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Yates AM, Aygun B, Nuss R, Rogers ZR. Health Supervision for Children and Adolescents With Sickle Cell Disease: Clinical Report. Pediatrics 2024; 154:e2024066842. [PMID: 39034826 DOI: 10.1542/peds.2024-066842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 07/23/2024] Open
Abstract
Sickle cell disease (SCD) is a group of complex genetic disorders of hemoglobin with multisystem manifestations. The scope of this clinical report is such that in-depth recommendations for management of all complications is not possible. Rather, the authors present an overview focused on the practical management of children and adolescents with SCD and the complications that are of particular relevance to pediatric primary care providers. References with detailed commentary provide further information. Timely and appropriate treatment of acute illness is critical, because life-threatening complications may develop rapidly. Specialized comprehensive medical care decreases morbidity and mortality during childhood. The provision of comprehensive care is a time-intensive endeavor that includes ongoing patient and family education, periodic comprehensive evaluations and other disease-specific health maintenance services, nursing support, psychosocial care, and genetic counseling. Ideally, this care includes comanagement by the pediatrician or other pediatric primary care provider and a team of specialist SCD experts: Hematologist, other pediatric specialists, advanced practice providers, nurse specialists, social workers, patient navigators, and educational liaisons.
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Affiliation(s)
- Amber M Yates
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | | | - Rachelle Nuss
- Center for Cancer and Blood Disorders, Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | - Zora R Rogers
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children's Heath, Dallas, Texas
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Gibson SMP, Hunter TA, Charles PE, Morgan MAC, Griffith-Anderson SKR, Cruickshank JK, Gossell-Williams MD, Johnson NA. Current obstetric outcomes in Jamaican women with sickle hemoglobinopathy - a balance of risks for aspirin? J Perinat Med 2024; 52:485-493. [PMID: 38629833 DOI: 10.1515/jpm-2023-0378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 02/29/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVES Sickle cell disease (SCD) occurs in 2.8 % of our Jamaican antenatal population with homozygous HbSS being most associated with adverse maternal and perinatal outcomes. METHODS A retrospective comparative analysis of HbSS, HbSC and HbSβThal pregnancy outcomes at the University Hospital of the West Indies (UHWI) between January 2012 and December 2022 was conducted. RESULTS Of 120 patients (138 pregnancies), obesity occurred in 36 % (20/56) of the 'non-HbSS' group, i.e. HbSβThal (55 %, 5/9) and HbSC (32 %, 15/47) combined vs. 9.7 % of the HbSS (8/82). HbSS patients had more crises requiring transfusions, acute chest syndrome (ACS), maternal 'near-misses' (OR=10.7, 95 % 3.5-32.3; p<0.001), hospitalizations (OR 7.6, 95 % CI 3.4-16.9; p<0.001), low birth weight (LBW) neonates (OR 3.1, 1.1-8.9; p=0.037) and preterm birth (OR=2.6, 1.2-5.8; p=0.018) compared to HbSC and HbSβThal. Low dose aspirin was prescribed in 43 %. Logistic regression showed those NOT on aspirin (n=76) had more miscarriages (22 v. 2 %), were LESS likely to have a live birth (75 v. 95 % (0.2, 0.04-0.57, p=0.005)), but surprisingly had fewer painful crises (28 v. 46 % (0.5, 0.03-0.9, p=0.03)). CONCLUSIONS HbSS women had a 10-fold excess of maternal near-misses. Additional research may further clarify the effects of aspirin on pregnancy outcomes as related to SCD genotypes.
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Affiliation(s)
- Shanea M P Gibson
- Department of Obstetrics and Gynaecology, 233759 University Hospital of the West Indies , Mona, Jamaica
| | - Tiffany A Hunter
- Department of Obstetrics and Gynaecology, 233759 University Hospital of the West Indies , Mona, Jamaica
- Department of Obstetrics and Gynaecology, 62707 University of the West Indies , Mona, Jamaica
| | - Phillip E Charles
- Department of Obstetrics and Gynaecology, 233759 University Hospital of the West Indies , Mona, Jamaica
- Department of Obstetrics and Gynaecology, 62707 University of the West Indies , Mona, Jamaica
| | - Melonie A C Morgan
- Department of Obstetrics and Gynaecology, 62707 University of the West Indies , Mona, Jamaica
| | - Shari K R Griffith-Anderson
- Department of Obstetrics and Gynaecology, 233759 University Hospital of the West Indies , Mona, Jamaica
- Department of Obstetrics and Gynaecology, 62707 University of the West Indies , Mona, Jamaica
| | | | | | - Nadine A Johnson
- Department of Obstetrics and Gynaecology, 233759 University Hospital of the West Indies , Mona, Jamaica
- Department of Obstetrics and Gynaecology, 62707 University of the West Indies , Mona, Jamaica
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Haering C, Coyne K, Daunov K, Anim S, Christianson MS, Flyckt R. Ovarian Tissue Cryopreservation for Fertility Preservation in Patients with Hemoglobin Disorders: A Comprehensive Review. J Clin Med 2024; 13:3631. [PMID: 38999197 PMCID: PMC11242023 DOI: 10.3390/jcm13133631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/11/2024] [Accepted: 06/17/2024] [Indexed: 07/14/2024] Open
Abstract
Hemoglobin diseases like sickle cell disease (SCD) and β-thalassemia (BT) present fertility challenges for affected patients. SCD and BT result from abnormal hemoglobin production or structure and pose numerous health concerns. Despite medical advancements improving the quality of life or even providing cures, SCD and BT pose unique fertility concerns for women. Young women with these disorders already contend with reduced ovarian reserve and a narrower fertile window, a situation that is compounded by the gonadotoxic effects of treatments like medications, transfusions, stem cell transplants, and gene therapy. While crucial for disease control, these interventions may lead to reproductive health issues, increasing infertility and early menopause risks. Ovarian tissue cryopreservation (OTC) offers potential for future motherhood to women with hemoglobin disorders facing infertility related to curative treatments. OTC involves surgically removing, preparing, and freezing ovarian tissue containing primordial follicles capable of producing mature oocytes, offering advantages over oocyte cryopreservation alone. However, the application of OTC for patients with hemoglobin disorders presents unique challenges, including special health risks, financial barriers, and access to care. This comprehensive literature review delves into the current state of ovarian tissue cryopreservation for fertility preservation in patients with hemoglobin disorders. Empowering patients with informed reproductive choices in the context of their hemoglobin disorders stands as the ultimate goal.
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Affiliation(s)
- Catherine Haering
- Division of Reproductive Endocrinology and Infertility, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA;
| | - Kathryn Coyne
- Department of Reproductive Endocrinology and Infertility, University Hospitals Ahuja, Beachwood, OH 44122, USA
| | - Katherine Daunov
- Department of Hematology and Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH 44106, USA
| | - Samuel Anim
- Department of Hematology and Oncology, University Hospitals Seidman Cancer Center, Cleveland, OH 44106, USA
| | - Mindy S. Christianson
- Department of Reproductive Endocrinology and Infertility, Cleveland Clinic Foundation Beachwood Family Health Center, Beachwood, OH 44122, USA
| | - Rebecca Flyckt
- Department of Reproductive Endocrinology and Infertility, University Hospitals Ahuja, Beachwood, OH 44122, USA
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Obeagu EI, Obeagu GU. Management of diabetes mellitus patients with sickle cell anemia: Challenges and therapeutic approaches. Medicine (Baltimore) 2024; 103:e37941. [PMID: 38669382 PMCID: PMC11049766 DOI: 10.1097/md.0000000000037941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
The coexistence of diabetes mellitus (DM) and sickle cell anemia (SCA) poses significant challenges in clinical management due to the complex interactions and overlapping complications associated with both conditions. Managing diabetes in individuals with SCA requires a comprehensive approach that addresses the unique physiological and pathological aspects of both diseases. This paper reviews the challenges encountered in the management of DM in patients with SCA and explores therapeutic strategies and approaches to optimize patient care. Challenges in the management of DM in individuals with SCA stem from several factors, including the impact of hemoglobin variants on glycemic control assessment, increased susceptibility to infections, altered immune response, and complications associated with both diseases. Moreover, the coexistence of SCA and DM heightens the susceptibility to infections due to compromised immune function, emphasizing the need for vigilant preventive measures, including vaccinations and close monitoring for infectious complications. Close collaboration among healthcare providers specializing in diabetes, hematology, and other relevant fields is crucial for developing comprehensive care plans. Individualized treatment strategies that balance glycemic control, pain management, and preventive care are essential to mitigate complications and optimize the overall health outcomes of patients with both DM and SCA. In conclusion, managing diabetes in the context of SCA necessitates a nuanced and patient-centered approach. By addressing the challenges and employing tailored therapeutic strategies, healthcare providers can improve the quality of life and health outcomes for individuals affected by both conditions.
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Poliektov NE, Vuncannon DM, Ha TK, Lindsay MK, Chandrasekaran S. The Association between Sickle Cell Disease and Postpartum Severe Maternal Morbidity. Am J Perinatol 2024. [PMID: 38653453 DOI: 10.1055/s-0044-1786174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To compare the risk of severe maternal morbidity (SMM) from the delivery admission to 42 days' postdischarge among persons with sickle cell disease (SCD) to those without SCD. STUDY DESIGN This retrospective cohort study included deliveries ≥20 weeks' gestation at an urban safety net hospital in Atlanta, GA from 2011 to 2019. The exposure was SCD diagnosis. The outcome was a composite of SMM from the delivery admission to 42 days' postdischarge. SMM indicators as defined by the Centers for Disease Control and Prevention were identified using the International Classification of Diseases, Ninth and Tenth Revisions (ICD-9/10) codes; transfusion of blood products and sickle cell crisis were excluded. RESULTS Of N = 17,354 delivery admissions, n = 92 (0.53%) had SCD. Persons with SCD versus without SCD had an increased risk of composite SMM (15.22 vs. 2.29%, p < 0.001), acute renal failure (6.52 vs. 0.71%, p < 0.001), acute respiratory distress syndrome (4.35 vs. 0.17%, p < 0.001), puerperal cerebrovascular disorders (3.26 vs. 0.10%, p < 0.001), sepsis (4.35 vs. 0.42%, p < 0.01), air and thrombotic embolism (5.43 vs. 0.10%, p < 0.001), and ventilation (2.17 vs. 0.09%, p < 0.01). Ultimately, those with SCD had an approximately 6-fold higher incidence risk ratio of SMM, which remained after adjustment for confounders (adjusted incidence risk ratio [aIRR]: 5.96, 95% confidence interval [CI]: 3.4-9.19, p < 0.001). Persons with SCD in active vaso-occlusive crisis at the delivery admission had an approximately 9-fold higher risk of SMM up to 42 days' postdischarge compared with those with SCD not in crisis at the delivery admission (incidence: 25.71 vs. 8.77%, p < 0.05; aIRR: 8.92, 95% CI: 4.5-10.04, p < 0.05). Among those with SCD, SMM at the delivery admission was primarily related to renal and cerebrovascular events, whereas most postpartum SMM was related to respiratory events or sepsis. CONCLUSION SCD is significantly associated with an increased risk of SMM during the delivery admission and through 42 days' postdischarge. Active crisis at delivery further increases the risk of SMM. KEY POINTS · Sickle cell disease was associated with an approximately 6-fold increased risk of SMM.. · Active vaso-occlusive crisis at delivery was associated with an approximately 9-fold increased risk of SMM.. · 48% of SMM events in persons with SCD occurred postpartum and were respiratory- or sepsis-related..
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Affiliation(s)
- Natalie E Poliektov
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Danielle M Vuncannon
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Thoa K Ha
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Michael K Lindsay
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
| | - Suchitra Chandrasekaran
- Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, Georgia
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Sikdar O, Ambulkar H, Jenkinson A, Hedley C, Johns J, Bhat R, Dassios T, Harris C, Greenough A. Maternal and infant outcomes in women with sickle cell disease: a matched cohort study. Arch Dis Child Fetal Neonatal Ed 2024:fetalneonatal-2024-326848. [PMID: 38604649 DOI: 10.1136/archdischild-2024-326848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE Women with sickle cell disease (SCD) have adverse maternal and infant outcomes. Our aim was to determine whether the outcomes of SCD mothers and their infants differed from African or Caribbean women not affected by SCD and whether there were differences between SCD individuals with the haemoglobin SS (HbSS) or haemoglobin SC (HbSC) genotypes. Furthermore, we wished to determine if any differences related to deprivation. DESIGN A matched cohort study. SETTING Tertiary perinatal centre in London PATIENTS: 4964 African or Caribbean women without SCD and 148 with SCD. MAIN OUTCOME MEASURES Mode of delivery, maternal exchange transfusion, birthweight, neonatal unit admission, neonatal death and deprivation indices RESULTS: SCD women were more likely to be delivered by caesarean section (p<0.001) and had babies of lower birthweight (p<0.001). Their infants were no more likely to be admitted to neonatal intensive care unit or suffer a neonatal death. There were no significant differences between the SCD women and those without SCD in their deprivation index or deprivation decile. The women with the HbSS genotype compared to those with the HbSC genotype were more anaemic (p<0.02), required more exchange transfusions (p<0.001) and were more likely to be delivered by caesarean section (p=0.008). The infant outcomes did not differ significantly between the genotypes. CONCLUSIONS Although, the SCD women, particularly those with the HbSS genotype, had greater morbidity, infant morbidity, and mortality was similar in mothers with the HbSS or HbSC genotypes and those without SCD.
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Affiliation(s)
- Oishi Sikdar
- Department of Women and Children's Health, King's College London, London, UK
| | - Hemant Ambulkar
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Allan Jenkinson
- Department of Women and Children's Health, King's College London, London, UK
| | - Catherine Hedley
- Department of Obstetrics and Gynaecology, King's College Hospital NHS Foundation Trust, London, UK
| | - Jemma Johns
- Department of Obstetrics and Gynaecology, King's College Hospital NHS Foundation Trust, London, UK
| | - Ravindra Bhat
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Theodore Dassios
- Department of Women and Children's Health, King's College London, London, UK
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Christopher Harris
- Department of Women and Children's Health, King's College London, London, UK
- Neonatal Intensive Care Unit, King's College Hospital NHS Foundation Trust, London, UK
| | - Anne Greenough
- Department of Women and Children's Health, King's College London, London, UK
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Thomas SP, Fletcher FE, Willard R, Ranson TM, Bonham VL. Patient Perceptions on the Advancement of Noninvasive Prenatal Testing for Sickle Cell Disease among Black Women in the United States. AJOB Empir Bioeth 2024; 15:154-163. [PMID: 38349128 DOI: 10.1080/23294515.2024.2302996] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
Abstract
BACKGROUND Noninvasive prenatal testing (NIPT) designed to screen for fetal genetic conditions, is increasingly being implemented as a part of routine prenatal care screening in the United States (US). However, these advances in reproductive genetic technology necessitate empirical research on the ethical and social implications of NIPT among populations underrepresented in genetic research, particularly Black women with sickle cell disease (SCD). METHODS Forty (N = 40) semi-structured interviews were conducted virtually with Black women in the US (19 participants with SCD; 21 participants without SCD) from June 2021 to January 2022. We employed a qualitative approach to examine the study participants' perceptions of the potential advancement of NIPT for screening SCD in the fetus. Data were analyzed using NVivo 12 qualitative software. RESULTS The themes revealed the complexities involving the intersectional lived experiences of SCD, prenatal care, lack of synergy among health providers, and NIPT decision-making. The results further revealed that even when Black women have shared commonalities in their lived experiences while navigating SCD and motherhood, their perceptions of NIPT screening technologies are divergent. CONCLUSION Expanding the ethical discourse on the social implications of NIPT is critical to fully elucidate how Black women perceive NIPT's utility, particularly as NIPT advances to screen for SCD in the fetus. Neglecting to include Black women with genetic conditions in empirical studies on NIPT may contribute to ongoing health inequities and limit and constrain reproductive choices among Black women with and without SCD.
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Affiliation(s)
- Shameka P Thomas
- School of Public Health, Harvard University, Boston, Massachusetts, USA
- National Institutes of Health-National Genome Research Institute, Bethesda, Maryland, USA
| | - Faith E Fletcher
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas, USA
| | - Rachele Willard
- National Institutes of Health-National Genome Research Institute, Bethesda, Maryland, USA
| | - Tiara Monet Ranson
- National Institutes of Health-National Genome Research Institute, Bethesda, Maryland, USA
- School of Public Health, University of Washington, Washington, Seattle, USA
| | - Vence L Bonham
- National Institutes of Health-National Genome Research Institute, Bethesda, Maryland, USA
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Figueira CO, Guida JPS, Surita FG, Antolini-Tavares A, Saad ST, Costa FF, Fertrin KY, Costa ML. Sickle cell disease and increased adverse maternal and perinatal outcomes in different genotypes. Hematol Transfus Cell Ther 2024:S2531-1379(24)00056-7. [PMID: 38494406 DOI: 10.1016/j.htct.2024.02.013] [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: 06/21/2023] [Revised: 11/23/2023] [Accepted: 02/12/2024] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND Sickle cell disease (SCD) comprises a heterogeneous group of inherited hemolytic disorders that increases the risk of maternal and perinatal complications due to chronic systemic inflammatory response, endothelial damage and vaso-occlusion. The contribution of genotypes to the severity of outcomes during pregnancy is not completely established. METHODS A retrospective study of medical charts was performed to compare maternal and perinatal outcomes in Hb SS, Hb SC disease and sickle-beta thalassemia (Hb Sβ) pregnancies followed at a high-risk antenatal care unit over a 6-year period. A descriptive analysis of morphological findings was performed of the placenta when pathology reports were available. RESULTS Sixty-two SCD pregnant women [25 Hb SS (40 %), 29 Hb SC (47 %) and 8 Hb Sβ (13 %)] were included. Overall, SCD was associated with maternal complications (77 %), preterm birth (30 %), cesarean section (80 %) and a need of blood transfusion. In general there were no statistically significant differences between genotypes. The only significant difference was the hemoglobin level at first antenatal care visit which was lower for the homozygous genotype (7.7 g/dL) compared to Hb SC and Hb Sβ (9.7 g/dL and 8.4 g/dL, respectively; p-value = 0.01). Ten of 15 evaluated placentas showed abnormal morphological findings CONCLUSION: SCD, regardless of the underlying genotype, is associated with increased adverse maternal and perinatal outcomes and placental abnormalities associated with maternal vascular malperfusion.
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Affiliation(s)
- Camilla Olivares Figueira
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil
| | - José Paulo S Guida
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil
| | - Fernanda G Surita
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil
| | - Arthur Antolini-Tavares
- Department of Pathological Anatomy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil
| | - Sara T Saad
- Department of Hematology and Hemotherapy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil
| | - Fernando F Costa
- Department of Hematology and Hemotherapy, State University of Campinas (UNICAMP), 126, Tessália Vieira de Camargo St, Campinas, São Paulo 13083-887, Brazil
| | - Kleber Y Fertrin
- Division of Hematology, Department of Medicine, University of Washington, WA 98195, Seattle, WA, USA
| | - Maria Laura Costa
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), 101, Alexander Fleming St, Campinas, São Paulo 13084-881, Brazil.
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Sharma D, Kozanoğlu I, Ataga KI, Benachi A, Büyükkurt S, Lanzkron S, Ozdogu H, Pancham S, Pecker LH, Robinson SE, Yilmaz Baran S, Howard J. Managing sickle cell disease and related complications in pregnancy: results of an international Delphi panel. Blood Adv 2024; 8:1018-1029. [PMID: 38206762 PMCID: PMC10879679 DOI: 10.1182/bloodadvances.2023011301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/13/2024] Open
Abstract
ABSTRACT Data to guide evidence-based management of pregnant people with sickle cell disease (SCD) are limited. This international Delphi panel aimed to identify consensus among multidisciplinary experts for SCD management during pregnancy. The 2-round Delphi process used questionnaires exploring 7 topics (antenatal care, hydroxyurea use, transfusion, prevention of complications, treatment of complications, delivery and follow-up, and bottlenecks and knowledge gaps) developed by a steering committee. Thirteen panelists (hematologists, physiologists, obstetricians, maternal fetal medicine, and transfusion medicine physicians) from the United States, the United Kingdom, Turkey, and France completed the first survey; 12 panelists completed the second round. Anonymized responses were collected and summarized by a contract research organization (Akkodis Belgium). Consensus and strong consensus were predefined as 75% to 90% (9-10 of 12) and >90% (≥11 of 12) of panelists, respectively, agreeing or disagreeing on a response to a predefined clinical scenario or statement. In several areas of SCD management, consensus was achieved: experts recommended performing at least monthly multidisciplinary antenatal follow-up, administering prophylactic aspirin for preeclampsia prevention between gestational weeks 12 and 36, initiating prophylactic transfusion therapy in certain cases, or choosing automated red blood cell exchange over other transfusion methods for patients with iron overload or severe acute chest syndrome. No consensus was reached on several topics including the prophylactic aspirin dose, indications for starting infection prophylaxis, routine use of prophylactic transfusions, or use of prophylactic transfusions for preventing fetal complications. These recommendations could inform clinical care for patients with SCD who are pregnant in the absence of large clinical trials involving this population; the identified knowledge gaps can orient future research.
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Affiliation(s)
- Deva Sharma
- Vanderbilt University Medical Center, Nashville, TN
| | - Ilknur Kozanoğlu
- Department of Physiology, Faculty of Medicine, Başkent University, Ankara, Turkey
- Adana Adult Bone Marrow Transplantation Center (CIC. 589), Apheresis Unit, Başkent University, Yuregir, Adana, Turkey
| | - Kenneth I. Ataga
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN
| | - Alexandra Benachi
- Division of Obstetrics and Gynecology, Department of Obstetrics and Gynecology, Antoine Béclère Hospital, Assistance Publique Hôpitaux de Paris, Paris Saclay University Hospitals, Clamart, France
| | - Selim Büyükkurt
- Department of Obstetrics and Gynecology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Sophie Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
| | - Hakan Ozdogu
- Department of Hematology, Faculty of Medicine, Başkent University, Ankara, Turkey
- Adana Adult Bone Marrow Transplantation Center (CIC. 589), Apheresis Unit, Başkent University, Yuregir, Adana, Turkey
| | - Shivan Pancham
- Department of Haematology, Sandwell and West Birmingham Hospitals National Health Service Trust, West Bromwich, United Kingdom
| | - Lydia H. Pecker
- Division of Hematology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD
- Department of Gynecology and Obstetrics, Johns Hopkins School of Medicine, Baltimore, MD
| | - Susan E. Robinson
- Department of Women's Health, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
| | - Safak Yilmaz Baran
- Department of Obstetrics and Gynecology, Başkent University, Dr. Turgut Noyan Application and Research Center, Adana, Turkey
| | - Jo Howard
- Department of Clinical Haematology, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
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Sinkey RG, Ogunsile FJ, Kanter J, Bean C, Greenberg M. Society for Maternal-Fetal Medicine Consult Series #68: Sickle cell disease in pregnancy. Am J Obstet Gynecol 2024; 230:B17-B40. [PMID: 37866731 PMCID: PMC10961101 DOI: 10.1016/j.ajog.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
Pregnant individuals with sickle cell disease have an increased risk of maternal and perinatal morbidity and mortality. However, prepregnancy counseling and multidisciplinary care can lead to favorable maternal and neonatal outcomes. In this consult series, we summarize what is known about sickle cell disease and provide guidance for sickle cell disease management during pregnancy. The following are Society for Maternal-Fetal Medicine recommendations.
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Joseph L, Driessen M. A comprehensive view of pregnancy in patients with sickle cell disease in high-income countries: the need for robust data and further decline in morbidity and mortality. Lancet Haematol 2024; 11:e75-e84. [PMID: 38135375 DOI: 10.1016/s2352-3026(23)00310-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 12/24/2023]
Abstract
Sickle cell disease is a major public health concern due to its prevalence and associated morbidities. In high-income countries, diagnosis and treatment advancements have extended patient's lives and enabled women to embrace motherhood. Although the provision of care in specialist centres has reduced maternal-fetal complication rates, the mortality rate among pregnant women with sickle cell disease remains disproportionately high. Complications arise from vaso-occlusive events, worsening organ damage, thrombotic risks, infections, and pregnancy-related issues, such as pre-eclampsia, premature birth, small-for-gestational-age, and pregnancy loss. Effective management during pregnancy includes preconception planning, genetic counselling, education, and collaborative care. There is no consensus on the overall approach to managing pregnant women with sickle cell disease; however, fostering a collaborative relationship between health-care professionals and researchers is crucial for advancing the understanding and management of this illness. The disparities in health-care outcomes associated with ethnicity and economic insecurity affect patients with sickle cell disease but have not been examined extensively. Hence, health-care personnel need sufficient training to address these issues alongside broader societal efforts to confront racism and discrimination. Comprehensive national and global action plans are required to address the multifaceted challenges of sickle cell disease.
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Affiliation(s)
- Laure Joseph
- Biotherapy Department, French National Sickle Cell Referral Centre, Biotherapy Clinical Investigation Centre, Hôpital Necker-Enfant Malades, Assistance-Publique Hôpitaux de Paris, Paris, France.
| | - Marine Driessen
- Department of Obstetrics and Fetal Medicine, Hôpital Necker-Enfant Malades, Assistance-Publique Hôpitaux de Paris, Paris, France
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Mikobi TM, Kamuanya NC, Mikobi EKB, Kalela TI, Akilimali PZ, Lukusa PT. Sickle cell anemia and pregnancy: Profile of hemodynamic changes in sickle cell pregnant women in Kinshasa. EJHAEM 2023; 4:977-983. [PMID: 38024611 PMCID: PMC10660409 DOI: 10.1002/jha2.789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 07/30/2023] [Accepted: 08/29/2023] [Indexed: 12/01/2023]
Abstract
Pregnancy is accompanied by hormonal changes. These relate mainly to progesterone and placenate growth factor. Hemodynamic changes are also observed. in a sickle cell pregnant woman, all these changes have a direct effect on hypoxia. This is responsible for the polymerization of HbS. The latter causes the sickling of sickle red blood cells. sickling of red blood cells is responsible for hemolysis and vasoocclusion, two major acute manifestations during pregnancy in a sickle cell patient.
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Affiliation(s)
- Tite Minga Mikobi
- Centre d'Excellence de la Drépanocytose, Department of Molecular Biology and Genetics, Department of Basic Sciences, School of MedicineUniversity of KinshasaKinshasaDRC
- Center for Human Genetics, School of MedicineUniversity of MedicineKinshasaDRC
- Center of Sickle cell anemiaInstitut de Recherche en Sciences de la santé (IRSS)KinshasaDRC
| | - Nelly Ciombo Kamuanya
- Centre d'Excellence de la Drépanocytose, Department of Molecular Biology and Genetics, Department of Basic Sciences, School of MedicineUniversity of KinshasaKinshasaDRC
- Center of Sickle cell anemiaInstitut de Recherche en Sciences de la santé (IRSS)KinshasaDRC
| | - Emmanuelle Ketsia Bokashanga Mikobi
- Centre d'Excellence de la Drépanocytose, Department of Molecular Biology and Genetics, Department of Basic Sciences, School of MedicineUniversity of KinshasaKinshasaDRC
| | - Thérèse Ilunga Kalela
- Service of ecotoxicology, department of the environment, Faculty of sciencesUniversity of KinshasaKinshasaDRC
| | - Pierre Zalagile Akilimali
- Department of Epidemiology and Biostatistics, School of Public HealthUniversity of KinshasaKinshasaDRC
| | - Prosper Tshilobo Lukusa
- Centre d'Excellence de la Drépanocytose, Department of Molecular Biology and Genetics, Department of Basic Sciences, School of MedicineUniversity of KinshasaKinshasaDRC
- Center for Human Genetics, School of MedicineUniversity of MedicineKinshasaDRC
- Genetics Unit, Neonatology Service, Department of Pediatrics, University Hospital of KinshasaUniversity of KinshasaKinshasaDRC
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13
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Bala NS, Stanek JR, Vesely SK, Cronin RM, Creary SE, Roe AH, Xu W, O’Brien SH. Comparison of thromboembolism outcomes in patients with sickle cell disease prescribed hormonal contraception. Blood Adv 2023; 7:6140-6150. [PMID: 37585480 PMCID: PMC10582388 DOI: 10.1182/bloodadvances.2023010204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/09/2023] [Accepted: 07/25/2023] [Indexed: 08/18/2023] Open
Abstract
Patients with sickle cell disease (SCD) are at a risk of thromboembolism (TE), and use of hormonal contraception can further increase that risk. This study aims to assess patterns of hormonal contraceptive use and compare risk of contraception-related TE between combined hormonal contraceptives (CHCs) and progestin-only contraceptives (POCs). Patients with SCD aged between 12 and 44 years with a new prescription of a hormonal contraceptive in the Centers for Medicare and Medicaid Services Medicaid Analytic eXtract database (2006-2018) were followed up to 1 year. We identified 7173 new users: 44.6% initiated CHC and 55.4% initiated POC. Combined oral contraceptive pills (OCPs; 36.5%) and progestin-only depot medroxyprogesterone acetate (33.9%) were the most frequently prescribed agents. A total of 1.8% of contraception users had a new diagnosis of TE within 1 year of the first identified contraception prescription. There were no significant differences in TE event rates between CHC and POC users (17.2 and 24.7 events per 1000 person-years, respectively). In patients prescribed OCP, there were no differences in TE event rates based on estrogen dose or progestin generation. Transdermal patch had a 2.4-fold increased risk of TE as compared with that of OCP. Although limited by the retrospective study design and use of administrative claims data, this study found no significant differences in TE rates between new users of CHC and POC in patients with SCD. Careful evaluation of underlying TE risk factors should be considered for each patient with SCD before initiation of hormonal contraception.
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Affiliation(s)
- Natasha S. Bala
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, OH
| | - Joseph R. Stanek
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, OH
- Biostatistics Resource at Nationwide Children's Hospital, Columbus, OH
| | - Sara K. Vesely
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, The University of Oklahoma, Oklahoma City, OK
| | - Robert M. Cronin
- Department of Internal Medicine, The Ohio State University, College of Medicine, Columbus, OH
| | - Susan E. Creary
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, OH
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
| | - Andrea H. Roe
- Department of Obstetrics and Gynecology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Wendy Xu
- Division of Health Services Management and Policy, The Ohio State University, College of Public Health, Columbus, OH
| | - Sarah H. O’Brien
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital and The Ohio State University, College of Medicine, Columbus, OH
- Center for Child Health Equity and Outcomes Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH
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Eltyeb EE, Ibrahim Mokhasha A, Ali Al-Makramani A, Murtada Abdelmageed M, Amin Basheer R. Sickle cell anemia in pregnant Saudi women and its impact on birth weight and gestational maturity. J Chin Med Assoc 2023; 86:892-896. [PMID: 37528521 DOI: 10.1097/jcma.0000000000000974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND It is well documented that sickle cell anemia (SCA) in pregnancy increases the risk of problems that can influence the growth and maturation of the newborn. To assess the gestational maturity and birth weight of babies born to Saudi mothers with SCA in the Jazan region. METHODS A case-control study was conducted in three hospitals in the Jazan region. An interview with a semi-structured questionnaire was used to collect data from the participants' women, and then the birth weight was taken. RESULTS Of 187 delivered women, 20.3% had SCA (13% had sickle cell disease, and the remaining had sickle cell trait). Among the 38 affected mothers, 15.7% were considered to have an additional risk (7.9% had diabetes mellitus, 5.3% had hypertension, and 2.6% were smokers). The mean birth weight was 2.95 ± 0.40 kg and 2.99 ± 0.55 kg in the case and control groups, respectively. However, the low birth weight babies constitute 31% of the delivered babies in the SCA group with a weight of 2.33 ± 0.16 kg and 15% of the control group with a mean weight of 2.16 ± 0.30 kg. The gestational age was 39.36 ± 1.02 weeks in the SCA group compared to 39.5 ± 1.17 weeks in the control group. Maternal age and hypertension significantly influence the birth weight in the SCA group compared to the influence of diabetes mellitus on the birth weight in the control group. CONCLUSION This study indicates that SCA in pregnant mothers influences birth weight, which is more impacted by maternal age and co-morbidities. Therefore, a multidisciplinary approach must monitor these risky pregnancies well to avoid undesirable neonatal outcomes.
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Affiliation(s)
| | | | - Ali Ali Al-Makramani
- Department of Paediatrics, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | | | - Randa Amin Basheer
- Department of Nursing, Farasan University College, Jazan University, Saudi Arabia
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15
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Mishra A, Hirani S, Hirani S, Shaikh MYD, Khanholkar S, Prasad R, Wanjari M. Arnold-Chiari Malformations in Pregnancy and Labor: Challenges and Management Strategies. Cureus 2023; 15:e43688. [PMID: 37724202 PMCID: PMC10505272 DOI: 10.7759/cureus.43688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 08/17/2023] [Indexed: 09/20/2023] Open
Abstract
Arnold-Chiari malformations (ACMs) present unique challenges in pregnancy and labor, requiring a comprehensive understanding and multidisciplinary approach to care. This review article provides an overview of ACMs, including their definition, classification, and prevalence. The challenges in diagnosing ACMs during pregnancy, the available imaging modalities, and screening recommendations are discussed. The impact of ACMs on maternal health, fetal development, and the management strategies employed during pregnancy and labor are explored. Emphasis is placed on the importance of a multidisciplinary approach involving neurologists, obstetricians, and other specialists. Medical management options for symptom relief, surgical interventions, and anesthetic considerations during labor and delivery are also addressed. The importance of postpartum care, breastfeeding considerations, and long-term follow-up for women with ACMs who desire future pregnancies are highlighted. Finally, areas for further research and advancements in ACM management are identified. By improving our understanding and management of ACMs in pregnancy and labor, healthcare professionals can optimize care and improve outcomes for mothers and babies affected by this condition.
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Affiliation(s)
- Aditi Mishra
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shoyeb Hirani
- Medicine, Mahatma Gandhi Medical College and Hospital, Aurangabad, IND
| | - Sajid Hirani
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mohammed Yusuf D Shaikh
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shubham Khanholkar
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Roshan Prasad
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Mayur Wanjari
- Research and Development, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Shegekar T, Pajai S. A Comprehensive Review of Pregnancy in Sickle Cell Disease. Cureus 2023; 15:e41165. [PMID: 37525766 PMCID: PMC10387184 DOI: 10.7759/cureus.41165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/29/2023] [Indexed: 08/02/2023] Open
Abstract
Sickle cell hemoglobinopathies encompass a range of qualitative and quantitative hemoglobin disorders that are inherited genetically. This group of disorders includes sickle cell beta thalassemia, sickle cell trait, and sickle cell disease (SCD). Globally, SCD is the most common disorder. Even epidemiological data suggests the majority of diseases, as well as traits, are concentrated in Sub-Saharan Africa, North-East Africa, the Middle East, and India. The physiological changes in pregnancy predispose to an increased risk of catastrophic events like a vaso-occlusive crisis, thromboembolic events, and their related sequelae, leading eventually to villous infarction, necrosis, and fibrosis leading to compromising uteroplacental circulation. Conversely, the mother may exhibit exacerbated symptoms of gestational hypertension, placental abruption, preterm labor, and venous thromboembolism. Although this disease is manageable, it has the potential to adversely impact maternal and child health on a national level. The chances of severe complications in the pregnant state affecting both mother and fetus attract due attention of health services towards redefining and researching this disease and its management frequently. The literature review on the following situation advocates the general treatment to be observed under the headings of preconceptual care, strengthened antenatal care, strict intranatal care, and compliant post-natal care. Preconceptually, genetic screening of couples, with education on the adverse effects of the disease, comes as the first line of management. Newer facilities like preimplantation genetic diagnosis and celocentesis may even allow for early diagnosis as well as help patients who do not wish to terminate the pregnancy by selective transfer of unaffected embryos. This may be combined with an extensive evaluation of the psychosocial aspect and socioeconomic status of couples who administer vaccines as prophylaxis for preventable diseases. Strengthening antenatal care is associated with routine blood investigations for every registered antenatal patient with adequate awareness about the conditions that precipitate the crisis. All patients should be prophylactically treated with appropriate doses of aspirin, iron, folic acid, and multivitamins. Radiological examinations by ultrasonography may be used to monitor placenta previa, abruption, or preterm labor. Later in pregnancy, it should be recommended to perform biophysical profiling and assessment of umbilical artery flow. Intranatal care deals with strict-term institutional delivery of all sickle cell-diseased mothers with a preference for vaginal delivery. Post-natal care requires a precise assessment of blood loss during labor to initiate transfusion therapy as soon as needed. Exclusive breastfeeding, with the importance of early initiation of it, must be emphasized. Screening of neonates as quickly as possible must be done for hemoglobinopathies. Through this review, authors are trying to make aware of the complications that can be faced during pregnancy in SCD patients, its prevention, and its treatment according to various new guidelines and research available.
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Affiliation(s)
- Tejas Shegekar
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Adesina OO, Brunson A, Fisch SC, Yu B, Mahajan A, Willen SM, Keegan THM, Wun T. Pregnancy outcomes in women with sickle cell disease in California. Am J Hematol 2023; 98:440-448. [PMID: 36594168 PMCID: PMC9942937 DOI: 10.1002/ajh.26818] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 01/04/2023]
Abstract
Adverse pregnancy outcomes occur frequently in women with sickle cell disease (SCD) across the globe. In the United States, Black women experience disproportionately worse maternal health outcomes than all other racial groups. To better understand how social determinants of health impact SCD maternal morbidity, we used California's Department of Health Care Access and Information data (1991-2019) to estimate the cumulative incidence of pregnancy outcomes in Black women with and without SCD-adjusted for age, insurance status, and Distressed Community Index (DCI) scores. Black pregnant women with SCD were more likely to deliver at a younger age, use government insurance, and live in at-risk or distressed neighborhoods, compared to those without SCD. They also experienced higher stillbirths (26.8, 95% confidence interval [CI]: 17.5-36.1 vs. 12.4 [CI: 12.1-12.7], per 1000 births) and inpatient maternal mortality (344.5 [CI: 337.6-682.2] vs. 6.1 [CI: 2.3-8.4], per 100 000 live births). Multivariate logistic regression models showed Black pregnant women with SCD had significantly higher odds ratios (OR) for sepsis (OR 14.89, CI: 10.81, 20.52), venous thromboembolism (OR 13.60, CI: 9.16, 20.20), and postpartum hemorrhage (OR 2.25, CI 1.79-2.82), with peak onset in the second trimester, third trimester, and six weeks postpartum, respectively. Despite adjusting for sociodemographic factors, Black women with SCD still experienced significantly worse pregnancy outcomes than those without SCD. We need additional studies to determine if early introduction to reproductive health education, continuation of SCD-modifying therapies during pregnancy, and increasing access to multidisciplinary perinatal care can reduce morbidity in pregnant women with SCD.
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Affiliation(s)
- Oyebimpe O. Adesina
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Ann Brunson
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Samantha C. Fisch
- University of California San Francisco School of Medicine, San Francisco, CA
| | - Bo Yu
- Department of Obstetrics & Gynecology, Stanford University School of Medicine; Stanford Maternal & Child Health Research Institute, Stanford, CA
| | - Anjlee Mahajan
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Shaina M. Willen
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
- Division of Pediatric Pulmonary and Sleep Medicine, University of California, Davis School of Medicine, Sacramento, CA
| | - Theresa H. M. Keegan
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
| | - Ted Wun
- Center for Oncology Hematology Outcomes Research and Training, Division of Hematology Oncology, University of California Davis School of Medicine, Sacramento, CA
- UC Davis Clinical and Translational Science Center, University of California, Davis, CA
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18
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Early ML, Eke AC, Gemmill A, Lanzkron S, Pecker LH. Severe Maternal Morbidity and Mortality in Sickle Cell Disease in the National Inpatient Sample, 2012-2018. JAMA Netw Open 2023; 6:e2254552. [PMID: 36729452 PMCID: PMC9896307 DOI: 10.1001/jamanetworkopen.2022.54552] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
IMPORTANCE Pregnancy outcomes are historically poor among people with sickle cell disease (SCD) in the US, most of whom have Black race. Whether outcomes have improved is unknown. OBJECTIVE To tabulate adverse pregnancy outcomes among patients with SCD, comparing outcomes of deliveries among Black people with SCD with those of Black people without SCD and a control non-Black population, and to measure the association of racial disparities with adverse outcomes in SCD pregnancies. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was a secondary analysis involving data from National Inpatient Sample, a nationally representative sample of 20% of acute hospital admissions in the US, between 2012 and 2018. The data set included all admissions with codes for delivery of a pregnancy among people aged 11 to 55 years. Data were analyzed from September 2021 to August 2022. EXPOSURES SCD, racial disparities. MAIN OUTCOMES AND MEASURES Severe maternal morbidity (SMM) as measured by the US Centers for Disease Control and Prevention's index alongside other outcomes; multiple logistic regression was used to compare the odds for adverse pregnancy outcomes. RESULTS The sample included 5 401 899 deliveries, including 3901 deliveries among people with SCD and 742 164 deliveries among people with Black race. Compared with the non-Black control group, patients with SCD and Black patients were younger (mean [SD] age: SCD, 27.2 [5.9] years; Black, 27.1 [6.1] years vs 28.7 [5.9] years) and more likely to have public insurance (SCD, 2609 deliveries [67.3%]; Black, 496 828 deliveries [65.4%] vs 1 880 198 deliveries [40.8%]). The maternal mortality rate in deliveries among people with SCD was 26 times greater than in the non-Black control group and more than 10 times greater than among Black pregnant people without SCD (Per 10 000 deliveries: SCD 13.3; 95% CI, 5.7-31.2; Black race, 1.2; 95% CI, 1.0-1.5; non-Black control 0.5; 95% CI, 0.5-0.6). Compared with the control group, SCD deliveries had higher odds of SMM (adjusted odds ratio [aOR], 7.22; 95% CI, 6.25-8.34; P < .001), especially cerebrovascular events (aOR, 22.00; 95% CI, 15.25-31.72; P < .001) and thromboembolism (aOR, 17.34; 95% CI, 11.55-26.03; P < .001). Racial disparities explained a median (IQR) 28.9% (21.2%-33.1%) of the increased risk in deliveries to people with SCD and between 40% and 50% of the increased risk for acute kidney failure (excess risk [ER], 56.9%; 95% CI, 54.3%-59.3%), intrauterine fetal demise (ER, 47.8%; 95% CI, 46.6%-49.1%), and eclampsia (ER, 42.1%; 95% CI, 37.9%-46.1%). CONCLUSIONS AND RELEVANCE In this large cross-sectional study of pregnancy outcomes in people with SCD, the risk for SMM was higher compared with deliveries among people without SCD, especially for thrombotic events, organ failure, and death. Racial disparities were associated with adverse outcomes. Our findings compel scientific, clinical, and political effort to improve outcomes for pregnant people with SCD.
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Affiliation(s)
- Macy L. Early
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ahizechukwu C. Eke
- Division of Maternal-Fetal Medicine & Clinical Pharmacology, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alison Gemmill
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sophie Lanzkron
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lydia H. Pecker
- Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Muacevic A, Adler JR, Mujalda A, Mujalda J, Yadav S, Kundal RK. The Effect of Sickle Cell Hemoglobinopathy on Pregnancy, Labor, Puerperium, and Fetal Outcome: A Retrospective Cohort Study From a Single Centre. Cureus 2023; 15:e34318. [PMID: 36865957 PMCID: PMC9971241 DOI: 10.7759/cureus.34318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is a major risk factor as far as pregnancy and obstetric complications are concerned. It possesses major perinatal and postnatal mortality. The management of pregnancy along with SCD requires a multispecialty team consisting of hematologists, obstetricians, anesthesiologists, neonatologists and intensivists. OBJECTIVES The objective of this study was to investigate the effect of sickle cell hemoglobinopathy on pregnancy, labor, puerperium, and fetal outcome in the rural and urban localities of Maharashtra, India. MATERIAL AND METHODS The present study is a comparative retrospective analysis of 225 pregnant women with SCD (genotype AS and SS) and 100 age- and gravida-matched pregnant women with normal hemoglobin (genotype AA) as a control who were treated between June 2013 to June 2015, in Indira Gandhi Government Medical College (IGGMC), Nagpur, India. We analyzed various data regarding obstetrical outcomes and complications in sickle cell disease mothers. RESULTS Out of 225 pregnant women, 38 (16.89%) were diagnosed with homozygous sickle cell disease (SS group) while 187 (83.11%) were diagnosed with sickle cell trait (AS group). The most common antenatal complications were sickle cell crisis (17; 44.74%) and jaundice (15; 39.47%) in the SS group whereas pregnancy-induced hypertension (PIH) was noted in 33 (17.65%) in the AS group. Intrauterine growth restriction (IUGR) was recorded in 57.89% of the SS group and 21.39% of the AS group. A higher chance of emergency lower segment cesarean section (LSCS; 66.67% in the SS group and 79.09% in the AS group) was recorded as compared with the control group at 32%. CONCLUSION In order to minimize risks to the mother and fetus and for better outcomes it is prudent to manage pregnancy with SCD vigilantly in the antenatal period. In the antenatal period mothers with this disease should be screened for hydrops or bleeding manifestations such as intracerebral hemorrhage in the fetus. Better feto-maternal outcomes can be achieved by effective multispecialty intervention.
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20
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Evidence-based obstetric management of women with sickle cell disease in low-income countries. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:414-420. [PMID: 36485120 PMCID: PMC9821549 DOI: 10.1182/hematology.2022000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pregnancy in women with sickle cell disease (SCD) is fraught with complications, some of which are life-threatening. Managing pregnancy in these women can be challenging, especially with poor resources, which is often the case in low-income countries. In Nigeria, for instance, up to 90% of patients pay out of pocket for medical care due to the poorly developed health insurance system, and this worsens the morbidity and mortality associated with this condition. We describe a pragmatic approach to routinely managing pregnant women with SCD in the antenatal period, showing the feasibility of effective management of these high-risk pregnancies in limited-resource settings. We also present the case of a pregnant Nigerian woman with SCD who has intrauterine growth restriction (IUGR) and acute chest syndrome (ACS), conditions that are life-threatening for the fetus and the mother, respectively, and require prompt intervention. We highlight how we successfully managed this woman in a cost-effective manner by employing relatively inexpensive tests for diagnosis and treating her effectively with oxygen, appropriate antibiotics and manual exchange blood transfusion for the ACS, and finger pulse oximeters to monitor oxygen saturation. We explore pathophysiological concepts to IUGR in women with SCD and briefly discuss the appropriate mode of delivery, including the options for pain relief in labor.
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21
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Evidence-based management of pregnant women with sickle cell disease in high-income countries. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:408-413. [PMID: 36485166 PMCID: PMC9820817 DOI: 10.1182/hematology.2022000378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Globally, patients living with sickle cell disease are now surviving to reproductive age, with life expectancy approaching 50 years in most countries. Thus, reproductive options are now essential for patients living with the condition. However, it can be associated with maternal, delivery, and fetal complications. Outcomes may vary depending on the level of expertise and resources. In this piece we provide an optional guideline for managing sickle cell disease in pregnancy. The therapeutic option of serial exchange prophylactic transfusion has been offered in the context of a clinical trial (TAPS2).
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22
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Pecker LH, Nero A, Christianson M. No crystal stair: supporting fertility care and the pursuit of pregnancy in women with sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2022; 2022:459-466. [PMID: 36485154 PMCID: PMC9821326 DOI: 10.1182/hematology.2022000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Growing recognition that the ovary is an end organ in sickle cell disease (SCD), advances in SCD treatment and cure, and innovations in assisted reproductive technologies invite progressive challenges in fertility care for women with SCD. The reproductive life span of women with SCD may be reduced because ovarian reserve declines more rapidly in people with SCD compared to unaffected people. Some young women have diminished ovarian reserve, a risk factor for infertility. Referrals for fertility preservation may be offered and anticipatory guidance about when to seek infertility care provided. For a subset of people with SCD, this information is also applicable when pursuing in vitro fertilization with preimplantation genetic testing to avoid implantation of an embryo with SCD. Here we explore the dimensions of SCD-related fertility care illustrated by the case of a 28-year-old woman with hemoglobin SS disease who initially presented for a hematology consultation for preconception counseling. This case highlights the complexity of preconception SCD management and care and the need to partner with patients to help align pregnancy hopes with SCD treatment and the many associated uncertainties.
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Affiliation(s)
- Lydia H. Pecker
- Division of Hematology, Johns Hopkins University School of Medicine, Baltimore, MD
- Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, MD
- Correspondence Lydia H. Pecker, 720 Rutland Ave, Ross Bldg 1025, Johns Hopkins University School of Medicine, Baltimore, MD 21205; e-mail:
| | - Alecia Nero
- Division of Hematology-Oncology, UT Southwestern Medical Center, Dallas, TX
| | - Mindy Christianson
- Division of Reproductive Endocrinology and Infertility, Johns Hopkins University School of Medicine, Baltimore, MD
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Moukalled NM, Bou Fakhredin R, Taher AT. Pregnancy and sickle cell disease: an overview of complications and suggested perinatal care. Expert Rev Hematol 2022; 15:1055-1061. [PMID: 36413684 DOI: 10.1080/17474086.2022.2151432] [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: 11/24/2022]
Abstract
INTRODUCTION Pregnancy in women with sickle cell disease (SCD) has been identified as high risk owing to increased incidence of materno-fetal complications across various studies and reports. These complications include consequences related to the underlying hemoglobinopathy; chronic anemia/associated inflammation, and pregnancy related including the risk for thromboembolism, bleeding and maternal mortality. Outcomes of neonates born to women with SCD has been suboptimal over the years with recent improvement due to strict monitoring, preventive and therapeutic measures. Much is yet to be unraveled regarding the optimal management of women with SCD during pregnancy, identifying target hemoglobin, delivery mode or timing among others. AREAS COVERED This review includes a summary of available data of the maternal and fetal outcomes; in addition to current recommendations for monitoring and management of women with SCD during pregnancy. EXPERT OPINION To have a successful pregnancy, women should be closely monitored, and interventions provided as needed to guarantee adequate management of anemia, as well as prevention, diagnosis and management of disease. They should also be educated regarding their reproductive health, emphasizing that pregnancy is possible, and achieving optimal results depends on providing adequate care in a health care facility with expertise in high-risk pregnancies and SCD.
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Affiliation(s)
- Nour M Moukalled
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayan Bou Fakhredin
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Ali T Taher
- Division of Hematology and Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Ferreira de Matos C, Comont T, Castex MP, Lafaurie M, Walter O, Moulis G, Dion J, Cougoul P. Risk of vaso-occlusive episodes in patients with sickle cell disease exposed to systemic corticosteroids: a comprehensive review. Expert Rev Hematol 2022; 15:1045-1054. [PMID: 36412212 DOI: 10.1080/17474086.2022.2149488] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Sickle cell disease (SCD) is the most frequent inherited disorder in the world. It is caused by a single amino acid mutation on the beta-globin chain, which lead to red blood cell deformation, haemolysis, and chronic inflammation. Clinical consequences are vaso-occlusives crisis, acute chest syndrome, thrombosis, infection, and chronic endothelial injury. AREAS COVERED Corticosteroids are an old therapeutic class, that are inexpensive and widely available, which can be administered in different forms. Their adverse effects are numerous and well-known. This class could appear to be useful in SCD treatment due to its anti-inflammatory effect. Moreover, corticosteroids remain an essential therapeutic class for many indications, besides SCD. Although specific adverse effects of corticosteroids have been suspected in SCD patients for decades, recent papers has reported strong evidence of specific and severe adverse effects in this population. Based on a literature review, we will discuss pathophysiological considerations, consequences, and practical use of corticosteroids in SCD. EXPERT OPINION High corticosteroid doses, for any indication , induce vaso-occlusive crises, acute chest syndrome, and re-hospitalization in patients with SCD. There is no evidence of any benefits of corticosteroid use in the SCD acute events. Prevention by hydroxyurea and/or red blood cell transfusion or exchange should be discussed when corticosteroid use is indispensable.
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Affiliation(s)
| | - Thibault Comont
- Internal Medicine Department, Toulouse University Hospital, Toulouse, France
| | - Marie-Pierre Castex
- Pediatric Oncology Immunology Hematology Unit, Children's University Hospital - Toulouse University Hospital, Toulouse, France
| | - Margaux Lafaurie
- CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), Toulouse, France.,Department of Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Ondine Walter
- Internal Medicine Department, Toulouse University Hospital, Toulouse, France.,CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), Toulouse, France
| | - Guillaume Moulis
- Internal Medicine Department, Toulouse University Hospital, Toulouse, France.,CIC 1436, Team Pharmacologie en Population, Cohortes, Biobanques (PEPSS), Toulouse, France
| | - Jérémie Dion
- Internal Medicine Department, Toulouse University Hospital, Toulouse, France
| | - Pierre Cougoul
- Internal Medicine Department, Toulouse University Hospital, Toulouse, France
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Abstract
This overview of reproductive and sexual health care concerns for people with sickle cell disease (SCD) addresses clinical concerns that can be complex and are inherently multidisciplinary. Clinicians must be prepared to initiate reproductive health care discussions, as these intimate concerns may not be volunteered by patients. SCD is associated with delayed onset of puberty, sickle pain during menstruation, disease-specific contraceptive considerations, high-risk pregnancy, priapism, erectile dysfunction, and offspring who inherit a hemoglobinopathy trait from affected parents. Reproductive health considerations are underrecognized, undertreated, and understudied. They need attention in primary care and specialty SCD, urology, and obstetrics and gynecology clinics.
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26
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Papadakis E, Brenner B. Thrombosis in Pregnant Women with Hemolytic Anemia. Semin Thromb Hemost 2022; 49:364-370. [PMID: 36410400 DOI: 10.1055/s-0042-1758819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AbstractHemolytic anemias are a group of uncommon disorders affecting both genders, frequently occurring at the reproductive age. While a link between hemolysis and hypercoagulability has been suggested based on the elucidation of certain involved pathophysiological mechanisms, the extent of thrombotic risk in pregnant women with hemolytic anemia remains debatable. Due to the paucity of pregnancy-related data, risk assessment of gestations in women with hemolytic anemia is complicated. This review will highlight the latest advances in the diagnosis and management of these challenging disorders in pregnancy.
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Affiliation(s)
| | - Benjamin Brenner
- Department of Hematology, Rambam Health Care Campus, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa, Israel
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27
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Askew MA, Smaldone AM, Gold MA, Smith-Whitley K, Strouse JJ, Jin Z, Green NS. Pediatric hematology providers' contraceptive practices for female adolescents and young adults with sickle cell disease: A national survey. Pediatr Blood Cancer 2022; 69:e29877. [PMID: 35856776 PMCID: PMC9623811 DOI: 10.1002/pbc.29877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/25/2022] [Accepted: 06/15/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adolescent and young adult (AYA) women with sickle cell disease (SCD) have increased pregnancy-related health risks and are prescribed potentially teratogenic medications, yet limited data are available regarding pediatric SCD provider contraceptive practices. We aimed to assess pediatric hematology providers' beliefs, practices, motivators, and barriers for providing contraceptive care to female AYAs with SCD. METHODS Guided by the Health Belief Model (HBM), we developed a 25-question, web-based survey to assess practices. Survey links were distributed nationwide to pediatric SCD and/or general hematology providers through their publicly available emails and by request to directors of U.S.-accredited Pediatric Hematology-Oncology fellowship programs for distribution to their SCD providers. Data analysis included descriptive statistics, chi-square analysis, and logistic regression. RESULTS Of 177 respondents, 160 surveys meeting inclusion criteria were analyzed. Most providers reported counseling (77.5%) and referring female AYA patients for contraception (90.8%), but fewer reported prescribing contraception (41.8%). Proportionally fewer trainees provided counseling compared with established providers (54% vs. 85%, p < .001), with a similar trend for prescribing (p = .05). Prescription practices did not differ significantly by provider beliefs regarding potential teratogenicity of hydroxyurea. Key motivators included patient request and disclosure of sexual activity. Key barriers included inadequate provider training, limited visit time, and perceived patient/parent interest. CONCLUSION Provider contraceptive practices for female AYAs with SCD varied, especially by provider status. Health beliefs regarding teratogenic potential of hydroxyurea did not correlate with contraceptive practices. Clinical guidelines, provider training, and patient/parent decision-making tools may be tested to assess whether provider contraceptive practices could be improved.
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Affiliation(s)
- Megan A Askew
- Department of Pediatrics, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Arlene M Smaldone
- Department of Scholarship and Research, School of Nursing and College of Dental Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Melanie A Gold
- Department of Pediatrics, Division of Child and Adolescent Health, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
| | - Kim Smith-Whitley
- Division of Hematology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - John J Strouse
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zhezhen Jin
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Nancy S Green
- Department of Pediatrics, Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Columbia University Irving Medical Center/New York-Presbyterian Hospital, New York, New York, USA
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28
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Cunard R, Gopal S, Kopko PM, Dang MU, Hazle KM, Sanchez AP. Comprehensive guide to managing a chronic automated red cell exchange program in sickle cell disease. J Clin Apher 2022; 37:497-506. [PMID: 36172983 DOI: 10.1002/jca.22014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022]
Abstract
Sickle cell disease (SCD) is associated with significant morbidity and mortality, and limits both the quality and quantity of life. Transfusion therapy, specifically automated red cell exchange (aRCE), plays a key role in management of SCD and is beneficial for certain indications in the chronic, outpatient setting. The approach to maintain a successful chronic aRCE program for SCD is multifaceted. This review will highlight important considerations including indications for aRCE, patient selection, transfusion medicine pearls, vascular access needs, complications of therapy, aRCE prescription, and therapy optimization. Moreover, the importance of a multidisciplinary approach with frequent communication between the services involved cannot be overstated. Ultimately, the underlying goal of a chronic RCE program is to improve the quality of life and longevity of patients with SCD.
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Affiliation(s)
- Robyn Cunard
- Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Srila Gopal
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Patricia M Kopko
- Department of Pathology and Laboratory Medicine, University of California San Diego, La Jolla, California, USA
| | | | | | - Amber P Sanchez
- Department of Medicine, University of California San Diego, La Jolla, California, USA
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29
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Figueira CO, Surita FG, Fertrin K, Nobrega GDM, Costa ML. Main Complications during Pregnancy and Recommendations for Adequate Antenatal Care in Sickle Cell Disease: A Literature Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:593-601. [PMID: 35139577 PMCID: PMC9948053 DOI: 10.1055/s-0042-1742314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Sickle cell disease (SCD) is the most common monogenic disease worldwide, with a variable prevalence in each continent. A single nucleotide substitution leads to an amino-acid change in the β-globin chain, altering the normal structure ofhemoglobin, which is then called hemoglobin S inherited in homozygosity (HbSS) or double heterozygosity (HbSC, HbSβ), and leads to chronic hemolysis, vaso-occlusion, inflammation, and endothelium activation. Pregnant women with SCD are at a higher risk of developing maternal and perinatal complications. We performed a narrative review of the literature considering SCD and pregnancy, the main clinical and obstetrical complications, the specific antenatal care, and the follow-up for maternal and fetal surveillance. Pregnant women with SCD are at a higher risk of developing clinical and obstetric complications such as pain episodes, pulmonary complications, infections, thromboembolic events, preeclampsia, and maternal death. Their newborns are also at an increased risk of developing neonatal complications: fetal growth restriction, preterm birth, stillbirth. Severe complications can occur in patients of any genotype. We concluded that SCD is a high-risk condition that increases maternal and perinatal morbidity and mortality. A multidisciplinary approach during pregnancy and the postpartum period is key to adequately diagnose and treat complications.
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Affiliation(s)
| | | | - Kleber Fertrin
- Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington, United States
| | | | - Maria Laura Costa
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
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30
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Pompeo CM, Ferreira Júnior MA, Cardoso AIDQ, Souza MDC, Frota OP, Mota FM, Ivo ML. Clinical-Epidemiological Characteristics and Mortality in Patients with Sickle Cell Anemia: A Retrospective Cohort Study of 1980 at 2018. Int J Gen Med 2022; 15:1057-1074. [PMID: 35140508 PMCID: PMC8818769 DOI: 10.2147/ijgm.s342971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/07/2021] [Indexed: 01/09/2023] Open
Abstract
Purpose To analyze the clinical-epidemiological characteristics and mortality in patients with sickle-cell anemia (SCA). Patients and Methods A cohort study with retrospective data, conducted in two reference hospitals for SCA treatment from January 1980 to December 2018, recorded in two reference services. With a 5% significance level, the Chi-Square and Student’s t-tests were employed in the inferential statistical analysis. Results A total of 128 patients with SCA were studied. Diagnosis up to the fifth day of life was made in 10 patients. There were 19 deaths, of which 12 (63.2%) were female, and the average age at death was 27.05 (± 14.78) years. The leading causes of death were septic shock and cardiogenic shock. The use of invasive medical devices was considered a risk factor for death (RR=2.63; 95% CI=1.16–5.96; p=0.018), and monitoring time up to 20 years presented a 31% reduction in the risk of dying (RR=0.31; 95% CI=0.12–0.82; p=0.011) when compared to the monitoring of more than 20 years. Conclusion These findings are to be considered in the treatment of patients with SCA, mainly regarding early diagnosis and access to the treatment immediately afterward, since they are fundamental in improving survival and reducing severe complications.
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Affiliation(s)
- Carolina Mariano Pompeo
- Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
- Correspondence: Carolina Mariano Pompeo, Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil, Tel +55 67 99984-7048, Email
| | | | | | - Mercy da Costa Souza
- Graduate Program in Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Oleci Pereira Frota
- Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Felipe Machado Mota
- Integrated Institute of Health, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
| | - Maria Lúcia Ivo
- Graduate Program in Health and Development in the Midwest Region, Federal University of Mato Grosso do Sul, Campo Grande, Mato Grosso do Sul, Brazil
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31
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McCaw-Binns A, Campbell L, Harris A, James LA, Asnani M. Maternal mortality among women with sickle cell disease in Jamaica over two decades (1998-2017). EClinicalMedicine 2022; 43:101238. [PMID: 34977515 PMCID: PMC8683691 DOI: 10.1016/j.eclinm.2021.101238] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) affects 2.8% of Jamaican antenatal women. Between 1998-2007 their maternal mortality ratio was 7-11 times higher than women without these disorders. We aim to determine if outcomes improved between 2008 and 17 amid declining fertility and changes in referral obstetric care. METHODS Maternal deaths in Jamaica's maternal mortality surveillance database (assembled since 1998) with SCD reported as underlying or associated cause of death were compared to those without known SCD, over two decades from 1998 to 2017. Social, demographic and health service variables were analysed using SPSS and EpiInfo Open. FINDINGS Over the two decades from 1998 to 2017, 806 (74%) of the 1082 pregnancy-associated deaths documented by the Jamaican Ministry of Health and Wellness were maternal deaths. The maternal mortality ratio (MMR) did not statistically change over the two periods for women with (p = 0.502) and without SCD (p = 0.629). The MMR among women with and without SCD in 2008-17 was 378.1 (n = 41) and 89.2/100,000 live births (n = 336) respectively, an odds ratio of 4.24 (95% CI: 3.07-5.87). When deaths due to their blood disorders were excluded, risk remained elevated at 2.17 (95% CI: 1.36-3.32). There was an upward trend in direct deaths over the two decades (p [trend]=0.051). INTERPRETATION MMRs were unchanged over two decades for Jamaicans with SCD. The high contribution to maternal mortality by women with SCD may explain some of the persistently higher mortality experience of women in the African diaspora. Multi-disciplinary evidence-based strategies need to be developed and tested which improve survival for women with SCD who want to have children. FUNDING No external funding was provided.
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Affiliation(s)
- Affette McCaw-Binns
- Department of Community Health & Psychiatry, Faculty of Medical Sciences, The University of the West Indies, Mona Campus, Kingston, Jamaica
| | - Leroy Campbell
- Victoria Jubilee Hospital, South-East Regional Health Authority, North Street, Kingston, Jamaica
| | - Ardene Harris
- Ministry of Health & Wellness, Epidemiology Unit, 10-16 Grenada Crescent, Kingston 5, Jamaica
| | - Lesley-Ann James
- Ministry of Health & Wellness, Epidemiology Unit, 10-16 Grenada Crescent, Kingston 5, Jamaica
| | - Monika Asnani
- Sickle Cell Unit, Caribbean Institute for Health Research, The University of the Indies, Mona Campus, Kingston 7, Jamaica
- Corresponding author at: Sickle Cell Unit, Caribbean Institute for Health Research, The University of the Indies, Mona Campus, Kingston 7, Jamaica.
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Oakley LL, Mitchell S, von Rege I, Hadebe R, Howard J, Robinson SE, Oteng-Ntim E. Perinatal outcomes in women with sickle cell disease: a matched cohort study from London, UK. Br J Haematol 2021; 196:1069-1075. [PMID: 34881428 DOI: 10.1111/bjh.17983] [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: 09/09/2021] [Revised: 11/01/2021] [Accepted: 11/19/2021] [Indexed: 11/29/2022]
Abstract
There are limited data on contemporary outcomes for women with sickle cell disease (SCD) in pregnancy. We conducted a single-site matched cohort study, comparing 131 pregnancies to women with SCD between 2007 and 2017 to a comparison group of 1310 pregnancies unaffected by SCD. Restricting our analysis to singleton pregnancies that reached 24 weeks of gestation, we used conditional Poisson regression to estimate adjusted risk ratios (aRRs) for perinatal outcomes. Infants born to mothers with SCD were more likely to be small for gestational age [aRR 1·69, 95% confidence interval (CI) 1·13-2·48], preterm (aRR 2·62, 95% CI 1·82-3·78) and require Neonatal Unit (NNU) admission (aRR 3·59, 95% CI 2·18-5·90). Pregnant women with SCD were at higher risk of pre-eclampsia/eclampsia (aRR 3·53, 95% CI 2·00-6·24), more likely to receive induction of labour (aRR 2·50, 95% CI 1·82-1·76) and caesarean birth (aRR 1·44, 95% CI 1·18-1·76). In analysis stratified by genotype, the risk of adverse outcomes was highest in haemoglobin SS (HbSS) pregnancies (n = 80). There was no strong evidence that haemoglobin SC (HbSC) pregnancies (n = 46) were at higher risk of preterm birth, caesarean delivery, or NNU admission. Pre-eclampsia/eclampsia was more frequently observed in HbSC pregnancies. Despite improvements in the care of pregnant women with SCD, the increased risk of adverse perinatal outcomes remains.
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Affiliation(s)
- Laura L Oakley
- Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Sian Mitchell
- Department of Women & Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Inez von Rege
- Department of Women & Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Ruth Hadebe
- Department of Women & Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jo Howard
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Susan E Robinson
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Eugene Oteng-Ntim
- Department of Women & Children's Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Pecker LH, Sharma D, Nero A, Paidas MJ, Ware RE, James AH, Smith-Whitley K. Knowledge gaps in reproductive and sexual health in girls and women with sickle cell disease. Br J Haematol 2021; 194:970-979. [PMID: 34231198 PMCID: PMC8448913 DOI: 10.1111/bjh.17658] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 02/02/2023]
Abstract
There is an immediate need to address long-standing questions about the reproductive health of girls and women with sickle cell disease (SCD). There are many SCD-related reproductive risks and uncertainties across girls' and women's reproductive life span, with particularly outstanding concerns about menstruation, contraception, fertility and pregnancy. Extant literature addressing women's reproductive health topics is mostly descriptive; there are few high-quality interventional studies. In 2020, the Centers for Disease Control and Prevention and the Foundation for Women and Girls with Blood Disorders convened an expert panel to assess the knowledge gaps in women's reproductive health in SCD. The panel identified significant limitations to clinical care due to the need for research. The panel also identified prominent barriers to research and care. In this report, we frame these issues, providing a roadmap for investigators, funding agencies, and policy makers to advance care for girls and women with SCD.
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Affiliation(s)
- Lydia H. Pecker
- Johns Hopkins University School of Medicine, Division of Hematology, Department of Medicine & Gynecology & Obstetrics, Baltimore MD
| | - Deva Sharma
- Vanderbilt University Medical Center, Divisions of Transfusion Medicine and Hematology
| | - Alecia Nero
- Department of Medicine, Division of Hematology/Oncology, University of Texas Southwestern
| | - Michael J. Paidas
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Miller School of Medicine
| | - Russell E. Ware
- Division of Pediatric Hematology, Department of Pediatrics, Cincinnati Children’s Hospital
| | - Andra H. James
- Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, Department of Medicine, Division of Hematology, Duke University, Durham, NC
| | - Kim Smith-Whitley
- Division of Hematology, The Children’s Hospital of Philadelphia, Philadelphia, PA
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34
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Proske P, Distelmaier L, Aramayo-Singelmann C, Koliastas N, Iannaccone A, Papathanasiou M, Temme C, Klump H, Lenz V, Koldehoff M, Carpinteiro A, Reinhardt HC, Köninger A, Röth A, Yamamoto R, Dührsen U, Alashkar F. Pregnancies and Neonatal Outcomes in Patients with Sickle Cell Disease (SCD): Still a (High-)Risk Constellation? J Pers Med 2021; 11:jpm11090870. [PMID: 34575647 PMCID: PMC8464744 DOI: 10.3390/jpm11090870] [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: 07/29/2021] [Revised: 08/26/2021] [Accepted: 08/27/2021] [Indexed: 11/24/2022] Open
Abstract
Background: This monocentric study conducted at the University Hospital of Essen aims to describe maternal and fetal/neonatal outcomes in sickle cell disease (SCD) documented between 1996 to 2021 (N = 53), reflecting the largest monocentric analysis carried out in Germany. Methods/Results: 46 pregnancies in 22 patients were followed. None of the patients died. In total, 35% (11/31) of pregnancies were preterm. 15 pregnancies in eight patients were conceived on hydroxycarbamide (HC), of which nine had a successful outcome and three were terminated prematurely. There was no difference regarding the rate of spontaneous abortions in patients receiving HC compared to HC-naive patients prior to conception. In patients other than HbS/C disease, pregnancies were complicated by vaso-occlusive crises (VOCs)/acute pain crises (APCs) (96%, 23/24); acute chest syndrome (ACS) (13%, 3/24), transfusion demand (79%, 19/24), urinary tract infections (UTIs) (42%, 10/24) and thromboembolic events (8%, 2/24). In HbS/C patients complications included: VOCs/APCs (43%, 3/7; ACS: 14%, 1/7), transfusion demand (14%, 1/7), and UTIs (14%, 1/7). Independent of preterm deliveries, a significant difference with respect to neonatal growth in favor of neonates from HbS/C mothers was observed. Conclusion: Our data support the results of previous studies, highlighting the high rate of maternal and fetal/neonatal complications in pregnant SCD patients.
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Affiliation(s)
- Pia Proske
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (P.P.); (L.D.); (M.K.); (A.C.); (H.C.R.); (A.R.); (U.D.)
| | - Laura Distelmaier
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (P.P.); (L.D.); (M.K.); (A.C.); (H.C.R.); (A.R.); (U.D.)
- Vivantes, MVZ Neukölln, 12351 Berlin, Germany
| | - Carmen Aramayo-Singelmann
- Department of Pediatrics III, University Children’s Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany;
| | - Nikolaos Koliastas
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147 Essen, Germany; (N.K.); (A.I.); (A.K.)
| | - Antonella Iannaccone
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147 Essen, Germany; (N.K.); (A.I.); (A.K.)
| | - Maria Papathanasiou
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center, Medical Faculty, University Hospital Essen, 45147 Essen, Germany;
| | - Christian Temme
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (C.T.); (H.K.); (V.L.)
| | - Hannes Klump
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (C.T.); (H.K.); (V.L.)
| | - Veronika Lenz
- Institute for Transfusion Medicine, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (C.T.); (H.K.); (V.L.)
| | - Michael Koldehoff
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (P.P.); (L.D.); (M.K.); (A.C.); (H.C.R.); (A.R.); (U.D.)
| | - Alexander Carpinteiro
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (P.P.); (L.D.); (M.K.); (A.C.); (H.C.R.); (A.R.); (U.D.)
- Institute for Molecular Biology, University of Duisburg-Essen, 45147 Essen, Germany
| | - Hans Christian Reinhardt
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (P.P.); (L.D.); (M.K.); (A.C.); (H.C.R.); (A.R.); (U.D.)
| | - Angela Köninger
- Department of Gynecology and Obstetrics, University of Duisburg-Essen, 45147 Essen, Germany; (N.K.); (A.I.); (A.K.)
- Hospital of the Order of St. John of God Regensburg, Clinic for Gynaecology and Obstetrics, 93049 Regensburg, Germany
| | - Alexander Röth
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (P.P.); (L.D.); (M.K.); (A.C.); (H.C.R.); (A.R.); (U.D.)
| | | | - Ulrich Dührsen
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (P.P.); (L.D.); (M.K.); (A.C.); (H.C.R.); (A.R.); (U.D.)
| | - Ferras Alashkar
- Department of Hematology and Stem Cell Transplantation, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, 45147 Essen, Germany; (P.P.); (L.D.); (M.K.); (A.C.); (H.C.R.); (A.R.); (U.D.)
- Correspondence:
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Pecker LH, Hussain S, Lanzkron S, Tao X, Thaler K, Burke AE, Whaley N. Women with sickle cell disease report low knowledge and use of long acting reversible contraception. J Natl Med Assoc 2021; 113:552-559. [PMID: 34119338 DOI: 10.1016/j.jnma.2021.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 02/02/2021] [Accepted: 05/11/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND High rates of unplanned pregnancy and low rates of contraception use are reported among women with sickle cell disease (SCD). Pregnancy in women with SCD is high risk and unintended pregnancies limit opportunities to provide indicated preconception care and counseling. Contraceptive use in women with SCD is complicated by a lack of disease-specific data about treatment risks and benefits. The purpose of this study was to describe, for the first time in the U.S. context, contraceptive use, knowledge and preferences in adult cohort of women with SCD. MATERIALS AND METHODS A single-center survey study of women with SCD of reproductive age from our Center's adult and pediatric sickle cell centers. RESULTS Seventy-eight women ages 28-65 years (median 33.5 years, IQR 16) completed surveys. Seventy-three percent of respondents had an average of 2.5 pregnancies (S.D. 1.22) and of these, 58% reported being pregnant when they did not want to be pregnant at least once. The most common forms of contraception used were condoms (87%), birth control pills (46%), medroxyprogesterone (44%) and withdrawal (44%). Twenty-two percent of subjects reported using a long-acting reversible form of contraception and 21% reported a tubal ligation or partner vasectomy. Respondents demonstrated low knowledge of the efficacy of contraceptive options and over-estimated the risk of pregnancy with the IUD, implant. Contraceptive priorities included pregnancy prevention, decreasing HIV transmission and effects on SCD symptoms. CONCLUSIONS Women with SCD have high rates of unintended pregnancy, low knowledge of contraceptive efficacy and low use of long-acting reversible contraception.
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Affiliation(s)
- Lydia H Pecker
- Division of Hematology, Department of Medicine; Department of Gynecology and Obstetrics.
| | | | | | - Xueting Tao
- Department of Pediatrics; Biostatistics, Epidemiology and Data Management Core, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Anne E Burke
- Division of Family Planning; Department of Gynecology and Obstetrics
| | - Natalie Whaley
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester NY, USA
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Sousa VTD, Ballas SK, Leite JM, Olivato MCA, Cancado RD. Maternal and perinatal outcomes in pregnant women with sickle cell disease: an update. Hematol Transfus Cell Ther 2021; 44:369-373. [PMID: 33716021 PMCID: PMC9477754 DOI: 10.1016/j.htct.2020.12.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/30/2020] [Accepted: 12/08/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The aim of this study was to describe maternal and perinatal outcomes in pregnant women with sickle cell disease (SCD) followed at Santa Casa de Sao Paulo over a 10-year period (between 2010 and 2019). METHOD Fifty-five records of pregnancies were analyzed among 35 women with SCD. RESULTS Among 29 newborns, 19 (65.5%) were full-term and 10 pre-term; 24 (82.7%) caesareans and 5 (17.2%) natural births were observed. The mean gestational age at birth and mother`s age were 36.6 weeks (30-40) and 26.7 years (17-39), respectively. No maternal death was observed. The main maternal obstetric and non-obstetric complications were: pre-eclampsia and gestational diabetes, and vaso-occlusive crisis, urinary tract infection and acute chest syndrome, respectively. Twenty-six (47.0%) fetal deaths were observed, 24 being intrauterine fetal (14 early abortions, 10 late abortions and 2 stillbirths). Regarding the red blood cell transfusion history, 40 (72.7%) out of 55 pregnancies received transfusion. Pregnant women who received 6 or more transfusions throughout pregnancy had a significantly lower number of abortions, i.e., no cases of early abortion and only 1 case of late abortion, versus 14 and 9 cases in pregnancies with 0-5 transfusions, respectively. Despite advances in the management of SCD, pregnant women with SCD (particularly those with HbSS) are at a high risk for maternal and fetal complications, even though they are followed in reference centers. CONCLUSION The lower risk of intrauterine fetal death for those women who received more transfusions throughout pregnancy observed in the current study leads us once more to raise the need for prospective, multicenter, randomized trials to determine whether the potential benefits balance the risks of prophylactic transfusions.
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Affiliation(s)
- Viviane Teixeira de Sousa
- Santa Casa de São Paulo Medical School, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Samir K Ballas
- Cardeza Foundation for Hematologic Research, Thomas Jefferson University, Philadelphia, United States
| | - Júlia Mota Leite
- Santa Casa de São Paulo Medical School, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Maria Cristina Albe Olivato
- Santa Casa de São Paulo Medical School, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil
| | - Rodolfo D Cancado
- Santa Casa de São Paulo Medical School, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Brazil.
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Ogu UO, Badamosi NU, Camacho PE, Freire AX, Adams-Graves P. Management of Sickle Cell Disease Complications Beyond Acute Chest Syndrome. J Blood Med 2021; 12:101-114. [PMID: 33658881 PMCID: PMC7920619 DOI: 10.2147/jbm.s291394] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/07/2021] [Indexed: 12/14/2022] Open
Abstract
Sickle cell disease results in numerous complications that can lead to significant morbidity and mortality. Amongst them, acute chest syndrome is the leading cause of mortality. As a result, most providers are in tune with this complication and well versed with management. As sickle cell patients now live longer, they face a multitude of other complications that if left unattended, can lead to significant morbidity and mortality as well. It is critical to look beyond acute chest syndrome and adopt a more comprehensive approach to the management of the sickle cell patient.
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Affiliation(s)
- Ugochi O Ogu
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Nnenna U Badamosi
- Division of Pediatric Hematology and Oncology, Medical College of Georgia, Augusta, GA, USA
| | - Pamela E Camacho
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Amado X Freire
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Patricia Adams-Graves
- Center for Sickle Cell Disease, University of Tennessee Health Science Center, Memphis, TN, USA
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Singh Y, Chabra A, Venkateswaran V, Trikha A. Sickle cell disease in pregnancy and anaesthetic implications: A narrative review. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.4103/joacc.joacc_76_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
Sickle cell disease is an umbrella term for a group of hemoglobinopathies characterized by the presence of 2 β-globin gene mutations or deletions, at least 1 of which is the point mutation that leads to the production of hemoglobin S. Sickle cell disease is associated with hemolytic anemia, significant chronic end-organ damage, and early death. In high-income countries, at least 95% of children with the disease survive into adulthood, resulting in a growing population of affected adults with significant comorbidities, complex medical issues, and not enough specialists to provide care. Hydroxyurea is the primary therapy, and recent advances in understanding disease pathophysiology have led to new therapies; progress in bone marrow transplant and gene editing has resulted in cure in some patients. The purpose of this review is to provide an overview of the diagnosis, common acute and chronic clinical manifestations, and best practices for management of sickle cell disease.
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Affiliation(s)
- Lydia H Pecker
- Johns Hopkins University School of Medicine, Baltimore, Maryland (L.H.P., S.L.)
| | - Sophie Lanzkron
- Johns Hopkins University School of Medicine, Baltimore, Maryland (L.H.P., S.L.)
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Trikha A. A ten-year-old obstetric anaesthesia journal: Musings of an editor. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.4103/joacc.joacc_86_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Inusa BPD, Stewart CE, Mathurin-Charles S, Porter J, Hsu LLY, Atoyebi W, De Montalembert M, Diaku-Akinwumi I, Akinola NO, Andemariam B, Abboud MR, Treadwell M. Paediatric to adult transition care for patients with sickle cell disease: a global perspective. LANCET HAEMATOLOGY 2020; 7:e329-e341. [PMID: 32220342 DOI: 10.1016/s2352-3026(20)30036-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 01/26/2020] [Accepted: 01/28/2020] [Indexed: 01/19/2023]
Abstract
Sickle cell disease is a life-threatening inherited condition designated as a public health priority by WHO. Increased longevity of patients with sickle cell disease in high-income, middle-income, and low-income countries present unprecedented challenges for all settings; however, a globally standardised solution for patient transition from paediatric to adult sickle cell disease health care is unlikely to address the challenges. We established a task force of experts from a multicountry (the USA, Europe, Middle East, and Africa) consortium. We combined themes from the literature with viewpoints from members of the task force and invited experts to provide a global overview of transition care practice, highlighting barriers to effective transition care and provide baseline recommendations that can be adapted to local needs. We highlighted priorities to consider for any young person with sickle cell disease transitioning from paediatric to adult health care: skills transfer, increasing self-efficacy, coordination, knowledge transfer, linking to adult services, and evaluating readiness (the SICKLE recommendations). These recommendations aim to ensure appropriate benchmarking of transition programming, but multisite prospective studies are needed to address this growing public health need.
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Affiliation(s)
- Baba Psalm Duniya Inusa
- Department of Paediatric Haematology, Evelina London Children's Hospital, Guy's and St Thomas NHS Foundation Trust, London, UK.
| | | | | | - Jerlym Porter
- St Jude Children's Research Hospital, Memphis, TN, USA
| | - Lewis Li-Yen Hsu
- Comprehensive Sickle Cell Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Wale Atoyebi
- Cancer and Haematology Centre, Churchill Hospital, Oxford, UK
| | - Mariane De Montalembert
- Reference Center for Sickle Cell Disease, Hôpital Necker-Enfants malades, Assistance Publique - Hôpitaux de Paris, Université Paris Descartes, Paris France; Labex GR-Ex, Paris, France
| | | | - Norah O Akinola
- Department of Haematology and Immunology, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Biree Andemariam
- New England Sickle Cell Institute, Neag Comprehensive Cancer Center, University of Connecticut Health, Farmington, CT, USA
| | - Miguel Raul Abboud
- Department of Pediatric Hematology Oncology, American University Beirut, American University Beirut, Lebanon
| | - Marsha Treadwell
- University of California San Francisco Benioff Children's Hospital Oakland, Oakland, California, USA
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