title: Which side of the balance determines the frequency of vaso-occlusive crises in children with sickle cell anemia: Blood viscosity or microvascular dysfunction?
abstract: Vascular resistance and tissue perfusion may be both affected by impaired vascular function and increased blood viscosity. Little is known about the effects of vascular function on the occurrence of painful vaso-occlusive crises (VOC) in children with sickle cell anemia (SCA). The aim of the present study was to determine which side of the balance (blood viscosity or vascular function) is the most deleterious in SCA and increases the risk for frequent hospitalized VOC. Microvascular function, microcirculatory oxygenation and blood viscosity were determined in a group of 22 SCA children/adolescents at steady state and a group of 13 healthy children/adolescents. Univariate analyses demonstrated blunted microvascular reactivity during local thermal heating test and decreased microcirculatory oxygenation in SCA children compared to controls. Multivariate analysis revealed that increased blood viscosity and decreased microcirculatory oxygenation were independent risk factors of frequent VOC in SCA. In contrast, the level of microvascular dysfunction does not predict VOC rate. In conclusion, increased blood viscosity is usually well supported in healthy individuals where vascular function is not impaired. However, in the context of SCA, microvascular function is impaired and any increase of blood viscosity or decrease in microcirculatory oxygenation would increase the risks for frequent VOC.
authors.affiliation: UMR Inserm U1134, Université des Antilles et de la Guyane, Hôpital de Pointe-à-Pitre, Hôpital Ricou, 97159 Pointe-à-Pitre Cedex, Guadeloupe, France(2); Laboratoire ACTES (EA 3596), Université des Antilles et de la Guyane, UFR STAPS Campus Fouillole, BP 97159 Pointe-à-Pitre Cedex, Guadeloupe, France; Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France. Electronic address: keynecharlot@gmail.com.
authors.forename: Keyne
authors.initials: K
authors.lastname: Charlot
authors.affiliation: UMR Inserm U1134, Université des Antilles et de la Guyane, Hôpital de Pointe-à-Pitre, Hôpital Ricou, 97159 Pointe-à-Pitre Cedex, Guadeloupe, France(2); Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France. Electronic address: marc.romana@inserm.fr.
authors.forename: Marc
authors.initials: M
authors.lastname: Romana
authors.affiliation: UMR Inserm U1134, Université des Antilles et de la Guyane, Hôpital de Pointe-à-Pitre, Hôpital Ricou, 97159 Pointe-à-Pitre Cedex, Guadeloupe, France(2); Laboratoire ACTES (EA 3596), Université des Antilles et de la Guyane, UFR STAPS Campus Fouillole, BP 97159 Pointe-à-Pitre Cedex, Guadeloupe, France; Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France. Electronic address: berenike-moeckesch@web.de.
authors.forename: Berenike
authors.initials: B
authors.lastname: Moeckesch
authors.affiliation: Laboratoire ACTES (EA 3596), Université des Antilles et de la Guyane, UFR STAPS Campus Fouillole, BP 97159 Pointe-à-Pitre Cedex, Guadeloupe, France. Electronic address: stephanejumet@gmail.com.
authors.forename: Stéphane
authors.initials: S
authors.lastname: Jumet
authors.affiliation: UMR Inserm U1134, Université des Antilles et de la Guyane, Hôpital de Pointe-à-Pitre, Hôpital Ricou, 97159 Pointe-à-Pitre Cedex, Guadeloupe, France(2); Laboratoire ACTES (EA 3596), Université des Antilles et de la Guyane, UFR STAPS Campus Fouillole, BP 97159 Pointe-à-Pitre Cedex, Guadeloupe, France; Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France. Electronic address: xavier.waltz@wanadoo.fr.
authors.forename: Xavier
authors.initials: X
authors.lastname: Waltz
authors.affiliation: Unité Transversale de la Drépanocytose, Hôpital de Pointe-à-Pitre, Hôpital Ricou, 97159 Pointe-à-Pitre Cedex, Guadeloupe, France(2). Electronic address: ldoumccd@yahoo.fr.
authors.forename: Lydia
authors.initials: L
authors.lastname: Divialle-Doumdo
authors.affiliation: UMR Inserm U1134, Université des Antilles et de la Guyane, Hôpital de Pointe-à-Pitre, Hôpital Ricou, 97159 Pointe-à-Pitre Cedex, Guadeloupe, France(2); Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France. Electronic address: marie-dominique.hardy-dessources@inserm.fr.
authors.forename: Marie-Dominique
authors.initials: MD
authors.lastname: Hardy-Dessources
authors.affiliation: Unité Transversale de la Drépanocytose, Hôpital de Pointe-à-Pitre, Hôpital Ricou, 97159 Pointe-à-Pitre Cedex, Guadeloupe, France(2). Electronic address: eleonore.petras@chu-guadeloupe.fr.
authors.forename: Marie
authors.initials: M
authors.lastname: Petras
authors.affiliation: Centre Investigation Clinique Antilles Guyane, 1424 Inserm, Hôpital de Pointe-à-Pitre, Hôpital Ricou, 97159, Pointe-à-Pitre Cedex, Guadeloupe, France. Electronic address: benoit.tressieres@gmail.com.
authors.forename: Benoît
authors.initials: B
authors.lastname: Tressières
authors.affiliation: Unité Transversale de la Drépanocytose, Hôpital de Pointe-à-Pitre, Hôpital Ricou, 97159 Pointe-à-Pitre Cedex, Guadeloupe, France(2). Electronic address: vanessa.tarer@chu-guadeloupe.fr.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Tarer
authors.affiliation: Laboratoire ACTES (EA 3596), Université des Antilles et de la Guyane, UFR STAPS Campus Fouillole, BP 97159 Pointe-à-Pitre Cedex, Guadeloupe, France. Electronic address: ohue@univ-ag.fr.
authors.forename: Olivier
authors.initials: O
authors.lastname: Hue
authors.affiliation: Unité Transversale de la Drépanocytose, Hôpital de Pointe-à-Pitre, Hôpital Ricou, 97159 Pointe-à-Pitre Cedex, Guadeloupe, France(2). Electronic address: maryse.etienne-julan@chu-guadeloupe.fr.
authors.forename: Maryse
authors.initials: M
authors.lastname: Etienne-Julan
authors.affiliation: Laboratoire ACTES (EA 3596), Université des Antilles et de la Guyane, UFR STAPS Campus Fouillole, BP 97159 Pointe-à-Pitre Cedex, Guadeloupe, France. Electronic address: s_antoine@ymail.com.
authors.forename: Sophie
authors.initials: S
authors.lastname: Antoine-Jonville
authors.affiliation: UMR Inserm U1134, Université des Antilles et de la Guyane, Hôpital de Pointe-à-Pitre, Hôpital Ricou, 97159 Pointe-à-Pitre Cedex, Guadeloupe, France(2); Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France; Institut Universitaire de France (IUF), Ministère de l'Education Nationale, de l'Enseignement Supérieur et de la Recherche 1, rue Descartes, 75231 Paris Cedex 05 Paris, France; Laboratoire CRIS EA647, Equipe "Biologie Vasculaire et Globule Rouge", Université Claude Bernard Lyon 1, 43 Boulevard du 11 Novembre 1918, 69100 Villeurbanne, France. Electronic address: pconnes@yahoo.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Connes
mesh_terms: D000293:Adolescent; D000755:Anemia, Sickle Cell / Q000097:blood* / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D001809:Blood Viscosity; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation; D055806:Microvessels / Q000378:metabolism / Q000503:physiopathology*; D010100:Oxygen / Q000378:metabolism*; D010146:Pain / Q000209:etiology
chemical_list: D010100:Oxygen
keywords: Hemorheology; Microcirculation; Microcirculatory oxygenation; Sickle cell disease