Vitamin D deficiency and acute vaso-occlusive complications in children with sickle cell disease

2015 ◽  
Vol 62 (4) ◽  
pp. 643-647 ◽  
Author(s):  
Margaret T Lee ◽  
Maureen Licursi ◽  
Donald J McMahon
Keyword(s):  
Vitamin D ◽  
Sickle Cell Disease ◽  
Vitamin D Deficiency ◽  
Sickle Cell ◽  
Cell Disease

scholarly journals Vitamin D and Nonskeletal Complications among Egyptian Sickle Cell Disease Patients

2018 ◽  
Vol 2018 ◽  
pp. 1-7 ◽  
Author(s):  
Mona Hamdy ◽  
Niveen Salama ◽  
Ghada Maher ◽  
Amira Elrefaee
Keyword(s):  
Vitamin D ◽  
Sickle Cell Disease ◽  
Vitamin D Deficiency ◽  
Sickle Cell ◽  
Standard Of Care ◽  
Enzyme Linked Immunosorbent Assay ◽  
Cell Disease ◽  
P Values ◽  
Indirect Bilirubin ◽  
Deficient Group

Lower levels of vitamin D have been documented in many patients with sickle cell disease (SCD), but data are still inconclusive regarding the association between vitamin D deficiency (VDD) and the occurrence or the severity of various SCD complications. Our study aimed to detect the prevalence of vitamin D deficiency among Egyptian patients with SCD and to associate it with the clinical course of the disease. We measured the level of 25-hydroxy vitamin D in 140 children (age from 4.3 to 15.5years), 80 patients with SCD and 60 controls using enzyme-linked immunosorbent assay. Vitamin D was deficient in 60% of SCD compared to 26.7% of controls. Severe VDD was significantly higher in SCD patients than controls. Patients were divided into 2 groups; Normal group (32 patients) and Deficient group (48 patients). There were statistically significant differences between the 2 groups regarding their age, height percentile, the presence of clinical jaundice, and osseous changes (P values 0.043, 0.024, 0.001, and 0.015, respectively). Hemoglobin and hematocrit values were significantly lower in Deficient group (P values 0.022 and 0.004, respectively) while the levels of aspartate aminotransferase, lactate dehydrogenase, and total and indirect bilirubin were significantly higher in the same group (P values 0.006, 0.001, 0.038, and 0.016, respectively). The frequency of blood transfusions, hospitalization, and vasoocclusive crisis previous year as well as the history of bone fracture and recurrent infections proved to be significantly higher in Deficient group. These findings suggest that VDD may play a role in the pathogenesis of hemolysis and other complication of SCD. Vitamin D monitoring and supplementation in patients with SCD should be implemented as a standard of care to potentially improve health outcomes in these affected patients.

scholarly journals Age As an Independent Clinical Predictor for Vitamin D Deficiency in Sickle Cell Disease

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1385-1385
Author(s):  
Jin Han ◽  
Santosh L. Saraf ◽  
Taimur Abbasi ◽  
Xu Zhang ◽  
Robert E. Molokie ◽  
...  
Keyword(s):  
Vitamin D ◽  
Sickle Cell Disease ◽  
Blood Cell ◽  
Creatinine Clearance ◽  
Vitamin D Deficiency ◽  
Sickle Cell ◽  
Vitamin D Supplementation ◽  
Small Sample ◽  
Cell Disease

Abstract Background: Vitamin D deficiency (VDD) is highly prevalent among patients with sickle cell disease (SCD). Although little is known about the risk factors for VDD in SCD, it has been shown that VDD is associated with chronic pain, bone fragility, and pulmonary function in SCD. In this study we investigated the potential clinical predictors for VDD in patients with SCD. Method: In a retrospective, cross-sectional analysis, a total of 167 adults with SCD treated at the University of Illinois Medical Center with a baseline 25-hydroxy vitamin D (25-OHD) measurement were screened. Clinical variables were recorded from a clinic visit at least four weeks from a vaso-occlusive pain episode or red blood cell transfusion. Statistical association between 25-OHD and other clinical parameters were investigated. Results: After stratifying the patients based on 25-OHD levels, we observed the median age was significantly younger in patients with lower 25-OHD levels (Table 1). When analyzing different age groups by Kruskal Wallis analysis, 25-OHD levels were significantly elevated in patients ≥ 40 years old (Figure 1). When using Spearman correlation analysis, the 25-OHD levels as a continuous variable positively correlated with increasing age (p<0.001); they also showed a significant negative relationships with creatinine clearance, total bilirubin, platelet count, and white blood cell count (Table 2). Using ordinal logistic regression, age was an independent predictor of 25-OHD levels, as a three-categorical variable, in SCD (OR 0.55, 95% CI: 0.38 – 0.81; p =0.002) after adjusting for gender, creatinine clearance, and vitamin D supplementation (Table 3), which means that younger patients has higher chance of VDD. In the patients with VDD (25-OHD <20 ng/mL), weekly supplementation with oral ergocalciferol (50,000 units for twelve weeks) substantially improved 25-OHD levels (9.9 vs 23.7 ng/mL, p<0.0001, N=24). During a median of 40-month follow-up (range 0 to 96 months), thirteen patients died, but the log rank test or multivariate Cox regression analysis failed to show statistical significance between 25-OHD levels and mortality after adjusting ESRD and baseline vitamin D supplementation, likely due to a short follow-up period and a small sample size. Summary: Lower 25-OHD levels were associated with younger age in patients with SCD, especially patients younger than 40 years old. One possible explanation is that lower 25-OHD levels may be linked to higher mortality in SCD, but future research is needed to clarify the association between VDD and mortality in SCD. Disclosures No relevant conflicts of interest to declare.

scholarly journals Vitamin D Levels: Associations with Acute Pain Events and Self-Reported Pain in Children with Sickle Cell Disease

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 3089-3089
Author(s):  
Latika Puri ◽  
Nicole M Alberts ◽  
Guolian Kang ◽  
Juan Ding ◽  
Jane S Hankins ◽  
...  
Keyword(s):  
Vitamin D ◽  
Sickle Cell Disease ◽  
Vitamin D Deficiency ◽  
Sickle Cell ◽  
Care Utilization ◽  
Cell Disease ◽  
Cross Sectional ◽  
Vitamin D Levels ◽  
Patient Reported ◽  
Deficient Group

Abstract Background/Aims: Individuals with sickle cell disease (SCD) are at high risk for vitamin D deficiency due to dark skin color, limited physical activity, poor nutrition, and renal dysfunction. In smaller retrospective studies, vitamin D deficiency in SCD was associated with increased frequency of acute pain events and higher opioid use, however the impact of vitamin D deficiency on pain related patient reported outcomes has not been described . Supplementation with high dose vitamin D is shown to be associated with fewer pain days per week and higher physical activity scores in patients with chronic pain. Thus, the objective of our study was to evaluate relationship between vitamin D levels, acute health care utilization and self-reported pain among children with SCD. We hypothesized that vitamin D deficiency is associated with increase health care utilization for pain and patient-reported outcomes for pain. Methods: Patients with SCD (1 to 18 years of age), enrolled in Sickle Cell Clinical Research and Intervention Program (SCCRIP), at St. Jude Children's Research Hospital were included in the study (Hankins et.al., Pediatric Blood and Cancer, 2018). Demographic, clinical and laboratory data were extracted from SCCRIP database. Prospective pain event leading to a hospital visit was analyzed. We analyzed pain-related hospitalizations in two ways: the number of pain-related hospitalizations within 2 years prior to and after vitamin D measurement in a cross-sectional design and longitudinally. Generalized linear regression model was used to examine associations between vitamin D and cross-sectional pain events with adjusting for hydroxyurea use. Generalized linear mixed effect model was used to assess the associations between vitamin D and longitudinal pain events, with adjusting for SCD genotype, sex, age, hydroxyurea use and interaction between age and hydroxyurea use. Pediatric Quality of Life Inventory™ Sickle Cell Disease Module (PedsQL™ SCD) was used to measure pain and pain interference using 1) Pain and Hurt and 2) Pain Impact scales. PedsQL™ SCD assessments include a Likert response scale. Items are reverse -scored and transformed to a 0-100 scale where higher scores indicate better health related quality of life in that scale. Two sample t-test or Wilcoxon rank sum test was used to compare mean scores between the two groups. Results: A total of 799 patients (females, n=398; males, n=401) were included in the study. Mean age (Standard Deviation [SD]), range at time of first vitamin D measurement for entire cohort was 8.7 (4.7), (0.8-18 years). Mean (SD) initial vitamin D level for entire cohort was 19.0 (9.4) ng/dl. Mean (SD) number of pain-related hospitalizations within two years of first vitamin D measurement was higher in the vitamin D deficient group as compared to non deficient group [0.81(1.97) vs 0.66 (1.2), (p=0.0034)]. Longitudinal data analyses showed vitamin D deficiency was associated with increased number of pain related hospitalizations (p=0.0091), after adjusting for covariates listed above (Figure 1a). Mean (SD) scores for Pain and Hurt in vitamin D deficient versus non deficient group were [74.5.7(18.2) versus 83.5(15.6), p &lt; 0.001]. Mean (SD) scores for Pain Impact in vitamin D deficient group as compared to non deficient group were [(66.7 (22.7) versus 75.5 (22.3), p &lt;0.001] (Figure 1b) Conclusion: Results indicated that low vitamin D levels predicted higher frequency of painful events leading to a hospital visit and were associated with higher prevalence of self-reported pain and pain interference. Further studies evaluating mechanisms by which vitamin D influences sickle cell pain are warranted and larger controlled trials can help evaluate the therapeutic efficacy of vitamin D for sickle cell pain. Figure 1 Figure 1. Disclosures Hankins: UpToDate: Consultancy; Bluebird Bio: Consultancy; Vindico Medical Education: Consultancy; Global Blood Therapeutics: Consultancy.

scholarly journals Prevalence of vitamin D deficiency in patients with sickle cell disease in Bahrain

2013 ◽  
Vol 1 (2) ◽  
Author(s):  
Adla H Bakri ◽  
Taysir S Garadah ◽  
Ahmed A Jaradat ◽  
Abdulla Al Ajmi ◽  
Mohamed E Alawi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Sickle Cell Disease ◽  
Vitamin D Deficiency ◽  
Sickle Cell ◽  
Cell Disease

Vitamin D Level and Its Correlation With Hemoglobin In Pediatric Sickle Cell Disease Patients

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4677-4677 ◽  
Author(s):  
Jennifer Alison Busse ◽  
Kranthi Nandan Seelaboyina ◽  
Grace Malonga ◽  
Madhuri Jakkam Setty ◽  
Thomas Moulton
Keyword(s):  
Bone Marrow ◽  
Vitamin D ◽  
Sickle Cell Disease ◽  
Vitamin D Deficiency ◽  
Sickle Cell ◽  
Blood Levels ◽  
Cell Type ◽  
Cell Disease ◽  
Erythroid Precursor ◽  
Over Time

Introduction It has been well characterized that people living with sickle cell disease are more likely than the general population to be vitamin D deficient. New literature suggests there is an association between vitamin D deficiency and increased anemia in patients with chronic anemia. To date, this has been examined only in patients with end stage renal disease, heart failure, and anemia of other chronic diseases, but not in sickle cell disease, a chronic inflammatory disease with an elevation in inflammatory markers. Vitamin D has been shown to increase erythroid precursor proliferation by increasing erythropoietin sensitivity. It is also thought that vitamin D has pleiotropic effects, which may have influence on the bone marrow. Additionally, vitamin D has been shown to suppress pro-inflammatory cytokines, which causes a decrease in the anemia of chronic inflammation. Severe vitamin D deficiency also causes hyperparathyroidism, which leads to an inhibition of endogenous production of erythropoietin. Our hypothesis implies supplementation of vitamin D will improve anemia of vitamin D deficient sickle cell patients. Methods We utilized laboratory and demographic data from the Bronx Lebanon Hospital Center's patient electronic medical record between November 2009 and July 2013. Our sample included a population of 50 sickle cell disease patients aged 0 to 21 who were vitamin D deficient (serum 25-hydroxyvitamin D (25-OHD) <30ng/ml). Sickle cell disease types included SS (64%), SC (32%), Sβ+ thalassemia and Sβ0 thalassemia (4%). Using a linear mixed model with an autoregressive correlation structure to account for variance within the subject, we examined the association between time dependent 25-OHD level (ng/ml) and hemoglobin in (g/dl), as well as between 25-OHD and reticulocyte percentage over time in days. We began at the time of first supplementation of 25-OHD to the most recent blood levels in each patient. Results After adjusting for mean corpuscular volume (MCV), hemoglobin, sickle cell type and hydroxyurea (Table 1), there was a linear increase in reticulocyte percentage over time associated with increasing 25-OHD levels (β = 0.000060, SE = 0.000030, p =0.050). However, after controlling for MCV, gender, race, sickle cell type, and hydroxyurea (Table 2), we found trend of a negative association between 25-OHD and hemoglobin levels, which was statistically significant (β = -0.000017, SE = 0.000007, p =0.017). Conclusion Our results did not support our original hypothesis, which stated that supplementation of vitamin D in vitamin D deficient sickle cell patients would lead to an improvement in anemia. However, a trend was noted of a decrease in hemoglobin with increasing 25-OHD. In turn, there was a statistically significant increase in reticulocyte percentage with increasing 25-OHD. This is suggestive that there is increased hemolysis with increased erythropoiesis caused by increasing 25-OHD. This is seen even when controlling for patients taking hydroxyurea. Further study is required to elucidate this possible correlation. It is important to examine this relationship further, as supplementing vitamin D in vitamin D deficient sickle cell disease patients is becoming standard of care for improvement in bone density. It is unclear what potential implications this may have on increased production of sickle cells from the bone marrow, including a possible increase in hemolysis and a worsened anemia. Disclosures: Seelaboyina: Bronx Lebanon Hospital: Employment.

Relationship between vitamin D deficiency and bone fragility in sickle cell disease: A cohort study of 56 adults

Bone ◽  
2013 ◽  
Vol 52 (1) ◽  
pp. 206-211 ◽  
Author(s):  
Jean-Benoît Arlet ◽  
Marie Courbebaisse ◽  
Gilles Chatellier ◽  
Dominique Eladari ◽  
Jean-Claude Souberbielle ◽  
...  
Keyword(s):  
Vitamin D ◽  
Cohort Study ◽  
Sickle Cell Disease ◽  
Vitamin D Deficiency ◽  
Sickle Cell ◽  
Bone Fragility ◽  
Cell Disease

Osteopenia and vitamin D deficiency in children with sickle cell disease

2009 ◽  
Vol 83 (6) ◽  
pp. 572-578 ◽  
Author(s):  
E. Chapelon ◽  
M. Garabedian ◽  
V. Brousse ◽  
J. C. Souberbielle ◽  
J. L. Bresson ◽  
...  
Keyword(s):  
Vitamin D ◽  
Sickle Cell Disease ◽  
Vitamin D Deficiency ◽  
Sickle Cell ◽  
Cell Disease

scholarly journals Prevalence of Vitamin D Deficiency in Sickle Cell Disease: A Systematic Review

PLoS ONE ◽  
2015 ◽  
Vol 10 (3) ◽  
pp. e0119908 ◽  
Author(s):  
Vikki G. Nolan ◽  
Kerri A. Nottage ◽  
Elliott W. Cole ◽  
Jane S. Hankins ◽  
James G. Gurney
Keyword(s):  
Systematic Review ◽  
Vitamin D ◽  
Sickle Cell Disease ◽  
Vitamin D Deficiency ◽  
Sickle Cell ◽  
Cell Disease
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