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Jagtiani A, Chou E, Gillespie SE, Liu K, Krishnamurti L, McClish D, Smith WR, Bakshi N. High-impact chronic pain in sickle cell disease: insights from the Pain in Sickle Cell Epidemiology Study (PiSCES). Pain 2024:00006396-990000000-00609. [PMID: 38787626 DOI: 10.1097/j.pain.0000000000003262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 03/15/2024] [Indexed: 05/26/2024]
Abstract
ABSTRACT The US National Pain Strategy recommends identifying individuals with chronic pain (CP) who experience substantial restriction in work, social, or self-care activities as having high-impact chronic pain (HICP). High-impact chronic pain has not been examined among individuals with CP and sickle cell disease (SCD). We analyzed data from 63 individuals with SCD and CP who completed at least 5 months of pain diaries in the Pain in Sickle Cell Epidemiology Study (PiSCES). Forty-eight individuals met the definition for HICP, which was operationalized in this study as reporting pain interference on more than half of diary days. Compared with individuals without HICP, individuals with HICP experienced higher mean daily pain intensity, particularly on days without crises. They also experienced a greater proportion of days with pain, days with healthcare utilization, and days with home opioid use and higher levels of stress. They did not have a statistically significantly higher proportion of days with crises or experience higher mean daily pain intensity on days with crises. Individuals with HICP experienced worse physical functioning and worse physical health compared with those without HICP, controlling for mean pain intensity, age, sex, and education. The results of this study support that HICP is a severely affected subgroup of those with CP in SCD and is associated with greater pain burden and worse health outcomes. The findings from this study should be confirmed prospectively in a contemporary cohort of individuals with SCD.
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Affiliation(s)
- Ashna Jagtiani
- Division of Pediatric Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, Georgia, United States
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, Georgia, United States, Dr. Nitya Bakshi is now with the Division of Pediatric Hematology-Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Eric Chou
- Division of Pediatric Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, Georgia, United States
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, Georgia, United States, Dr. Nitya Bakshi is now with the Division of Pediatric Hematology-Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Scott E Gillespie
- Department of Pediatrics, Pediatric Biostatistics Core, Emory University, Atlanta, Georgia, United States
| | - Katie Liu
- Department of Pediatrics, Pediatric Biostatistics Core, Emory University, Atlanta, Georgia, United States
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States
| | - Donna McClish
- Department of Biostatistics, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Wally R Smith
- Division of General Internal Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, Virginia, United States
| | - Nitya Bakshi
- Division of Pediatric Hematology-Oncology-BMT, Emory University School of Medicine, Atlanta, Georgia, United States
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, Georgia, United States, Dr. Nitya Bakshi is now with the Division of Pediatric Hematology-Oncology, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, United States
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Hanna D, Kamal DE, Fawzy HM, Abd Elkhalek R. Safety and efficacy of monthly high-dose vitamin D 3 supplementation in children and adolescents with sickle cell disease. Eur J Pediatr 2024:10.1007/s00431-024-05572-w. [PMID: 38743288 DOI: 10.1007/s00431-024-05572-w] [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: 03/04/2024] [Revised: 04/02/2024] [Accepted: 04/13/2024] [Indexed: 05/16/2024]
Abstract
Little is known about the impact of vitamin D supplementation on hand grip strength (HGS) and health-related quality of life (HRQoL) in children and adolescents with sickle cell disease (SCD). We aimed to evaluate the safety and efficacy of monthly high-dose vitamin D3 supplementation and its implications on bone mineral density (BMD), HGS, and HRQoL in patients with SCD and healthy controls. The study included 42 children with SCD and 42 healthy matched controls. The study participants were supplemented with high-dose monthly oral vitamin D3. Changes in the serum level of 25(OH) vitamin D3, maximum HGS, and BMD from baseline to 6 months were assessed, and the HRQoL questionnaire and Childhood Health Assessment Questionnaire (CHAQ) were used to evaluate the functional capacity. At baseline, SCD subjects had poorer growth status indicated by negative Z scores. Suboptimal BMD was detected by significantly lower Z score, and lower HGS and worse HRQL parameters were found compared to the controls (P < 0.001). Median 25(OH) vitamin D3 was significantly lower in SCD patients compared to controls (16.5 vs. 28 ng/mL, respectively (P < 0.001)). After 6 months of vitamin D supplementation, there was significant improvement in the DEXA Z-score (P < 0.001), limitation of physical health (P = 0.02), pain scores (P < 0.001), and CHAQ grades (P = 0.01) in SCD patients. A significant improvement in HGS (P < 0.001 and P = 0.005) as well as the CHAQ score (P < 0.001 and P = 0.003) was detected in the SCD group and controls, respectively. There were no reported clinical adverse events (AEs) or new concomitant medications (CMs) during the study duration, and safe levels of Ca and 25 (OH) D3 were observed at 3 and 6 months for both groups. There was a significant positive correlation between HGS and total physical score (r = 0.831, P < 0.001) and a negative correlation with CHAQ score (r = - 0.685, P < 0.001). We also detected a significant positive correlation between vitamin D levels at 6 months and HGS (r = 0.584, P < 0.001), pain score (r = 0.446, P < 0.001), and a negative correlation with CHAQ score (r = - 0.399, P < 0.001). Conclusion: Monthly oral high-dose vitamin D supplementation was safe and effective in improving vitamin D levels, HGS, and HRQoL in SCD children and healthy subjects, and BMD scores in SCD patients. Further randomized controlled trials are warranted to assess an optimal dosing strategy and to investigate the impact on clinically significant outcomes in children and adolescents with SCD and their healthy counterparts. Trial registration: ClinicalTrials.gov , identifier NCT06274203, date of registration: 23/02/2024, retrospectively registered. What is known: • Several studies have reported a high prevalence of vitamin D deficiency and suboptimal bone mineral density (BMD) in sickle cell disease (SCD) patients. • Musculoskeletal dysfunction is reported in SCD patients with a negative impact on physical activity and health-related quality of life (HRQL). • Little is known regarding the impact of vitamin D3 supplementation in children and adolescents with SCD. What is new: • We found that monthly oral high-dose vitamin D3 supplementation was safe, tolerated, and effective in improving serum vitamin D levels, HGS, BMD scores, and HRQL in SCD patients.
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Affiliation(s)
- Diana Hanna
- Pediatric Hematology and Oncology Unit, Pediatrics Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Doaa E Kamal
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hebatallah M Fawzy
- Public Health and Community Medicine Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reham Abd Elkhalek
- Rheumatology and Rehabilitation Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
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McClish D, Okhomina V, Pascale A, Valrie C, Sisler I, Villella A, Smith W. Vaso-occlusive crisis pain intensity, frequency, and duration: which best correlates with health-related quality of life in adolescents and adults with sickle cell disease? Pain 2024; 165:135-143. [PMID: 37578485 PMCID: PMC10840919 DOI: 10.1097/j.pain.0000000000003011] [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: 08/26/2022] [Accepted: 06/15/2023] [Indexed: 08/15/2023]
Abstract
ABSTRACT In a cross-sectional analysis of baseline data from a randomized clinical trial, we studied 198 adolescents and adults aged 15+ with sickle cell disease. Interest was in assessing the relative strengths of the relationship of vaso-occlusive crisis (VOC) pain domains of intensity, frequency, and duration, with health-related quality of life (HRQOL). Variation in psychosocial, physical function, and pain expression domains of HRQOL was partially explained by frequency, intensity, and duration of VOC pain, separately and together, over and above differences in age, sex, genotype, and organ system damage. However, no single domain measure accounted for more than an additional partial R2 of 12.5% alone. Vaso-occlusive crisis pain frequency explained the most variation, when simultaneously considering VOC intensity and duration, except for stiffness , where duration was most predictive. Yet VOC pain intensity, and even VOC duration, also contributed to variability in HRQOL. We recommend that for most purposes, because all 3 VOC pain domains contribute to variability in HRQOL, all 3 domains should be assessed and interventions should be targeted to improve all 3 domains to maximize HRQOL outcomes (Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT02197845 ).
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Affiliation(s)
| | | | - Angela Pascale
- Psychology, Virginia Commonwealth University, Richmond, VA, United States
| | - Cecelia Valrie
- Psychology, Virginia Commonwealth University, Richmond, VA, United States
- VCU Institute for Inclusion, Inquiry, and Innovation, Virginia Commonwealth University, Richmond, VA, United States
| | - India Sisler
- Division of Pediatric Haematology and Oncology, Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, VA, United States
| | - Anthony Villella
- Children's Hospital of King's Daughter, Norfolk, VA, United States
| | - Wally Smith
- Division of General Internal Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, VA, United States
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Mucalo L, Field JJ, Highland J, Khan H, Hankins JS, Singh A, Brandow AM. Preliminary construct validity of patient-reported outcomes to assess chronic pain in adults with sickle cell disease. Blood Adv 2023; 7:3658-3665. [PMID: 37058480 PMCID: PMC10365933 DOI: 10.1182/bloodadvances.2023009707] [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: 01/09/2023] [Revised: 03/23/2023] [Accepted: 04/10/2023] [Indexed: 04/15/2023] Open
Abstract
Chronic pain affects 30% to 40% of individuals with sickle cell disease (SCD) and impairs patient functioning. Clinically meaningful, practical, and valid assessment tools for investigation, evaluation, and management of chronic pain are limited, representing a barrier for advancing SCD care. We sought to determine whether patient-reported outcomes (PROs) show preliminary construct validity in identifying individuals with SCD who were a priori defined as suggestive of having chronic pain based on previously published criteria. All individuals completed the Patient-Reported Outcomes Measurement Information System (PROMIS) domains: pain interference, pain behavior, pain quality (nociceptive, neuropathic), fatigue, sleep disturbance, depression, and anxiety; the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) domains: pain impact and emotional impact; and the painDETECT questionnaire. Thirty-three adults living with SCD were enrolled, and 42.4% had chronic pain. Pain-related PROs scores distinctly differentiated individuals with chronic pain from those without. Individuals with chronic pain had significantly worse pain-related PROs scores: PROMIS pain interference (64.2 vs 54.3), PROMIS pain behavior (63.2 vs 50), and ASCQ-Me pain impact (42.9 vs 53.2). According to published PROMIS clinical cut scores for the pain-related domains, individuals with chronic pain were categorized as having moderate impairment, whereas those without chronic pain had mild or no impairment. Individuals with chronic pain had PRO pain features consistent with neuropathic pain and worse scores in fatigue, depression, sleep disturbance, and emotional impact. Pain-related PROs show preliminary construct validity in differentiating individuals with and without chronic SCD pain and could be used as valuable tools for research and clinical monitoring of chronic pain.
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Affiliation(s)
- Lana Mucalo
- Department of Pediatrics, Section of Hematology/Oncology/Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI
| | - Joshua J. Field
- Division of Hematology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
- Versiti, Medical Sciences Institute, Milwaukee, WI
| | - Janelle Highland
- Department of Pediatrics, Section of Hematology/Oncology/Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI
| | - Hamda Khan
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jane S. Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, TN
| | - Ashima Singh
- Department of Pediatrics, Section of Hematology/Oncology/Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI
| | - Amanda M. Brandow
- Department of Pediatrics, Section of Hematology/Oncology/Blood and Marrow Transplantation, Medical College of Wisconsin, Milwaukee, WI
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Mediators and Moderators of Education Plus Exercise on Perceived Improvement in Individuals With Gluteal Tendinopathy: An Exploratory Analysis of a 3-Arm Randomized Trial. J Orthop Sports Phys Ther 2022; 52:826-836. [PMID: 36306175 DOI: 10.2519/jospt.2022.11261] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE: To investigate mediators and moderators of effects of an education-plus-exercise program compared to corticosteroid injections or wait and see on perceived improvement in individuals with gluteal tendinopathy. METHODS: Exploratory analysis from a clinical trial (n = 204) comparing education plus exercise, corticosteroid injection, and wait and see on global rating of change at 52 weeks. Potential mediators measured at baseline and 8 weeks were hip active abduction range, abductor muscle torque, pain self-efficacy, pain constancy, and patient-specific function. Potential moderators at baseline were Victorian Institute of Sport Assessment for gluteal tendinopathy, menopausal status, symptom duration, magnetic resonance imaging-determined tendon pathology, and pain catastrophizing. RESULTS: There is evidence from mediation analysis that the beneficial effect of education plus exercise on global rating of change relative to corticosteroid injection or wait and see may be due to changes in patient-specific function (indirect effect relative risk; 95% CI: 1.14 [1.05-1.29], 1.29 [1.12-1.58], respectively), pain constancy (1.12 [1.03-1.27], 1.2 [1.08-1.41]), and pain self-efficacy (1.1 [1.02-1.25], 1.18 [1.04-1.44])-not active hip movement/muscle torque. Moderation analysis did not support our included patient characteristics. CONCLUSION: Education plus exercise is likely to improve global rating of change for persons with gluteal tendinopathy relative to corticosteroid injection and wait and see through improvements in patient-specific function, pain self-efficacy, and reduced pain constancy. We found no evidence of differences in the effect of education plus exercise in patient subgroups based on disability, menopausal status, symptom duration, tendon pathology, or pain catastrophizing. J Orthop Sports Phys Ther 2022;52(12):826-836. Epub: 17 October 2022. doi:10.2519/jospt.2022.11261.
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de Oliveira Toledo SL, Ladeira VS, Nogueira LS, Ferreira LGR, Oliveira MM, de Oliveira Renó C, dos Santos HL, Coelho-dos-Reis JGA, Campi-Azevedo AC, Teixeira-Carvalho A, Martins-Filho OA, Rios DRA, Barros-Pinheiro M. Plasma immune mediators as laboratorial biomarkers for Sickle Cell Disease patients according to the hydroxyurea therapy and disease severity. Blood Cells Mol Dis 2022; 98:102703. [DOI: 10.1016/j.bcmd.2022.102703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 08/17/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
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Jiao B, Hankins JS, Devine B, Barton M, Bender M, Basu A. Application of validated mapping algorithms between generic PedsQL scores and utility values to individuals with sickle cell disease. Qual Life Res 2022; 31:2729-2738. [PMID: 35715626 PMCID: PMC10827278 DOI: 10.1007/s11136-022-03167-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE There is a paucity of empirically estimated health state utility (HSU) values to estimate health-related quality of life among individuals with sickle cell disease (SCD). This study aims to map the Pediatric Quality of Life Inventory generic core scales (PedsQL GCS) to HSUs for children and adolescents with SCD in the United States, using published algorithms, and to assess the construct validity of these HSUs against SCD-specific PedsQL scores. METHODS We used the published mapping algorithms identified in four published articles, in which the PedsQL GCS was mapped to either the EuroQol-5 Dimension 3-Level, Youth Version or the Child Health Utility 9-Dimension to obtain HSUs. We employed the algorithms to calculate HSUs for a sample of children and adolescents from the Sickle Cell Clinical Research and Intervention Program. To assess the construct validity of the mapped HSUs in SCD patients, we computed Spearman's correlation coefficient comparing the HSUs with the PedsQL SCD total score and separately with each PedsQL SCD dimension-specific score. RESULTS The mean mapped HSU across published algorithms was 0.792 (95% CI: 0.782-0.801). It was significantly higher among children aged 5-12 years than children aged 13-17 years. The Spearman's correlation coefficient for HSUs versus PedsQL SCD total scores was 0.64 (95% CI: 0.57-0.71). Correlations ranged from 0.40 (95% CI: 0.32-0.48) to 0.60 (95% CI: 0.54-0.66) for HSUs versus PedsQL SCD dimension-specific scores. CONCLUSIONS The existing mapping algorithms show acceptable construct validity in children and adolescents with SCD. Additional algorithms are needed for adults and for specific SCD comorbidities.
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Affiliation(s)
- Boshen Jiao
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, 1959 NE Pacific Street, H-375Q, Box 357630, Seattle, WA, 98195-7630, USA
| | - Jane S Hankins
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, USA
| | - Beth Devine
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, 1959 NE Pacific Street, H-375Q, Box 357630, Seattle, WA, 98195-7630, USA
- Department of Health Services, University of Washington, 1959 NE Pacific Street, H-375Q, Box 357630, Seattle, WA, 98195-7630, USA
| | - Martha Barton
- Department of Hematology, St. Jude Children's Research Hospital, Memphis, USA
| | - M Bender
- Department of Pediatrics, University of Washington, Seattle, USA
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Anirban Basu
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, 1959 NE Pacific Street, H-375Q, Box 357630, Seattle, WA, 98195-7630, USA.
- Department of Health Services, University of Washington, 1959 NE Pacific Street, H-375Q, Box 357630, Seattle, WA, 98195-7630, USA.
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Bakshi N, Gillespie S, McClish D, McCracken C, Smith WR, Krishnamurti L. Intraindividual pain variability and phenotypes of pain in sickle cell disease: a secondary analysis from the Pain in Sickle Cell Epidemiology Study. Pain 2022; 163:1102-1113. [PMID: 34538841 PMCID: PMC9100443 DOI: 10.1097/j.pain.0000000000002479] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/10/2021] [Accepted: 09/02/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Mean pain intensity alone is insufficient to describe pain phenotypes in sickle cell disease (SCD). The objective of this study was to determine impact of day-to-day intraindividual pain variability on patient outcomes in SCD. We calculated metrics of pain variability and pain intensity for 139 participants with <10% missing data in the first 28 days of the Pain in Sickle Cell Epidemiology Study. We performed Spearman rank correlations between measures of intraindividual pain variability and outcomes. We then used k-means clustering to identify phenotypes of pain in SCD. We found that pain variability was inversely correlated with health-related quality of life, except in those with daily or near-daily pain. Pain variability was positively correlated with affective coping, catastrophizing, somatic symptom burden, sickle cell stress, health care utilization, and opioid use. We found 3 subgroups or clusters of pain phenotypes in SCD. Cluster 1 included individuals with the lowest mean pain, lowest temporal instability and dependency, lowest proportion of days with pain and opioid use, and highest physical function. Cluster 2 included individuals with the highest mean pain, highest temporal dependency, highest proportion of days with pain and opioid use, and lowest physical function. Cluster 3 included individuals with high levels of mean pain, highest temporal instability, but with lower temporal dependency, proportion of days with pain and opioid use, and physical function compared with cluster 2. We conclude that intraindividual pain variability is associated with patient outcomes and psychological characteristics in SCD and is useful in delineating phenotypes of pain in SCD.
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Affiliation(s)
- Nitya Bakshi
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, GA, United States
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Scott Gillespie
- Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA, United States
| | - Donna McClish
- Division of General Internal Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, VA, United States
- Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, United States
| | - Courtney McCracken
- Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA, United States
| | - Wally R. Smith
- Division of General Internal Medicine, Department of Medicine, Virginia Commonwealth University, Richmond, VA, United States
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Emory University, Atlanta, GA, United States
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
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Rodigari F, Brugnera G, Colombatti R. Health-related quality of life in hemoglobinopathies: A systematic review from a global perspective. Front Pediatr 2022; 10:886674. [PMID: 36090573 PMCID: PMC9452907 DOI: 10.3389/fped.2022.886674] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 07/18/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Sickle cell disease (SCD) and thalassemia are inherited blood disorders, which can lead to life-threatening events and chronic organ damage. Recent advances in treatments have increased life expectancy, and hemoglobinopathies have become chronic illnesses with social and emotional impairments. Thus, health-related quality of life (HRQOL) assessment has a fundamental role in disease management and treatment, and generic and disease-specific questionnaires are reliable and validated measures to estimate disease burden. The heterogeneous distribution of treatment opportunities worldwide influences physical, social, and emotional disease perception. OBJECTIVES To review publications concerning HRQOL for SCD and thalassemia in different areas of the world in order to gather a global perspective of questionnaires used and outcomes evaluated. METHODS A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The Medline databases were searched on 29 September 2021. Inclusion criteria were as follows: (1) studies of HRQOL assessment in SCD and thalassemia patients by using the PROMIS, the SF-36, the SCSES, the PedsQL-SCD, the PedsQOL generic core scale, the ASCQ-Me, and the TranQoL; and (2) every article type, including non-English studies. We excluded studies that were not limited to SCD or thalassemia and studies that were not specific to hemoglobinopathies, and not consistent with the topic of HRQOL assessment. We did not include the gray literature. A total of 102 out of 124 articles from PubMed, Cochrane Library, and Google Scholar were eligible for inclusion (66 SCD articles and 36 thalassemia articles). The quality of studies was assessed through Critical Appraisal tools for use in JBI Systematic Reviews. Data extraction was conducted using a standardized data collection form (authors, year and country of publication, study design, age and number of patients, HRQOL questionnaires, questionnaire language, and clinical outcomes). RESULTS The evaluation of HRQOL was conducted on all continents, but differences in the worldwide frequency of HRQOL assessment were observed. HRQOL of SCD patients was less investigated in Europe. HRQOL of thalassemia patients was less investigated in South-East Asia and Africa. Generic HRQOL questionnaires (PROMIS, SF-36, and PedsQL) were frequently adopted, while disease-specific ones (ASCQ-Me, SCSES for SCD, and TranQoL for thalassemia) were less used. Translation into local languages has been often performed. CONCLUSION Health-related quality of life is a complex outcome that has been increasingly incorporated in clinical research and clinical practice worldwide, although with regional differences. Disease-specific outcomes (pain for SCD and transfusion burden for thalassemia) and healthcare system characteristics, particularly in low-income countries, have an impact on HRQOL and should be considered in healthcare plans.
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Affiliation(s)
- Francesca Rodigari
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
| | - Giorgia Brugnera
- Department of Woman's and Child's Health, University of Padova, Padua, Italy
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Knisely MR, Tanabe PJ, Yang Q, Masese R, Jiang M, Shah NR. Severe Pain Profiles and Associated Sociodemographic and Clinical Characteristics in Individuals With Sickle Cell Disease. Clin J Pain 2021; 37:669-677. [PMID: 34265788 PMCID: PMC8373671 DOI: 10.1097/ajp.0000000000000957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 03/18/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify classes of individuals with sickle cell disease (SCD) who share distinct severe pain profiles and evaluate differences in demographic, clinical, and psychosocial characteristics between classes. METHODS This exploratory, cross-sectional study used data collected for the SCD Implementation Consortium Research Registry at Duke University. Using Adult Sickle Cell Quality of Life-Measurement System pain-item data from 291 adults with SCD, latent class analysis was used to determine classes of individuals sharing distinct severe pain profiles. Bivariate analyses and logistic regression models were used to assess the relationships between pain profile classes and demographic, clinical, and psychosocial characteristics. RESULTS Three classes sharing distinct severe pain profiles were identified: Low Frequency and Impact class (n=73), Moderate Frequency and Impact class (n=94), and High Frequency and Impact class (n=124). When compared with the Low Frequency and Impact class and controlling for age and sex, individuals in the Moderate Frequency and Impact class were more likely to: be female (P=0.031) and unemployed (P=0.013); report worse sleep (P=0.005) and social functioning (P=0.005); have less emotional distress (P=0.004); describe pain as "sore" (P=0.002); and have previous SCD-related lung complications (P=0.016). When compared with the Low Frequency and Impact class, individuals in the High Frequency and Impact class: had worse social functioning (P<0.001) and previous SCD-related lung complications (P=0.006); described pain as "sore" (P<0.001); and were taking pain medication daily for SCD (P=0.001). DISCUSSION Severe pain experiences in SCD are complex; however, there are subgroups of people who report similar experiences of severe pain.
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Affiliation(s)
| | - Paula J Tanabe
- Duke University School of Nursing
- Duke University School of Medicine, Durham, NC
| | | | | | - Meilin Jiang
- Department of Biostatistics, University of Florida, Gainesville, FL
| | - Nirmish R Shah
- Duke University School of Nursing
- Duke University School of Medicine, Durham, NC
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Bakshi N, Cooley A, Ross D, Hawkins L, Sullivan M, Astles R, Sinha C, Katoch D, Peddineni M, Gee BE, Lane PA, Krishnamurti L. A pilot study of the acceptability, feasibility and safety of yoga for chronic pain in sickle cell disease. Complement Ther Med 2021; 59:102722. [PMID: 33892094 DOI: 10.1016/j.ctim.2021.102722] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES To determine the acceptability, feasibility and safety of yoga for chronic pain in sickle cell disease. DESIGN AND SETTING In Part A of this two-part study, adolescents with SCD and chronic pain (Group 1) and their parent (Group 2) completed a survey designed to capture pain characteristics, attitudes and practices related to yoga, and potential acceptability of a yoga program. In Part B, the study assessed the feasibility and safety of an instructor-led group yoga program. The study was registered on clinicaltrials.gov (NCT03694548). INTERVENTION Eight instructor-led group yoga sessions. MAIN OUTCOME MEASURES Feasibility and safety outcomes were chosen a priori, as follows: 1) Proportion of adolescent patients with SCD and chronic pain approached that consent to participate in Part A, 2) Proportion of adolescent participants enrolled in Part A that consent to participate in Part B, 3) Proportion of participants enrolled in Part B that attend at least 6 of 8 yoga sessions, 4) Proportion of participants enrolled in Part B with an ED visit or a hospitalization for pain within 24 h of completion of each yoga session, 5) Proportion of participants in Part B who complete all study assessments before, and at the end of the yoga program, 6) Adherence to submission of pain diary. RESULTS The median age of 15 patient participants in Part A was 16 (IQR 14-17), and 14 parents was 43.5 (IQR 42-51). Most participants were female. Most participant responses indicated a positive opinion of yoga. Nine adolescents (60 %) from Part A participated in Part B of the study. The median age of 9 participants in Part B was 17 (IQR 15-18), and 5 of the 9 participants were female (53.3 %). Only one participant was able to attend 3 of the 8 yoga sessions offered, and did not experience any ED visits or hospitalizations following the yoga sessions. None of the other feasibility endpoints were met in this study. CONCLUSIONS Patients with SCD and chronic pain overall have a positive opinion of yoga, but there are challenges with recruitment and retention of participants in a clinical trial of yoga, and barriers to feasibility of an in-person group yoga intervention.
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Affiliation(s)
- Nitya Bakshi
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Anthony Cooley
- Division of Hospital Medicine, Department of Pediatrics, Emory University, USA
| | - Diana Ross
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Lauren Hawkins
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Rachel Astles
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Cynthia Sinha
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Deeksha Katoch
- Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Manasa Peddineni
- NOVA Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Beatrice E Gee
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Peter A Lane
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
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Karimi L, Wijeratne T, Crewther SG, Evans AE, Ebaid D, Khalil H. The Migraine-Anxiety Comorbidity Among Migraineurs: A Systematic Review. Front Neurol 2021; 11:613372. [PMID: 33536997 PMCID: PMC7848023 DOI: 10.3389/fneur.2020.613372] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 12/02/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Migraine is recognized as a neurological condition that is often associated with comorbid psychiatric symptoms such as anxiety, depression, bipolar disorder and/or panic disorder. Though some studies have demonstrated the link between migraine and anxiety disorders, there are no systematic reviews that have been published in this area to summarize the evidence. The aim of the present study is to systematically review the literature associated with comorbidity of migraine and anxiety disorders among migraineurs compared to non-migraineurs. Methods: The present systematic review included population-based, cohort and cross-sectional studies if they were reporting the frequency of migraine with either anxiety or depression as diagnosed by a medical practitioner according to the International Classification of Headache Disorders (ICHD-2/3). Results: Eight eligible studies from 2060 relevant citations were included in the review. All participants were migraine patients from both primary care and outpatient settings, as well as tertiary headache and anxiety centers, and were compared to non-migraineurs. The results of the systematic review showed that there is a strong and consistent relationship between migraine and anxiety. The co-morbidity of co-occurrence for migraine and anxiety has an average OR of 2.33 (2.20–2.47) among the prevalence and cross sectional studies and an average RR of 1.63 (1.37–1.93) for two cohort studies; The major limitations of included studies were small sample sizes and a lack of adjusting of confounding factors. Conclusion: The results highlight the need for inclusion of an anxiety screening tool during initial assessments of migraine patients by medical practitioners and/or physicians and may explain why some anxiolytic medications work better than others for migraine mitigation.
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Affiliation(s)
- Leila Karimi
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | - Tissa Wijeratne
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia.,Department of Neurology, Western Health & University Melbourne, AIMSS, Level Three, WHCRE, Sunshine Hospital, Melbourne, VIC, Australia.,Department of Medicine, Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka, Anuradhapura, Sri Lanka
| | - Sheila Gillard Crewther
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
| | | | - Deena Ebaid
- The Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia
| | - Hanan Khalil
- School of Psychology and Public Health, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
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13
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Dougherty KA, Schall JI, Bertolaso C, Smith-Whitley K, Stallings VA. Vitamin D Supplementation Improves Health-Related Quality of Life and Physical Performance in Children with Sickle Cell Disease and in Healthy Children. J Pediatr Health Care 2020; 34:424-434. [PMID: 32507538 PMCID: PMC7483775 DOI: 10.1016/j.pedhc.2020.04.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 04/17/2020] [Accepted: 04/18/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION No study determined if vitamin D supplementation improves health-related quality of life (HRQL) using pediatric Patient-Reported Outcomes Measurement Information System or physical functioning in type SS sickle cell disease (HbSS). METHOD Subjects with HbSS (n = 21) and healthy subjects (n = 23) were randomized to daily oral doses (4,000 vs. 7,000 IU) of cholecalciferol (vitamin D3) and evaluated at 6 and 12 weeks for changes in serum 25 hydroxyvitamin D (25(OH)D), HRQL, and physical functioning. RESULTS In subjects with HbSS, significant reductions in pain, fatigue, and depressive symptoms and improved upper-extremity function were observed. In healthy subjects, significant reductions in fatigue and improved upper-extremity function were observed. Significant improvements in peak power and dorsiflexion isometric maximal voluntary contraction torques were observed in both groups. In subjects with HbSS, improved plantar flexion isometric maximal voluntary contraction torques were observed. Both groups saw significant improvement in their total Bruininks-Oseretsky Test of Motor Proficiency score. DISCUSSION Daily high-dose vitamin D supplementation for African American children with and without HbSS improved HRQL and physical performance.
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Kanter J, Gibson R, Lawrence RH, Smeltzer MP, Pugh NL, Glassberg J, Masese RV, King AA, Calhoun C, Hankins JS, Treadwell M. Perceptions of US Adolescents and Adults With Sickle Cell Disease on Their Quality of Care. JAMA Netw Open 2020; 3:e206016. [PMID: 32469413 PMCID: PMC7260622 DOI: 10.1001/jamanetworkopen.2020.6016] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/22/2020] [Indexed: 12/19/2022] Open
Abstract
Importance Sickle cell disease (SCD) is the most common inherited red blood cell disorder in the United States, and previous studies have shown that individuals with SCD are affected by multiple health disparities, including stigmatization, inequities in funding, and worse health outcomes, which may preclude their ability to access quality health care. This needs assessment was performed as part of the Sickle Cell Disease Implementation Consortium (SCDIC) to assess barriers to care that may be faced by individuals with SCD. Objective To assess the SCD-related medical care experience of adolescents and adults with SCD. Design, Setting, and Participants This one-time survey study evaluated pain interference, quality of health care, and self-efficacy of 440 adults and adolescents (aged 15 to 50 years) with SCD of all genotypes and assessed how these variables were associated with their perceptions of outpatient and emergency department (ED) care. The surveys were administered once during office visits by trained study coordinators at 7 of 8 SCDIC sites in 2018. Results The SCDIC sites did not report the number of individuals approached to participate in this study; thus, a response rate could not be calculated. In addition, respondents were not required to answer every question in the survey; thus, the response rate per question differed for each variable. Of 440 individuals with SCD, participants were primarily female (245 [55.7%]) and African American (428 [97.3%]) individuals, with a mean (SD) age of 27.8 (8.6) years. The majority of participants (306 of 435 [70.3%]) had hemoglobin SS or hemoglobin S β0-thalassemia. Most respondents (361 of 437 [82.6%]) reported access to nonacute (usual) SCD care, and the majority of respondents (382 of 413 [92.1%]) noted satisfaction with their usual care physician. Of 435 participants, 287 (66.0%) reported requiring an ED visit for acute pain in the previous year. Respondents were less pleased with their ED care than their usual care clinician, with approximately half (146 of 287 [50.9%]) being satisfied with or perceiving having adequate quality care in the ED. Participants also noted that when they experienced severe pain or clinician lack of empathy, this was associated with a negative quality of care. Age group was associated with ED satisfaction, with younger patients (<19 vs 19-30 and 31-50 years) reporting better ED experiences. Conclusions and Relevance These results suggested that a negative perception of care may be a barrier for patients seeking care. These findings underscore the necessity of implementation studies to improve access to quality care for this population, especially in the acute care setting.
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Affiliation(s)
- Julie Kanter
- Department of Medicine, University of Alabama, Birmingham, Birmingham
| | - Robert Gibson
- Department of Hematology, Medical College of Georgia, Augusta University, Augusta
| | - Raymona H. Lawrence
- Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro
| | | | - Norma L. Pugh
- RTI International, Research Triangle Park, North Carolina
| | | | - Rita V. Masese
- Duke University School of Nursing, Durham, North Carolina
| | - Allison A. King
- Department of Pediatrics, Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri
- Department of Medicine, Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri
- Department of Surgery, Program in Occupational Therapy, Washington University School of Medicine, St Louis, Missouri
| | - Cecelia Calhoun
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Jane S. Hankins
- Department of Hematology, St Jude Children’s Research Hospital, Memphis, Tennessee
| | - Marsha Treadwell
- University of California, San Francisco, Benioff Children’s Hospital Oakland, Oakland
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15
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Neuropathic pain in individuals with sickle cell disease. Neurosci Lett 2020; 714:134445. [DOI: 10.1016/j.neulet.2019.134445] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 06/06/2019] [Accepted: 08/20/2019] [Indexed: 12/18/2022]
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16
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Powell-Roach KL, Yao Y, Jhun EH, He Y, Suarez ML, Ezenwa MO, Molokie RE, Wang ZJ, Wilkie DJ. Vasopressin SNP pain factors and stress in sickle cell disease. PLoS One 2019; 14:e0224886. [PMID: 31710639 PMCID: PMC6844466 DOI: 10.1371/journal.pone.0224886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/23/2019] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Frequencies of single nucleotide polymorphisms (SNPs) from pain related candidate genes are available for individuals with sickle cell disease (SCD). One of those genes, the arginine vasopressin receptor 1A gene (AVPR1A) and one of its SNPs, rs10877969, has been associated with pain and disability in other pain populations. In patients with SCD, clinical factors such as pain and stress have been associated with increased health care utilization, but it is not known if the presence of the AVPR1A SNP plays a role in this observation. The study purpose was to explore the relationships between rs10877969 and self-reported pain, stress, and acute care utilization events among individuals with SCD. METHODS In a cross-sectional investigation of outpatients with SCD, participants completed PAINReportIt®, a computerized pain measure, to describe their pain experience and contributed blood or saliva samples for genetic analysis. We extracted emergency department and acute care utilization from medical records. RESULTS The SNP genotype frequencies (%) for this sample were CC 30 (28%), CT 44 (41%), TT 33 (31%). Acute care utilization and stress as an aggravator of pain were significantly associated with the rs10877969 genotype (p = .02 and p = .002, respectively). The CT genotype had the highest mean utilization and CC genotype was associated with not citing stress as a pain aggravator. Chronic pain was not associated with rs10877969 (p = .41). CONCLUSION This study shows that rs10877969 is related to indicators of stress and acute pain. Further research is recommended with other measures of stress and acute pain.
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Affiliation(s)
- Keesha L. Powell-Roach
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, Florida, United States of America
- Center for Palliative Care Research and Education, University of Florida College of Nursing, Gainesville, Florida, United States of America
| | - Yingwei Yao
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, United States of America
- Department of Biobehavioral Health Sciences, University of Illinois at Chicago College of Nursing, Chicago, Illinois, United States of America
| | - Ellie H. Jhun
- Committee on Clinical Pharmacology and Pharmacogenetics, University of Chicago, Chicago, Illinois, United States of America
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Ying He
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Cancer Center, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Marie L. Suarez
- Department of Biobehavioral Health Sciences, University of Illinois at Chicago College of Nursing, Chicago, Illinois, United States of America
| | - Miriam O. Ezenwa
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, United States of America
| | - Robert E. Molokie
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Division of Hematology/Oncology, University of Illinois at Chicago College of Medicine, Chicago, Illinois, United States of America
- Jessie Brown Veteran’s Administration Medical Center, Chicago, Illinois, United States of America
| | - Zaijie Jim Wang
- Department of Biopharmaceutical Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
- Cancer Center, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Diana J. Wilkie
- Center for Palliative Care Research and Education, University of Florida College of Nursing, Gainesville, Florida, United States of America
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, United States of America
- Department of Biobehavioral Health Sciences, University of Illinois at Chicago College of Nursing, Chicago, Illinois, United States of America
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Toledo SLDO, Guedes JVM, Alpoim PN, Rios DRA, Pinheiro MDB. Sickle cell disease: Hemostatic and inflammatory changes, and their interrelation. Clin Chim Acta 2019; 493:129-137. [PMID: 30825426 DOI: 10.1016/j.cca.2019.02.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/26/2019] [Accepted: 02/26/2019] [Indexed: 12/23/2022]
Abstract
Sickle cell disease, the most common genetic blood disorder in the world, has high clinical variability, negatively impacts quality of life and contributes to early mortality. Sickled erythrocytes cause blood flow obstruction, hemolysis, and several hemostatic changes that promote coagulation. These events, in turn, induce chronic inflammation, characterized by elevated plasma levels of pro-inflammatory markers, which aggravates the already unfavorable state of the circulatory system. Empirical evidence indicates that the hemostatic and inflammatory systems continuously interact with each other and thereby further propagate the hypercoagulability and inflammatory conditions. In this review article, we discuss the pathophysiological aspects of sickle cell disease and the hemostatic and inflammatory changes that underlie its pathogenesis.
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Affiliation(s)
- Sílvia L de O Toledo
- Federal University of São João del-Rei (UFSJ), Dona Lindu Center-West Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour, 35501-296 Divinópolis, MG, Brazil
| | - João V M Guedes
- Federal University of São João del-Rei (UFSJ), Dona Lindu Center-West Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour, 35501-296 Divinópolis, MG, Brazil
| | - Patrícia N Alpoim
- Departamento de Análises Clínicas e Toxicológicas, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais (MG), Brazil
| | - Danyelle R A Rios
- Federal University of São João del-Rei (UFSJ), Dona Lindu Center-West Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour, 35501-296 Divinópolis, MG, Brazil
| | - Melina de B Pinheiro
- Federal University of São João del-Rei (UFSJ), Dona Lindu Center-West Campus, Sebastião Gonçalves Coelho Street, 400, Chanadour, 35501-296 Divinópolis, MG, Brazil.
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