Turcant F, Metzger S, Tourniaire B, Marec-Berard P. Efficacy and Tolerance of Lidocaine 5% Patches in Neuropathic Pain and Pain Related to Vaso-occlusive Sickle Cell Crises in Children: A Prospective Multicenter Clinical Study. Pain Pract 2018; 18:788-797. [DOI: 10.1111/papr.12674] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/11/2017] [Accepted: 12/14/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Vanessa Rousseau
- Emergency Department and Pediatric Resuscitation; Civil Hospitals of Lyon; Mother-Child Hospital; Bron France
- Léon Bérard Center; Institute of Hematology and Pediatric Oncology; Lyon France
| | - Magali Morelle
- Léon Bérard Center; Department of Clinical Research and Innovation; Lyon France
- GATE (Analysis and Economic Theory Group); UMR5824; Lyon University; Lyon France
| | - Céline Arriuberge
- Pediatric Analgesia Unit; Trousseau University Hospital Center; Paris France
| | - Sophie Darnis
- Léon Bérard Center; Department of Clinical Research and Innovation; Lyon France
| | - Sylvie Chabaud
- Léon Bérard Center; Department of Clinical Research and Innovation; Lyon France
| | - Valérie Launay
- Emergency Department and Pediatric Resuscitation; Civil Hospitals of Lyon; Mother-Child Hospital; Bron France
| | - Sandrine Thouvenin
- Department of Hematology and Pediatric Oncology; University Hospital Center; Saint-Etienne France
| | | | - Séverine Metzger
- Léon Bérard Center; Department of Clinical Research and Innovation; Lyon France
| | - Barbara Tourniaire
- Pediatric Analgesia Unit; Trousseau University Hospital Center; Paris France
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10
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Abstract
Acute vaso-occlusive crisis (VOC) is a hallmark of sickle cell disease (SCD). Multiple complex pathophysiological processes can result in pain during a VOC. Despite significant improvements in the understanding and management of SCD, little progress has been made in the management of pain in SCD, although new treatments are being explored. Opioids and non-steroidal anti-inflammatory drugs (NSAIDs) remain the mainstay of treatment of VOC pain, but new classes of drugs are being tested to prevent and treat acute pain. Advancements in the understanding of the pathophysiology of SCD and pain and the pharmacogenomics of opioids have yet to be effectively utilized in the management of VOC. Opioid tolerance and opioid-induced hyperalgesia are significant problems associated with the long-term use of opioids, and better strategies for chronic pain therapy are needed. This report reviews the mechanisms of pain associated with acute VOC, describes the current management of VOC, and describes some of the new therapies under evaluation for the management of acute VOC in SCD.
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11
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Case M, Shirinpour S, Zhang H, Datta YH, Nelson SC, Sadak KT, Gupta K, He B. Increased theta band EEG power in sickle cell disease patients. J Pain Res 2017; 11:67-76. [PMID: 29343982 PMCID: PMC5749555 DOI: 10.2147/jpr.s145581] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Pain is a major issue in the care of patients with sickle cell disease (SCD). The mechanisms behind pain and the best way to treat it are not well understood. We studied how electroencephalography (EEG) is altered in SCD patients. Methods We recruited 20 SCD patients and compared their resting state EEG to that of 14 healthy controls. EEG power was found across frequency bands using Welch's method. Electrophysiological source imaging was assessed for each frequency band using the eLORETA algorithm. Results SCD patients had increased theta power and decreased beta2 power compared to controls. Source localization revealed that areas of greater theta band activity were in areas related to pain processing. Imaging parameters were significantly correlated to emergency department visits, which indicate disease severity and chronic pain intensity. Conclusion The present results support the pain mechanism referred to as thalamocortical dysrhythmia. This mechanism causes increased theta power in patients. Significance Our findings show that EEG can be used to quantitatively evaluate differences between controls and SCD patients. Our results show the potential of EEG to differentiate between different levels of pain in an unbiased setting, where specific frequency bands could be used as biomarkers for chronic pain.
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Affiliation(s)
| | | | | | | | - Stephen C Nelson
- Pediatric Hematology-Oncology, Children's Hospitals and Clinics of Minnesota
| | - Karim T Sadak
- Pediatric Hematology-Oncology, University of Minnesota Masonic Children's Hospital
| | | | - Bin He
- Department of Biomedical Engineering.,Institute for Engineering in Medicine, University of Minnesota, Minneapolis, MN, USA
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12
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Telfer P, Kaya B. Optimizing the care model for an uncomplicated acute pain episode in sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2017; 2017:525-533. [PMID: 29222301 PMCID: PMC6142581 DOI: 10.1182/asheducation-2017.1.525] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The pathophysiology, clinical presentation, and natural history of acute pain in sickle cell disease are unique and require a disease-centered approach that also applies general principles of acute and chronic pain management. The majority of acute pain episodes are managed at home without the need to access health care. The long-term consequences of poorly treated acute pain include chronic pain, adverse effects of chronic opioid usage, psychological maladjustment, poor quality of life, and excessive health care utilization. There is no standard protocol for management of an acute pain crisis in either the hospital or the community. The assumptions that severe acute pain must be managed in the hospital with parenteral opioids and that strong opioids are needed for home management of pain need to be questioned. Pain management in the emergency department often does not meet acceptable standards, while chronic use of strong opioids is likely to result in opioid-induced hyperalgesia, exacerbation of chronic pain symptoms, and opioid dependency. We suggest that an integrated approach is needed to control the underlying condition, modify psychological responses, optimize social support, and ensure that health care services provide safe, effective, and prompt treatment of acute pain and appropriate management of chronic pain. This integrated approach should begin at an early age and continue through the adolescent, transition, and adult phases of the care model.
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Affiliation(s)
- Paul Telfer
- Centre for Genomics and Child Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom; and
| | - Banu Kaya
- Departments of Haematology and Paediatric Haematology, Royal London Hospital, Bart’s Health National Health Service Trust, London, United Kingdom
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13
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Correia CR, Soares AT, Azurara L, Palaré MJ. Use of gabapentin in the treatment of chronic pain in an adolescent with sickle cell disease. BMJ Case Rep 2017; 2017:bcr-2016-218614. [PMID: 28432164 DOI: 10.1136/bcr-2016-218614] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vaso-occlusive crises are the most common manifestation of sickle cell disease (SCD) and the main cause of hospital admission in these patients. There is emerging evidence that vaso-occlusive pain has both nociceptive and neuropathic components. However, the treatment of SCD-related pain with neuropathic drugs has not yet been systematically studied, particularly in children. We describe a 14-year-old girl with SCD and multiple hospital admissions for pain management for severe acute vaso-occlusive pain episodes. The patient was evaluated by a multidisciplinary team of specialists which considered that the chronic, refractory pain she was experiencing for years was probably neuropathic in origin and it was decided to start oral gabapentin (300 mg/day). At 10 months follow-up, the patient reported remarkable improvement in her quality of life with a significant decrease in the number of hospital admissions (three admissions for acute vaso-occlusive pain episodes in 10 months versus the previously monthly recurrences).
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Affiliation(s)
- Cátia R Correia
- Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
| | | | - Laura Azurara
- Pediatrics, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal
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14
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Pecker LH, Schaefer BA, Luchtman-Jones L. Knowledge insufficient: the management of haemoglobin SC disease. Br J Haematol 2016; 176:515-526. [PMID: 27982424 DOI: 10.1111/bjh.14444] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Although haemoglobin SC (HbSC) accounts for 30% of sickle cell disease (SCD) in the United States and United Kingdom, evidence-based guidelines for genotype specific management are lacking. The unique pathology of HbSC disease is complex, characterized by erythrocyte dehydration, intracellular sickling and increased blood viscosity. The evaluation and treatment of patients with HbSC is largely inferred from studies of SCD consisting mostly of haemoglobin SS (HbSS) patients. These studies are underpowered to allow definitive conclusions about HbSC. We review the pathophysiology of HbSC disease, including known and potential differences between HbSS and HbSC, and highlight knowledge gaps in HbSC disease management. Clinical and translational research is needed to develop targeted treatments and to validate management recommendations for efficacy, safety and impact on quality of life for people with HbSC.
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Affiliation(s)
- Lydia H Pecker
- Center for Cancer and Blood Disorders, Children's National Medical Center, Washington, DC, USA.,Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Beverly A Schaefer
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Lori Luchtman-Jones
- Cancer and Blood Diseases Institute, Division of Hematology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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