The older sickle cell patient

Abstract

The lifespan of sickle cell patients has increased substantially. We chose to compare the attributes of older sickle cell patients with younger ones within the confines of a single institutional study serving the local Bronx population. Laboratory and clinical assessments from 40 patients with sickle cell disease over 40 years of age were compared to 40 patients under 30 years of age. When the older group was compared to the younger group, hemoglobin, indirect bilirubin, and platelet counts were significantly lower. Creatinine clearances were lower and BUN levels were higher in the older group. Although the prevalence of radiographically measured cardiomegaly was significantly higher in the older group, systolic and diastolic blood pressures remained unchanged. The number of crises and number of admissions were higher in the younger group than in the older, but there was wide variation, and no significant differences could be detected; days spent in hospital over the previous 2 years did not differ. No statistically significant differences were observed for absolute reticulocyte count, MCV, % HbF, white cell count, liver function tests, or oxygen saturation. Comparing genders within age groups, younger males had higher hemoglobin levels and absolute reticulocyte counts than younger females, while only the older females had higher HbF levels than the corresponding males. Lower levels of hemoglobin associated with older age may reflect decreased hematopoietic potential that may in part be due to decreased renal function. Lower platelet counts in older sickle cell patients may be a consequence of this decreased hematopoietic potential but may also represent a secondary survival benefit effect in sickle cell anemia. Am.

Aging in Sickle Cell Disease: Co-morbidities and New Issues in Management

“…Similarly, chronic renal disease, defined as an irreversible reduction in GFR, was quite frequent. These findings are consistent with prior reports of higher serum creatinine and lower GFR levels seen in older sickle cell patients (4). This in turn, compromises optimal care of these patients, including dose modifications or interruptions needed for certain medications such as iron chelating agents.…”

Pulmonary hypertension diagnosed by right heart catheterisation in sickle cell disease

“…It is not possible, however, to exclude that lower platelet counts could be associated with the presence of hepatitis C or older age, as already described in SCD [29,30]. Although our study evidenced older age in this subgroup of patients, no association with hepatitis C could be noted.…”

Morphological and functional platelet abnormalities in Berkeley sickle cell mice

“…While a single study found thrombocytosis to be associated with impaired cognitive dysfunction in children with SCD (74), epidemiological studies have not reported thrombocytosis to be associated with increased overall severity of SCD, (75)(76)(77)(78)(79)(80), although such studies did not consider platelet size or mass. Despite the evidence for increased platelet consumption during painful crises (9), there are few data to support a role for platelets in microvascular obstruction, and small studies of aspirin, aspirin with dipyridamole, and ticlopidine failed to show a definitive benefit in reducing the frequency of pain crises (20)(21)(22)(23)(24).…”