title: Vitamin D deficiency and its correction in children with sickle cell anaemia.
abstract: Vitamin D deficiency is common in sickle cell anaemia (SCA, HbSS), although its significance and optimal means of correction are unknown. We conducted an audit to assess the clinical significance of 25-hydroxy vitamin D (25-OHD) deficiency in children with SCA and to evaluate two methods of vitamin D supplementation. We audited 25-OHD levels in 81 children with SCA and looked for statistical associations with biochemical, haematological and clinical parameters. In a separate group of regularly transfused children with SCA, we compared changes in 25-OHD blood concentrations following treatment with either high-dose intramuscular ergocalciferol (n = 15) or 4 days of high-dose oral cholecalciferol (n = 64). Ninety-one percent of children with SCA had 25-OHD levels <20 μg/L. The 25-OHD levels were negatively correlated with increasing age (P < 0.001) but showed no significant relationship to laboratory measurements, transcranial Doppler velocities or hospital attendance. Both intramuscular ergocalciferol and oral cholecalciferol supplementations resulted in increases of 25-OHD blood concentration to normal levels. The mean dose of ergocalciferol was greater than that of cholecalciferol (7,729 versus 5,234 international units (IU)/kg, P < 0.001), but the increment in 25-OHD levels was significantly greater in the oral cholecalciferol group (6.44 versus 2.82 (ng/L)/(IU/kg), P < 0.001). Both approaches resulted in vitamin D sufficiency for about 120 days. Increased 25-OHD concentration was significantly associated with increased serum calcium concentration. Vitamin D deficiency is very common in SCA and can be effectively corrected with high-dose intramuscular ergocalciferol or 4 days of high-dose oral cholecalciferol. Prospective, randomised studies are needed to assess the clinical value of vitamin D supplementation.
authors: Department of Paediatric Haematology, King's College Hospital, King's College London, Denmark Hill, London, SE5 9RS, UK.
authors: Clare
authors: C
authors: Wykes
authors: Anita
authors: A
authors: Arasaretnam
authors: Sandra
authors: S
authors: O'Driscoll
authors: Laura
authors: L
authors: Farnham
authors: Caje
authors: C
authors: Moniz
authors: David C
authors: DC
authors: Rees
mesh_terms: D000284:Administration, Oral; D000469:Alkaline Phosphatase / Q000097:blood; D000755:Anemia, Sickle Cell / Q000097:blood / Q000150:complications*; D001783:Blood Flow Velocity; D002112:Calcifediol / Q000097:blood / Q000172:deficiency*; D002118:Calcium / Q000097:blood; D002560:Cerebrovascular Circulation; D002648:Child; D002762:Cholecalciferol / Q000008:administration & dosage / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004872:Ergocalciferols / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008485:Medical Audit; D012189:Retrospective Studies; D017585:Ultrasonography, Doppler, Transcranial; D014808:Vitamin D Deficiency / Q000097:blood / Q000150:complications* / Q000188:drug therapy
chemical_list: D004872:Ergocalciferols; D002762:Cholecalciferol; D000469:Alkaline Phosphatase; D002112:Calcifediol; D002118:Calcium