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Raffa EH, Raffa L, Almadani S, Murad W, Alshanti H. Optical Coherence Tomography Angiography of Macular Microangiopathy in Children With Sickle Cell Disease. J Pediatr Hematol Oncol 2024:00043426-990000000-00471. [PMID: 39092906 DOI: 10.1097/mph.0000000000002934] [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] [Received: 12/23/2023] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
In this study, we identified the presence of sickle cell maculopathy and determined correlations between hemolysis indicators and systemic and ocular manifestations in children with sickle cell disease (SCD). Thirty-three patients with SCD 5 to 18 years of age underwent optical coherence tomography angiography (OCTA) as part of a thorough eye examination. The hematological indices and clinical data (hemoglobin, fetal hemoglobin, mean corpuscular volume, and frequency of sickle cell-associated complications and therapy) were collected. The SCD group contained 33 patients (66 eyes), and the control group contained 36 healthy participants (72 eyes). The SCD group had significantly thinner parafoveal thickness (P=0.041) and significantly smaller parafoveal volume (P=0.041) than the controls. The SCD group had lower deep capillary plexus density than the controls (P=0.029). The SCD group had significantly smaller flow areas than the controls (P<0.001). The foveal avascular zone (FAZ) perimeter, foveal density, and FAZ area in the entire retina did not differ significantly between the groups (P>0.05). The platelet level was negatively correlated with parafoveal and perifoveal thickness and density. OCTA detected early macular microvascular changes in children and adolescents with asymptomatic SCD.
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Affiliation(s)
- Enass H Raffa
- Department of Pediatrics, King Abdulaziz University Hospital
- Faculty of Medicine, King Abdulaziz University
- Department of Oncology, King Faisal Specialist Hospital and Research Center
| | - Lina Raffa
- Faculty of Medicine, King Abdulaziz University
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Wesal Murad
- Faculty of Medicine, King Abdulaziz University
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Alan S, Kanter J. Advances in pharmacotherapy for sickle cell disease: what is the current state of play? Expert Opin Pharmacother 2024; 25:1325-1334. [PMID: 38973339 DOI: 10.1080/14656566.2024.2377711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/04/2024] [Indexed: 07/09/2024]
Abstract
INTRODUCTION Despite over 100 years of neglect and insufficient funding, sickle cell disease has risen to the top of the discussions due to the recent approval of two new genetic therapies. Prior to these approvals, there were only four prior approved medications for sickle cell disease in spite of being the most common inherited blood disorder. The advent and expense of these new genetic therapies have finally brought the trials and tribulations associated with SCD including the suffering and early mortality of affected individuals to the much-needed limelight. Presently, questions about how these therapies will be used and what that means for ongoing pharmaceutical development remain. AREAS COVERED Here, we wish to highlight the current medications and treatments for SCD using already published literature as well as scrutinize the tedious process of implementation for these newly approved commercial genetic therapies. EXPERT OPINION In our expert opinion, despite the progress we have made, significant challenges remain and the most important requirement for any of these treatments is ensuring all affected individuals have access to a sickle cell specialist who can provide comprehensive care.
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Affiliation(s)
- Sheinei Alan
- Inova Adult Sickle Cell Center, University of Virginia School of Medicine, Inova Fairfax Medical Campus, Fairfax, VA, USA
| | - Julie Kanter
- Lifespan Comprehensive Sickle Cell Center, University of Alabama Birmingham, Birmingham, AL, USA
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Yaya I, Pourageaud A, Derbez B, Odièvre MH, Oudin Doglioni D, Podevin M, Thomas G, Yombo-Kokule L, Godart C, Lepetit M, Cassubie-Mercier T, Galacteros F, Chassany O. Predictors of health-related quality of life in a large cohort of adult patients living with sickle cell disease in France: the DREPAtient study. Front Public Health 2024; 12:1374805. [PMID: 38832226 PMCID: PMC11144927 DOI: 10.3389/fpubh.2024.1374805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/22/2024] [Indexed: 06/05/2024] Open
Abstract
Background Sickle cell disease (SCD) is an inherited autosomal recessive disorder exhibiting a range of symptoms and acute and/or chronic complications that affect the quality of life. This study aimed to assess health-related quality of life (HRQoL) and to identify the associated factors in adult patients with SCD in France. Methods DREPAtient is a cross-sectional, multicenter study conducted from June 2020 to April 2021 in France and in certain French overseas territories where SCD is highly prevalent. Sociodemographic and clinical data were collected online. HRQoL was assessed by the French version of the 36-Item Short Form Survey (SF-36) questionnaire. HRQoL determinants were identified using multivariable linear regression analysis. Results In total, 570 participants were included, mostly women (68.9%), with a mean age of 33.3 (±10.7) years. The highest mean score HRQoL was found in the Physical functioning domain (67.5 ± 21.8) and the lowest mean score in the General Health perception domain (37.7 ± 20.3). The mean score of the physical composite (PCS) and mental composite (MCS) of SF-36 summary scores was 40.6 ± 8.9 and 45.3 ± 9.8, respectively. Participants receiving oxygen therapy (β = -3.20 [95%CI: -5.56; -0.85]), those with a history of femoral osteonecrosis (-3.09 [-4.64; -1.53]), those hospitalized for vaso-occlusive crisis (VOC) or acute chest syndrome (ACS) (-2.58 [-3.93; -1.22]), those with chronic complications (-2.33 [-4.04; -0.62]), female participants (-2.17 [-3.65; -0.69]), those with psychological follow-up (-2.13 [-3.59; -0.67]), older participants (-1.69 [-3.28; -0.09]), and those receiving painkillers (-1.61 [-3.16; -0.06]) reported worse PCS score. By contrast, those who had completed secondary or high school (4.36 [2.41; 6.31]) and those with stable financial situation (2.85 [0.94, 4.76]) reported better PCS scores. Worse MCS scores were reported among participants with psychological follow-up (-2.54 [-4.28; -0.80]) and those hospitalized for VOC/ACS in the last 12 months (-2.38 [-3.99; -0.77]), while those who had relatives' support (5.27 [1.92; 8.62]) and those with stable financial situation (4.95 [2.65; 7.26]) reported better MCS scores. Conclusion Adults with major SCD reported poor physical and mental HRQoL scores. Hospitalization for VOC/ACS, chronic complications, use of painkillers, perceived financial situation, and support from relatives are important predictors of HRQoL in SCD patients. Interventions to improve HRQoL outcomes SCD should be considered.
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Affiliation(s)
- Issifou Yaya
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- ECEVE, UMR-S 1123, Université Paris Cité, Inserm, Paris, France
| | - Adrien Pourageaud
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- ECEVE, UMR-S 1123, Université Paris Cité, Inserm, Paris, France
| | | | - Marie-Hélène Odièvre
- Department of General Pediatrics, Sickle Cell Referal Center, Trousseau Hospital, AP-HP, Sorbonne Université, Paris, France
- INSERM U1134, Integrated Red Globule Biology, Paris, France
| | - Damien Oudin Doglioni
- Laboratoire Interuniversitaire de Psychologie/Personnalité, Cognition, Changement Social (LIP/PC2S), Université Grenoble Alpes, Grenoble, France
| | | | | | - Lisa Yombo-Kokule
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- ECEVE, UMR-S 1123, Université Paris Cité, Inserm, Paris, France
| | - Christian Godart
- Fédération nationale des associations de Malades Drépanocytaires et Thalassémiques SOS GLOBI (FMDT SOS GLOBI), Paris, France
| | - Maryannick Lepetit
- Fédération nationale des associations de Malades Drépanocytaires et Thalassémiques SOS GLOBI (FMDT SOS GLOBI), Paris, France
| | - Tania Cassubie-Mercier
- Fédération nationale des associations de Malades Drépanocytaires et Thalassémiques SOS GLOBI (FMDT SOS GLOBI), Paris, France
| | - Frederic Galacteros
- Sickle Cell Referral Center, Internal Medicine Unit, Henri Mondor Hospital, AP-HP, U-PEC; INSERM-U955, Institut Mondor, Université Paris-Est Créteil, Team 2 Transfusion et Maladies du Globule Rouge, Créteil, France
| | - Olivier Chassany
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
- ECEVE, UMR-S 1123, Université Paris Cité, Inserm, Paris, France
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Panosyan DE, Panosyan WS, Corral I, Hanudel MR, Pak Y, Gotesman M. Sickle Cell Disease Related Vasculopathies and Early Evaluation in a Pediatric Population. In Vivo 2024; 38:1203-1212. [PMID: 38688623 PMCID: PMC11059870 DOI: 10.21873/invivo.13556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/12/2024] [Accepted: 01/31/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND/AIM Cardiovascular pathologies are ubiquitous in sickle cell disease (SCD). A targeted literature review was conducted to compare the overall epidemiology of selected vasculopathies seen in SCD (SCDVs) compared to the general population. Since many SCDV may originate in childhood, the study also focused on the retrospective investigation of SCDVs in a pediatric cohort at the Harbor-UCLA Medical Center. PATIENTS AND METHODS SCDVs were studied along patient age, β-globin genotypes, and fetal hemoglobin (HbF). Urine microalbumin/creatinine ratios (UM/Cr), trans-cranial doppler (TCD) and tricuspid regurgitant jet velocities (TRJV) were analyzed as well. Retinographies and overt vasculopathies were presented descriptively. RESULTS Among 20 females and 20 males [average 8.3 years (2.3-19 years)], 70% had HbSS/Sβ0, 22.5% HbSC and 7.5%-HbSβ+. The mean(±SD) HbF% was 17.4±12.7% (30% higher in <10 vs. ≥10 y/o, and 3 times higher in SS/Sβ0). Twenty-six patients received hydroxyurea and 13/26, L-glutamine. Thirty-six patients had TCDs within 1.4±0.9 years and all laboratory values were obtained within the last 12 months. TCDs showed low-normal velocities, but 2 were higher for HbSS/Sβ0 vs. HbSC/Sβ+ (MCA-96 vs. 86 cm/s, p=0.03; and PCA-50 vs. 41, p<0.001). Nineteen of 28 patients with echocardiograms had measurable TRJV (2.46±0.19 m/s); 9 had TRJV ≥2.5-2.8 m/s, but BNP ≤80 pg/ml. SS/Sβ0 was associated with higher UM/Cr. There were 2 cases with silent infarcts, 1-Moyamoya, 2-persistent macroalbuminuria, and 1-hematuria/renal papillary necrosis. Most ≥9 y/o patients had retinographies without SCD-related changes. There was no correlation among TCD (MCA), TRJV, and UM/Cr (n=17); thus, in this subpopulation, pathologies of cerebral, cardiopulmonary, and renal vasculatures evolved independently. Patients with higher TRJV and/or overt vasculopathy (n=14) were older than ones without (12.5±4.7 vs. 6.1±3.1 y/o, p<0.001), and had lower HbF (11.4±7.6 vs. 20.6±13.8%, p=0.026). CONCLUSION While overt SCDVs are less frequent in children, age-dependent trends/surrogate markers suggest their early origination in youth, justifying intense screening to prevent their progression with disease-modifying measures.
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Affiliation(s)
- Daniel E Panosyan
- University of California Los Angeles, UCLA College of Letters & Science, Los Angeles, CA, U.S.A
| | - William S Panosyan
- University of California Los Angeles, UCLA College of Letters & Science, Los Angeles, CA, U.S.A
| | - Ismael Corral
- Department of Pediatrics, Harbor-UCLA Medical Center (HUMC), Torrance, CA, U.S.A
| | - Mark R Hanudel
- Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, U.S.A
| | - Youngju Pak
- The Lundquist Institute for Biomedical Innovation, Torrance, CA, U.S.A
| | - Moran Gotesman
- Department of Pediatrics, Harbor-UCLA Medical Center (HUMC), Torrance, CA, U.S.A.;
- The Lundquist Institute for Biomedical Innovation, Torrance, CA, U.S.A
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Girish G, Xiang B, Hsu LL. A 21-Year-Old Woman with Sickle Cell Disease and Vaso-Occlusive Pain Associated with Using an Electronic Nicotine Dispensing System (E-Cigarette or Vape) - a Case Report. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e941268. [PMID: 37990483 PMCID: PMC10681956 DOI: 10.12659/ajcr.941268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/17/2023] [Accepted: 09/25/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Sickle cell disease is an inherited blood disorder that leads to multisystem complications. The heterogeneous course of sickle cell disease is due to both genetic modifiers and environmental factors. Cigarette smoking is a strong risk factor for sickle cell complications and even secondhand exposure to tobacco smoke can be detrimental for individuals with sickle cell disease. However, no prior reports have associated e-cigarettes and sickle cell vaso-occlusive pain. CASE REPORT A 21 year old woman presented with sickle cell disease SS complicated by frequent pain, multiple acute chest syndrome episodes, sickle cell nephropathy, and avascular necrosis of the left hip, plus mild intermittent asthma. She developed pain in the ribs and back after her first use of e-cigarettes. After 4 days of home pain management, she came to the Emergency Department. She was mildly hypoxic and received supplemental oxygen. Chest radiograph did not show airspace consolidation, and the sites of pain were consistent with her prior pain episodes, so the diagnosis was sickle cell vaso-occlusive pain. Her hemoglobin was more than 2 g/dL below baseline and she received a red blood cell transfusion on hospital day 2. Overall, this was among her more severe pain episodes. CONCLUSIONS The rising popularity of e-cigarettes, also known as vapes or Electronic Nicotine Delivery Systems (ENDS), is partly due to the misconception that they are safer than traditional cigarettes. Although firm conclusions will depend on studies designed to provide rigorous evidence, this case suggests that the acute adverse effects of ENDS might trigger complications of sickle cell disease, especially with asthma as a comorbidity.
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Affiliation(s)
- Ganga Girish
- Medical College, Chalmeda Anand Rao Institute of Medical Sciences, Bommakal Village, Karimnagar, India
| | - Bingtao Xiang
- College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Lewis L. Hsu
- Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, USA
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Serras-Pereira R, Vieira L, Saunders CJ, Maleita D, Figueiredo R, Anjos R, Marques M, Flores R. Identifying Clinical Predictors of Proliferative Sickle Cell Retinopathy. Curr Eye Res 2023; 48:1063-1067. [PMID: 37494145 DOI: 10.1080/02713683.2023.2242010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE To identify systemic and/or ophthalmologic predictors of proliferative sickle retinopathy. METHODS Cross-sectional study comparing clinical, laboratory, and structural choriorretinal aspects between sickle cell disease patients with and without proliferative retinopathy. Patients underwent complete systemic and ophthalmologic evaluation. Enhanced depth spectral domain optical coherence tomography with choroidal binarization and optic coherence tomography angiography were performed and choriorretinal vascular components were compared. RESULTS Forty-five eyes from 45 sickle cell patients were included. Ninety-one percent of patients were diagnosed with sickle cell retinopathy, 29% with proliferative retinopathy. Mean corpuscular volume, lactate dehydrogenase, and percentage of fetal hemoglobin were reduced in the subgroup of patients with proliferative retinopathy when compared with patients without proliferative retinopathy (p ≤ 0.001; p = 0.04; p ≤ 0.001, respectively). The best predictor of proliferative retinopathy was mean corpuscular volume (AUC = 0.842; p = 0.001), followed by the percentage of fetal hemoglobin (AUC = 0.763, p = 0.009) and lactate dehydrogenase (AUC curve = 0.706; p = 0.039). No differences were found between groups in the quantitative analysis of retinal vascularization using OCTA and choroidal vascularization using OCT (p ≥ 0.05). CONCLUSION Fetal hemoglobin and mean corpuscular volume may be good predictors of proliferative sickle retinopathy. The association between proliferative retinopathy and reduced levels of lactate dehydrogenase and mean corpuscular volume points to hypoxia and not hemolysis as a possible driving force in its pathophysiology.
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Affiliation(s)
- Rita Serras-Pereira
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Luísa Vieira
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Christopher J Saunders
- Hematology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Diogo Maleita
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Ricardo Figueiredo
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rita Anjos
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Margarida Marques
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Rita Flores
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
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Brandsen RP, Diederen RMH, Bakhlakh S, Nur E, Schlingemann RO, Biemond BJ. Natural history and rate of progression of retinopathy in adult patients with sickle cell disease: an 11-year follow-up study. Blood Adv 2023; 7:3080-3086. [PMID: 36897257 PMCID: PMC10331402 DOI: 10.1182/bloodadvances.2022009147] [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: 10/14/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 03/11/2023] Open
Abstract
Sickle cell retinopathy (SCR) is a complication of sickle cell disease (SCD). Proliferative SCR (PSCR) can lead to severe visual impairment due to vitreous hemorrhage or retinal detachment. Knowledge of risk factors for progression and complications of SCR is limited. The aim of this study is to describe the natural history of SCR and to identify risk factors for progressive SCR and development of PSCR. We retrospectively analyzed disease progression in 129 patients with SCD with a median follow-up period of 11 years (interquartile range, 8.5-12). Patients were divided in 2 groups. The genotypes hemoglobin SS (HbSS), HbSβ0-thalassemia, and HbSβ+-thalassemia were grouped together (n = 83; 64.3%), whereas patients with HbSC (n = 46; 35.7%) were grouped separately. Progression of SCR was observed in 28.7% (37 of 129) of patients. Older age (adjusted odds ratio [aOR], 1.073; 95% confidence interval [CI], 1.024-1.125; P = .003), HbSC genotype (aOR, 25.472; 95% CI, 3.788-171.285; P ≤ 0.001), and lower HbF (aOR, 0.786; 95% CI, 0.623-0.993; P = .043) were associated with PSCR at end of follow-up. Lack of any SCR at end of follow-up was associated with female sex (aOR, 2.555; 95% CI, 1.101-5.931; P = .029), HbSS/HbSβ0/HbSβ+ genotype (aOR, 3.733; 95% CI, 1.131-12.321; P = .031), and higher HbF levels (aOR, 1.119; 95% CI, 1.007-1.243; P = .037). Differentiated strategies for screening and follow-up of SCR could be considered for patients at low or high risk.
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Affiliation(s)
- Rajani P. Brandsen
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Roselie M. H. Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Siham Bakhlakh
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Erfan Nur
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Amsterdam, The Netherlands
| | - Reinier O. Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Ophthalmology, University of Lausanne, Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Lausanne, Switzerland
| | - Bart J. Biemond
- Department of Hematology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
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Bojja S, Javed N, Allena N, Bojja S, Khaja M. Rare Cause of Acute Loss of Vision in a Patient With Sickle Cell Trait. Cureus 2023; 15:e42535. [PMID: 37637596 PMCID: PMC10460114 DOI: 10.7759/cureus.42535] [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: 07/27/2023] [Indexed: 08/29/2023] Open
Abstract
Sickle cell disease (SCD) is a prevalent inherited blood disorder with various ocular manifestations, including sickle cell retinopathy (SCR), characterized by retinal microcirculation impairment and ischemic complications. We present the case of a 21-year-old male with sickle cell trait who experienced a sudden, painless loss of vision in his left eye. Ophthalmologic examination revealed vitreous hemorrhage and neovascularization, indicating SCR. Initial treatment with hydroxyurea and exchange transfusions led to partial improvement. However, due to persistent vitreous hemorrhage, the patient underwent a vitrectomy. The sickle cell trait affects a large global population, and its retinopathy is a rare but severe complication. The pathogenesis and risk factors for SCR are similar to those for SCD. The diagnosis of SCR is established through fundoscopic examination and graded based on Goldberg's classification. Management involves a multidisciplinary approach targeting systemic illness and visual defects, including hydroxyurea, photocoagulation, anti-vascular endothelial growth factors, and vitrectomy. Awareness, early diagnosis, and timely intervention are essential to preventing vision-threatening complications in sickle cell trait patients with SCR.
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Affiliation(s)
- Srikaran Bojja
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Nismat Javed
- Internal Medicine, BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Nishant Allena
- Pulmonology, BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York City, USA
| | - Shreya Bojja
- Medicine, Mallareddy Institute Of Medical Sciences, Hyderabad , IND
| | - Misbahuddin Khaja
- Internal Medicine/Pulmonary Critical Care, BronxCare Health System, Icahn School of Medicine at Mount Sinai, New York City, USA
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Caranfa JT, Witkin AJ. Severe proliferative retinopathy in a patient with sickle cell trait. Am J Ophthalmol Case Rep 2023; 30:101824. [PMID: 36874356 PMCID: PMC9976204 DOI: 10.1016/j.ajoc.2023.101824] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/25/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Affiliation(s)
| | - Andre J Witkin
- Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
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