title: Addition of multimodal therapy to standard management of steady state sickle cell disease.
abstract: Most people on folic acid to boost erythropoiesis and prophylactic antimicrobials, the standard management of steady state sickle cell disease (SCD), have unacceptable numbers of crises. The objective of this study was to evaluate the effects of adding multimodal therapy with potassium thiocyanate and omega-3 fatty acids to the standard management of steady state SCD. Pre- and post-treatment numbers of crises and other disease indices were compared in 16 HbSS individuals on folic acid and paludrine after 12 months of adding eicosapentaenoic acid 15 mg/kg/day, docosahexaenoic acid 10 mg/kg/day, and potassium thiocyanate 1-2 mL/day, each milliliter of which contained 250 mg of thiocyanate and 100 micrograms of iodine to prevent hypothyroidism: a possible side-effect due to competitive inhibition of the transport of iodide into the thyroid gland by thiocyanate. Median number of crises reduced from 3/yr to 1/yr (P < 0.0001). There was no evidence of impaired thyroid function. Plasma level of tri-iodothyronine improved (P < 0.0001). Steady state full blood count and bilirubin level did not change significantly. The findings suggest that addition of potassium thiocyanate and eicosapentaenoic and docosahexaenoic acids to standard management of steady state SCD reduces the number of crises. This observation needs to be evaluated in larger studies.
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria ; Department of Haematology, College of Medicine, University of Nigeria, Enugu Campus, Nigeria.
authors.forename: Iheanyi
authors.initials: I
authors.lastname: Okpala
authors.affiliation: Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Osita
authors.initials: O
authors.lastname: Ezenwosu
authors.affiliation: Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Anthony
authors.initials: A
authors.lastname: Ikefuna
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Augustine
authors.initials: A
authors.lastname: Duru
authors.affiliation: Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Barth
authors.initials: B
authors.lastname: Chukwu
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Anazoeze
authors.initials: A
authors.lastname: Madu
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Theresa
authors.initials: T
authors.lastname: Nwagha
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Sunday
authors.initials: S
authors.lastname: Ocheni
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Obike
authors.initials: O
authors.lastname: Ibegbulam
authors.affiliation: Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Ifeoma
authors.initials: I
authors.lastname: Emodi
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Uche
authors.initials: U
authors.lastname: Anike
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Charles
authors.initials: C
authors.lastname: Nonyelu
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Chukwudi
authors.initials: C
authors.lastname: Anigbo
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Kingsley
authors.initials: K
authors.lastname: Agu
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Ifeoma
authors.initials: I
authors.lastname: Ajuba
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Awele
authors.initials: A
authors.lastname: Chukwura
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Ogechukwu
authors.initials: O
authors.lastname: Ugwu
authors.affiliation: Department of Haematology, University of Nigeria Teaching Hospital, Enugu 46000, Nigeria.
authors.forename: Uche
authors.initials: U
authors.lastname: Ololo