Are There Phases to the Vaso-Occlusive Painful Episode in Sickle Cell Disease?

Abstract

The purpose of this study was to describe the pain experience of children with sickle cell disease who were hospitalized for vaso-occlusive painful episodes. The pain experience, and signs and symptoms prior to admission and during hospitalization, are presented in the context of whether there is evidence to support the existence of phases to a vaso-occlusive painful episode. Children were interviewed about the onset of the painful episode and were asked to describe their pain from the day of admission to the day of discharge from the hospital. They were also observed for the absence or presence of signs and symptoms associated with the painful vaso-occlusive episode. Findings from this study provide some evidence to support previous observations related to changes during the evolution of painful episodes that may be occurring in phases (e.g., evolving, inflammatory, resolving), as previously described in adults and children. These phases had different names, although the concepts were similar.

More definitions in sickle cell disease: Steady state v base line data

“…This change coincides with the prodromal phase of the acute painful crisis described in children and adults [3,4]. 3. No history of blood transfusion during the previous 4 months of the point in time.…”

“…Previous studies showed that the number of irreversibly sickled cells increases and RBC deformability decreases 2-3 days before admission to the hospital in crisis [2]. This change coincides with the prodromal phase of the acute painful crisis described in children and adults [3,4]. 3.…”

“…This is the first report showing a drug interaction between lenalidomide and itraconazole, which is a potent inhibitor of CYP3A4 and P-glycoprotein activity [2]. Hofmeister et al recently reported an in vitro study indicating that P-glycoprotein is involved in the lenalidomide pharmacokinetics, and drug-interactions via P-glycoprotein between lenalidomide and CCI-779 (temsirolimus) as substrates of P-glycoprotein [3]. Because lenalidomide is scarcely metabolized by cytochrome P450s (CYP), the activity of drug-transporters such as P-glycoprotein may be a key determinant of lenalidomide pharmacokinetics.…”

The Construction of Sickle Cell Disorder in Saudi Arabia: The Invisible Disease

“…The pain that characterises SCD (Okpala et al, 2002) means that those with the disease will suffer unpredicted and acute pain episodes throughout their lives (Jacob et al, 2005). Managing SCD in specialised communities may help minimise the severity of pain and decrease suffering.…”

“…First time stroke in children with SCD has been found to be highest in early childhood that is from 2-5 years and decreases in incidence from 10-19 years (Ohene-Frempong et al, 1998). Furthermore, it has been recently noted that the incidence of stroke in SCD patients aged over 29 years is increased and hence life expectancy is reduced for this group and the very young (Adzika, Glozah, Ayim-Aboagye, & Ahorlu, 2017 The complications lead to frequent and prolonged admissions (Jacob et al, 2005 Long term hospitalisation, during schooling or work time, influenced stability and opportunities to be a regular student or employee. Absenteeism due to the complications of the disease would also undermine performance.…”