title: Growth differentiation factor-15 in young sickle cell disease patients: relation to hemolysis, iron overload and vascular complications.
abstract: BACKGROUND
  High expression of growth differentiation factor-15 (GDF-15) contributes to pathological iron overload in thalassemia. Sickle cell syndromes are characterized by increased levels of erythropoiesis, although the primary defect involves the destruction of mature erythrocytes.
  
  
  OBJECTIVE
  To determine serum GDF-15 in 35 children and adolescents with sickle cell disease (SCD) compared to 35 healthy controls and assess its relation to markers of hemolysis, iron overload and vascular complications.
  
  
  METHODS
  GDF-15 was measured and correlated to genotype, frequency of sickling crises, hydroxyurea therapy and serum ferritin.
  
  
  RESULTS
  GDF-15 levels were increased in SCD patients whether sickle cell anemia or sickle β° thalassemia compared with controls (p<0.001) with no significant difference between patients' groups. GDF-15 was significantly higher in patients who had serum ferritin ≥2500 μg/L, previous cerebral stroke, and splenectomy. GDF-15 was not significantly related to frequency of sickling crises, pulmonary hypertension, or hydroxyurea therapy. On regression analysis, transfusion index, lactate dehydrogenase and serum ferritin were independently related to GDF-15.
  
  
  CONCLUSIONS
  Increased GDF-15 in SCD reflects the importance of ineffective erythropoiesis in the pathophysiology and severity of anemia in SCD. GDF-15 levels are related to hemolysis and iron overload and may provide utility for identifying patients at increased risk of thrombotic events.
authors: Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Electronic address: azatantawy@hotmail.com.
authors: Azza Abdel Gawad
authors: AA
authors: Tantawy
authors: Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors: Amira Abdel Moneam
authors: AA
authors: Adly
authors: Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors: Eman Abdel Rahman
authors: EA
authors: Ismail
authors: Clinical Pathology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors: Yasser Wagih
authors: YW
authors: Darwish
authors: Pediatrics Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.
authors: Marwa
authors: M
authors: Ali Zedan
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000097:blood / Q000235:genetics* / Q000473:pathology / Q000628:therapy; D000986:Antisickling Agents / Q000627:therapeutic use; D001808:Blood Vessels / Q000473:pathology; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005293:Ferritins / Q000097:blood; D015870:Gene Expression; D005838:Genotype; D055436:Growth Differentiation Factor 15 / Q000235:genetics*; D006461:Hemolysis; D006801:Humans; D006918:Hydroxyurea / Q000627:therapeutic use; D019190:Iron Overload / Q000097:blood* / Q000209:etiology / Q000473:pathology; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008297:Male; D013927:Thrombosis / Q000097:blood* / Q000209:etiology / Q000473:pathology; D065227:Transfusion Reaction; D017086:beta-Thalassemia / Q000097:blood / Q000235:genetics* / Q000473:pathology / Q000628:therapy
chemical_list: D000986:Antisickling Agents; C526140:GDF15 protein, human; D055436:Growth Differentiation Factor 15; D005293:Ferritins; D007770:L-Lactate Dehydrogenase; D006918:Hydroxyurea
keywords: Growth differentiation factor-15; Ineffective erythropoiesis; Iron overload; Sickle cell disease