BackgroundLittle is known about the effects of blood rheology on the occurrence of acute chest syndrome and painful vaso-occlusive crises in children with sickle cell anemia and hemoglobin SC disease.
Design and MethodsTo address this issue, steady-state hemorheological profiles (blood viscosity, red blood cell deformability, aggregation properties) and hematologic parameters were assessed in 44 children with sickle cell anemia and 49 children with hemoglobin SC disease (8-16 years old) followed since birth. Clinical charts were retrospectively reviewed to determine prior acute chest syndrome or vaso-occlusive episodes, and rates of these complications were calculated.
ResultsMultivariate analysis revealed that: 1) a higher steady-state blood viscosity was associated with a higher rate of vaso-occlusive crises in children with sickle cell anemia, but not in children with hemoglobin SC disease; 2) a higher steady-state red blood cell disaggregation threshold was associated with previous history of acute chest syndrome in children with hemoglobin SC disease and boys with sickle cell anemia.
ConclusionsOur results indicate for the first time that the red blood cell aggregation properties may play a role in the pathophysiology of acute chest syndrome in children with hemoglobin SC disease and boys with sickle cell anemia. In addition, whereas greater blood viscosity is associated with a higher rate of vaso-occlusive crises in children with sickle cell anemia, no association was found in children with hemoglobin SC disease, underscoring differences in the etiology of vaso-occlusive crises between sickle cell anemia and hemoglobin SC disease.
Design and Methods
SubjectsThe study included 62 consecutive SCA children followed either at the Sickle Cell Disease Reference Centres of the University Hospital of Pointe-à-Pitre, Guadeloupe (n=41) and of the Robert Debré Mother and Child University Hospital in Paris (n=21), France. Overall, 27 boys and 35 girls between 2 months and 16 years of age were included. All children were at steadysate, i.e. free of any acute events for one month prior to blood sampling and transfusion-free for at least three months prior to blood sampling. Among the 62 children, 49 had never received HC and 13 had been treated with HC for at least six months at the time of the study, with an average dose of 21.8±3.2 mg/kg per day. This latter group was compared to a control group composed of 26 SCA children matched for sex and age, selected from the 49 SCA children untreated by HC. All the children's parents provided their written consent before inclusion in the study which had been approved by the ethical committees from Guadeloupe and Paris.
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