Hemoglobin sickle cell disease complications: a clinical study of 179 cases.
BACKGROUND
Hemoglobin sickle cell disease is one of the most frequent hemoglobinopathies. Surprisingly, few studies have been dedicated to this disease, currently considered to be a mild variant of homozygous sickle cell disease. The aim of this study was to update our knowledge about hemoglobin sickle cell disease.


METHODS
The study involved a single center series of 179 patients. Clinical and biological data were collected with special attention to the assessment of pulmonary arterial hypertension and nephropathy.


RESULTS
Hemoglobin sickle cell diagnosis was delayed and performed in adulthood in 29% of cases. Prevalence of hospitalized painful vasoocclusive crisis, acute chest syndrome and priapism was 36%, 20% and 20%, respectively. The most common chronic organ complications were retinopathy and sensorineural otological disorders in 70% and 29% of cases. Indeed, prevalence of complications reported in homozygous sickle cell disease, such as nephropathy, suspicion of pulmonary hypertension, strokes and leg ulcers was rather low (13%, 4% and 1%, respectively). Phlebotomy performed in 36% of this population (baseline hemoglobin 11.5 g/dL) prevented recurrence of acute events in 71% of cases.


CONCLUSIONS
Our data suggest that hemoglobin sickle cell disease should not be considered as a mild form of sickle cell anemia but as a separate disease with a special emphasis on viscosity-associated otological and ophthalmological disorders, and with a low prevalence of vasculopathy (strokes, pulmonary hypertension, ulcers and nephropathy). Phlebotomy was useful in reducing acute events and a wider use of this procedure should be further investigated.
Service de Médecine Interne, Hôpital Tenon, AP-HP, Paris. francois.lionnet@tnn.aphp.fr
François
F
Lionnet
Nadjib
N
Hammoudi
Katia Stankovic
KS
Stojanovic
Virginie
V
Avellino
Gilles
G
Grateau
Robert
R
Girot
Jean-Philippe
JP
Haymann
D000293:Adolescent; D000328:Adult; D000368:Aged; D000755:Anemia, Sickle Cell / Q000150:complications* / Q000628:therapy; D065627:Familial Primary Pulmonary Hypertension; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006976:Hypertension, Pulmonary / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy; D015995:Prevalence; D055815:Young Adult
D006454:Hemoglobins