title: Pain frequency, severity and QT dispersion in adult patients with sickle cell anemia: correlation with inflammatory markers.
abstract: BACKGROUND
  Inflammatory markers are increased during vaso-occlusive crisis (VOC) in adult patients with sickle cell anemia (SCA), but this is not clear in clinical steady state.
  
  
  OBJECTIVE
  The present study aims to establish the frequency and intensity of bone pain episodes in adult patients with SCA in clinical steady state and to determine the correlation between different inflammatory markers, other variables including QT dispersion (QTd) and pain frequency and intensity in SCA.
  
  
  METHODS
  Patients were classified into two groups: group 1, those with more than three hospital admissions in the last 6 months, and group 2, those with no hospital admission. Pearson correlation between variables such as body mass index (BMI), level of tumor necrosis factor (TNF-α), interleukin-1 (IL-1), C-reactive protein (CRP), hemoglobin (Hb), reticulocyte count, white blood cell count (WBC), ferritin, lactate dehydrogenase (LDH), parathormone (PTH), vitamin D3 (25-OH cholecalciferol) and bone pain frequency with severity was evaluated.
  
  
  RESULTS
  Forty-six patients were enrolled in this study with a mean age of 18.47±5.78 years, with 23 patients in each group. Vitamin D3 and Hb were lower (17.04±5.77 vs 37.59±4.83 ng/L,P<0.01 and 7.96±0.3 vs 8.44±0.27 g/dL,P<0.01, respectively); the inflammatory markers showed significantly higher level of TNF-α, IL-1 and CRP (56.52±5.43 pg/ml, 44.17±4.54 pg/ml and 3.20±0.72 mg/L, respectively,P<0.05); WBC, LDH and reticulocyte count were also significantly higher and the QTd was higher (45.0±2.22 vs 41.55±0.8 ms,P<0.05) in group 1 when compared with group 2. Pearson correlation coefficient showed significant positive correlation between serum level of TNF-α and bone pain frequency (r=0.414,P<0.005) and serum level of IL-1 (r=0.39,P<0.008).
  
  
  CONCLUSIONS
  There is a strong positive correlation between TNF-α, IL-1 and WBC and bone pain frequency in steady state in adult patients with SCA. CRP and low hemoglobin had weak positive correlation. QTd was significantly longer in patients who had hospitalizations with VOC.
authors.affiliation: Salmanyia Medical Complex, Ministry of Health; College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
authors.forename: Taysir S
authors.initials: TS
authors.lastname: Garadah
authors.affiliation: College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Jaradat
authors.affiliation: Salmanyia Medical Complex, Ministry of Health.
authors.forename: Mohammed E
authors.initials: ME
authors.lastname: AlAlawi
authors.affiliation: Salmanyia Medical Complex, Ministry of Health.
authors.forename: Adla B
authors.initials: AB
authors.lastname: Hassan
authors.affiliation: College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain.
authors.forename: Reginald P
authors.initials: RP
authors.lastname: Sequeira
keywords: analog pain scale; immunological markers; sickle cell anemia