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Alshurafa A, Alkhatib M, Abu-Tineh M, Yassin MA. Sickle cell leg ulcer successfully managed by hyperbaric oxygen: a case report. Front Med (Lausanne) 2023; 10:1171971. [PMID: 37396892 PMCID: PMC10310543 DOI: 10.3389/fmed.2023.1171971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/18/2023] [Indexed: 07/04/2023] Open
Abstract
Sickle cell leg ulcers (SCLUs) are usually chronic, painful, and devastating complications of sickle cell disease. Skin vaso-occlusion with compromised blood flow, chronic inflammation, and endothelial dysfunction is thought to be the underlying mechanism. It is usually slow to heal, and it may become chronic and superinfected. The management of SCLUs is usually challenging and requires a multidisciplinary team. Multiple systemic and local therapies have been tried in SCLU treatment. However, the outcome is variable: currently, there are no official recommendations for the best effective treatment. Herein, we report a 34-year-old male patient with non-transfusion-dependent sickle cell disease who was suffering from a chronic left ankle ulcer and was successfully managed with hyperbaric oxygen therapy, resulting in a complete resolution of this devastating complication.
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Affiliation(s)
- Awni Alshurafa
- Hematology Department, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Alkhatib
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
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Asbeutah AM, Zahra AM, Al‐Abboh H, AlMajran AA, Adekile A. Repeat transcranial Doppler ultrasound imaging in Kuwaiti children with sickle cell disease after a 10‐year interval: A prospective, cohort study. Health Sci Rep 2023; 6:e1159. [PMID: 36992713 PMCID: PMC10041544 DOI: 10.1002/hsr2.1159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
Objectives Transcranial Doppler imaging (TCDI) of the cerebral arteries is the method of choice to predict patients with sickle cell disease (SCD) at risk for stroke. This study reports TCDI follow‐up of cerebral blood flow in a cohort of Kuwaiti children with SCD after a 10‐year interval. Methods Twenty‐one pediatric patients with SCD, aged 16.0 ± 1.6 years were initially studied when they were aged 6.5 ± 1.2 years. TCDI scanning was carried out using a phased‐array transducer of 1–3 MHz through the trans‐temporal window. Peak systolic velocity (PSV), end‐diastolic velocity (EDV), time‐averaged mean of the maximum velocity (TAMMV), resistive index (RI), and pulsatility index (PI) were obtained in the anterior and posterior Circle of Willis vessels. Results The follow‐up indices were mostly lower than in the initial study although they remained within the normal range in all the arteries. TAMMV was less than 170 cm/s, and PSV did not exceed 200 cm/s in all vessels. The initial and follow‐up TAMMV (mean ± SD) were: 77.3 ± 20.9 and 71.6 ± 9.9 in the terminal internal carotid artery, 94.3 ± 25.8 and 82 ± 18.2 in the middle cerebral artery, 76.6 ± 25.6 and 70.6 ± 10.7 in the anterior cerebral artery, and 59.1 ± 15.8 and 63.9 ± 8.5 in the posterior cerebral artery, respectively. The mean differences between the old and follow‐up data for RI, and PI were statistically significant (p < 0.05). Conclusions Kuwaiti patients with SCD appear to be largely protected from cerebral artery vasculopathy in childhood. Stroke is a common complication in sickle cell disease (SCD) in many parts of the world and it tends to be recurrent. Transcranial Doppler Imaging (TCDI) is used to identify patients at risk for stroke. Patients with timed average mean of the maximum velocity (TAMMV) > 200 cm/s in the arteries of the Circle of Willis, are at increased risk of stroke and need chronic transfusion for the primary prevention of stroke. However, stroke is uncommon among Kuwaiti SCD patients with high HbF. A previous study carried out, about 10 years ago, in a cohort of Kuwaiti pediatric SCD found none with abnormal TAMMV values. A repeat TCDI study has now been carried out on 21 patients from the cohort that was studied 10 years ago. We found that TCD remains in the normal range in all the patients and, in fact, the TAMMV and other values were significantly lower in the latest study compared to the initial data. Cerebral vasculopathy is uncommon among Kuwaiti SCD patients.
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Affiliation(s)
- Akram M. Asbeutah
- Department of Radiologic Sciences, Faculty of Allied Health SciencesKuwait UniversitySafatKuwait
| | - Akmal M. Zahra
- Department of PediatricsMubarak Al‐Kabeer Hospital, Ministry of HealthSafatKuwait
| | - Hanan Al‐Abboh
- Department of PediatricsMubarak Al‐Kabeer Hospital, Ministry of HealthSafatKuwait
| | - Abdullah A. AlMajran
- Department of Community Medicine & Behavioral Sciences, Health Sciences Centre, Faculty of MedicineKuwait UniversitySafatKuwait
| | - Adekunle Adekile
- Department of Pediatrics, Faculty of MedicineKuwait UniversitySafatKuwait
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Ata F, Rahhal A, Malkawi L, Iqbal P, Khamees I, Alhiyari M, Yousaf Z, Qasim H, Alshurafa A, Sardar S, Javed S, Fernyhough L, Yassin M. Genotypic and Phenotypic Composition of Sickle Cell Disease in the Arab Population - A Systematic Review. Pharmgenomics Pers Med 2023; 16:133-144. [PMID: 36851992 PMCID: PMC9961577 DOI: 10.2147/pgpm.s391394] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 02/01/2023] [Indexed: 02/24/2023] Open
Abstract
Sickle cell disease (SCD) is a genetic disease influenced by ethnicity and regional differences in its clinical course. Recent advances in the management of SCD with newer therapies are being introduced to the Western population. However, many of these treatments are yet to be used in the Arabic SCD population. Understanding the genetic variations of SCD regionally is essential to anticipate the utilization of new treatments. This systematic review's main objective is to pool the available data on the genetic composition of SCD in the Arabic population. Data for 44,034 patients was extracted from 184 studies (11 case reports, 8 case series, 56 retrospectives, 107 prospective observational studies, and 2 clinical trials) using PubMed, Scopus, and Google Scholar. Male (49%) and female (51%) patients were equally reported wherever gender was available (N=13105). Various SCD genotypes were reported in a total of 14,257 patients, including Hb SS (77%) Hb Sβ0 (9.9%), and Hb Sβ+ (7.2%), while the rest of the genotypes, including HbSC, HbSD, HbSE, HbSO Arab, Hb S/α-Thal, Hb Sβ0 + α-Thal, and HBS Oman were individually reported in <4% of the cases. Major SCD complications in the Arab population included pain crises (48.25%) followed by neurological complications (33.46%), hepatobiliary complications (25.53%), musculoskeletal complications (24.73%), and hemolytic anemia (23.57%). The treatments reported for SCD included hydroxyurea (20%), blood transfusion (14.32%), and Deferasirox (3.03%). We did not find the use of stem cell transplantation or newer treatments such as L-Glutamine, Voxelotor, Crizanlizumab, or gene therapy reported in any of the studies included in our review. This review highlights the genetic makeup of SCD in Arab countries and its common phenotypic manifestations and will help direct further research on SCD in this region, especially concerning genetic therapy. Systematic Review Registration The protocol has been registered in the International Prospective Register of Systematic Reviews(PROSPERO):CRD42020218,666. https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=218666.
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Affiliation(s)
- Fateen Ata
- Department of Endocrinology, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Alaa Rahhal
- Department of Clinical Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Lujain Malkawi
- Department of Internal Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Phool Iqbal
- Department of Internal Medicine, Metropolitan Hospital, New York, NY, USA
| | - Ibrahim Khamees
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mousa Alhiyari
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zohaib Yousaf
- Department of Internal Medicine, Reading Hospital - Tower Health, West Reading, PA, USA
| | - Hana Qasim
- Department of Internal Medicine, UMKC School of medicine, Kansas, MO, USA
| | - Awni Alshurafa
- Department of Medical Oncology /Hematology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Sundus Sardar
- Department of Medicine, Division of Nephrology, Pennsylvania State University College of Medicine, Hershey Medical Center, Hershey, PA, USA
| | - Saad Javed
- Department of Internal Medicine, Icahn school of medicine at Mount Sinai/Queens Hospital Center, New York, NY, USA
| | - Liam Fernyhough
- Department of Medical Oncology /Hematology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.,Department of Medical Education, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Mohamed Yassin
- Department of Medical Oncology /Hematology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Muacevic A, Adler JR, Yashi K, Gopalakrishnan Ravikumar NP, Parmar N, Dankhara N, Satodiya V. Pediatric Sickle Cell Disease and Stroke: A Literature Review. Cureus 2023; 15:e34003. [PMID: 36811060 PMCID: PMC9939049 DOI: 10.7759/cureus.34003] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 01/21/2023] Open
Abstract
Both ischemic and hemorrhagic strokes in children can be a complication of sickle cell disease, which also affects adults. The occurrence is high without any screening or preventative care. This review article found that although transcranial Doppler (TCD) has reduced the prevalence of stroke in pediatric patients, there is still a need for an epidemiological survey to define such screening for adults, the ideal dose of hydroxyurea to reduce the incidence of stroke, and to identify silent cerebral stroke to prevent its complications. Increased hydroxyurea prescription and specific antibiotic and vaccination regimes lowered the occurrence of this condition. In pediatric cases with a time-averaged mean of the maximal velocity greater than 200cm/s, transcranial Doppler screening and preventive chronic transfusion for at least the first year have lowered the occurrence of stroke by up to 10 times. The ideal dose of hydroxyurea is still debatable, but it seems to reduce the risk of the first stroke to a comparable level in the average population. Adult ischemic and hemorrhagic stroke prevention has not yet received the same attention. Though there are fewer studies, sickle cell disease is also more common than age-matched controls in terms of silent cerebral infarction on magnetic resonance imaging (MRI), as well as other neurological problems such as cognitive impairment, seizures, and headaches. Currently, there is no evidence-supported way to prevent ischemic stroke in adults at any age. Also, there is no defined ideal dose of hydroxyurea that can be helpful in preventing strokes. Data also lack a way to identify a silent cerebral infarction, so its complications can be prevented. An additional epidemiological survey may help in the prevention of the condition. The primary aim of this article was to emphasize the importance of information on clinical, neuropsychological, and quantitative MRI assessment of sickle cell patients to understand the epidemiology and etiology of stroke in sickle cell patients to prevent stroke and its related morbidity.
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Alshurafa A, Elhissi M, Yassin MA. Complete resolution of stage II avascular necrosis affecting three joints by hyperbaric oxygen in a patient with sickle cell disease: A case report. Front Med (Lausanne) 2022; 9:1063255. [DOI: 10.3389/fmed.2022.1063255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/08/2022] [Indexed: 12/02/2022] Open
Abstract
Avascular necrosis (AVN) or joint osteonecrosis is a debilitating complication of sickle cell disease, increasing the disease burden on both patients and healthcare systems. AVN can be radiologically categorized into early and late stages depending on the extent of the disease. Management of AVN is challenging and controversial. Generally, it includes conservative measures for early disease to preserve the joint for as long as possible and surgical management for more advanced diseases. Hyperbaric oxygen (HBO) therapy can be used as primary or adjunctive therapy for different medical disorders. Currently, the main rule of HBO in AVN is an adjunctive therapy to control symptoms and improve the quality of life of a patient; however, the concept of using HBO as a primary treatment choice for AVN in patients with sickle cell disease is not well evaluated yet. In this case study, we reported a 15-year-old boy with sickle cell disease who was suffering from stage II AVN in bilateral femoral and right shoulder joints. A total of 57 sessions of HBO resulted in the complete resolution of AVN in post-treatment MRI.
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Alshurafa A, Yassin MA. Short- and long-term follow-up and additional benefits in a sickle cell disease patient experienced severe crizanlizumab infusion-related vaso-occlusive crisis: A case report. Front Med (Lausanne) 2022; 9:1048571. [PMID: 36523780 PMCID: PMC9745667 DOI: 10.3389/fmed.2022.1048571] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/02/2022] [Indexed: 09/20/2023] Open
Abstract
Sickle cell disease is an autosomal recessive disorder characterized by the presence of sickle hemoglobin that leads to chronic hemolysis and vaso-occlusive crisis. After decades of limited therapy options, crizanlizumab is a humanized monoclonal antibody approved by the Food and Drug Administration (FDA) in 2019 for sickle cell-related pain crises for patients 16 years of age and above. Although rare, infusion-related reactions, including painful crises, occurred in 3% as per the package insert. However, the data on how to deal with such reactions and about further treatment outcomes are limited as most patients stopped crizanlizumab after the reaction. Herein, we report the good outcome of 13 doses of crizanlizumab in a 19-year-old female patient with sickle cell disease on hydroxyurea, despite experiencing a severe infusion-related painful crisis during the second infusion. Additional benefits of crizanlizumab, in this case, were preventing new episodes of acute chest syndrome, quitting chronic narcotics use, and a remarkable improvement in quality of life and overall performance.
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Alshurafa A, Yassin MA. Case report: Safety and efficacy of voxelotor in a patient with sickle cell disease and stage IV chronic kidney disease. Front Med (Lausanne) 2022; 9:931924. [PMID: 36186817 PMCID: PMC9520303 DOI: 10.3389/fmed.2022.931924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
Sickle cell disease (SCD) is a heterogeneous group of inherited disorders characterized by the production of sickle hemoglobin which is less soluble than an adult or fetal hemoglobin. Voxelotor is a hemoglobin S polymerization inhibitor that has been approved for sickle cell disease treatment in the adult and adolescent populations. It acts as a hemoglobin modulator by increasing its affinity to oxygen which prevents red blood cells from sickling. Chronic kidney disease is a common but under-reported complication of SCD and it is a leading cause of morbidity and mortality. The data about the safety and efficacy of voxelotor use in chronic kidney disease is limited. Herein we report a 49-year-old man, with sickle cell disease and stage IV chronic kidney disease, who was managed successfully with voxelotor and resulted in decreasing transfusion requirement and vaso-occlusive painful crisis without affecting kidney function.
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Affiliation(s)
- Awni Alshurafa
- *Correspondence: Awni Alshurafa, ; orcid.org/0000-0002-4454-5307
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8
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Okar L, Ali Alzoubi H, Shukur Mahmud S, Elyas A, Yassin MA. Dilemma in approach to stroke in sickle cell disease patient: A case report. Medicine (Baltimore) 2022; 101:e29131. [PMID: 35839057 PMCID: PMC11132328 DOI: 10.1097/md.0000000000029131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/04/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Cerebrovascular accidents in sickle cell disease (SCD) patients carry a high socioeconomic impact and represent the most important cause of morbidity, neurological deficits, and impaired quality of life in SCD young population.Patent foramen ovale (PFO) is prevalent in 25% of the general population and it is associated with ischemic stroke in the young population via paradoxical embolism, yet there are no specific guidelines to address how to manage SCD patients with PFO who suffer a stroke. PATIENT CONCERNS AND DIAGNOSIS Here we present a young SCD patient, aged 24 years, who suffered a stroke in childhood and later was discovered to have a PFO on subsequent echocardiography. The patient has been receiving blood transfusion therapy since 3 years of age. INTERVENTIONS AND OUTCOMES No treatment was administered to the patient.The intervention that was done was echocardiography with a bubble study to detect PFO. CONCLUSION Recommendations need to be put in place regarding screening for PFO in patients with SCD, in addition to highlighting issues of whether screening needs to be done in patients who have not developed stroke, and if PFO were to be found, what would be the best management approach and how will prognosis be affected.
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Affiliation(s)
- Lina Okar
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Ahmed Elyas
- Department of Medical Oncology, Hematology Section, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A. Yassin
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
- Department of Cardiology, Hamad Medical Corporation, Doha, Qatar
- Department of Medical Oncology, Hematology Section, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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Ali E, Hatim A, Yassin M. SARS‐CoV‐2 omicron variant may present with severe sickle cell painful crisis: A report of two cases. Clin Case Rep 2022; 10:e05934. [PMID: 35702620 PMCID: PMC9178402 DOI: 10.1002/ccr3.5934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 03/29/2022] [Accepted: 05/08/2022] [Indexed: 11/13/2022] Open
Abstract
Coronavirus disease 2019 (COVID‐19) is a respiratory viral illness that is caused by coronavirus 2 (SARS‐CoV‐2). The disease often presents with non‐specific symptoms such as fever, headache, and fatigue, accompanied by respiratory symptoms (e.g., cough and dyspnea) and other systemic involvement. Currently, the virus had shown significant changes and mutations that resulted in the emergence of different strains. Each strain varies in its virulence, disease severity, and the response of the body's immune system. Sickle cell disease characterized by hemolytic anemia particularly in associated with stress. Patients with sickle cell disease infected with SARS‐CoV‐2 are reported to have increased risk for hospitalization, thrombosis, and other complications compared with non‐sickle cell patients. The Omicron variant causes mild disease in general population; however, in patients with sickle cell disease, the data are limited. We present two patients known to have sickle cell disease presented with a severe acute painful crisis that required hospitalization after infection with Omicron variant of the SARS‐CoV‐2 virus.
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Affiliation(s)
- Elrazi Ali
- Internal Medicine Department Hamad Medical Corporation Doha Qatar
| | - Ahmed Hatim
- Internal Medicine Department Hamad Medical Corporation Doha Qatar
| | - Mohamed Yassin
- Department of Hematology and Medical Oncology Hamad Medical Corporation Doha Qatar
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Ata F, Yousaf Z, Sardar S, Javed S, Iqbal P, Khamees I, Malkawi LS, Yassin MA. Protocol for "Genetic composition of sickle cell disease in the Arab population: A systematic review". Health Sci Rep 2022; 5:e450. [PMID: 35509404 PMCID: PMC9062566 DOI: 10.1002/hsr2.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 10/17/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
Background Sickle Cell Disease (SCD) is a global health issue in hematology with a progressively increasing prevalence. There are recent advances in the management of SCD, with new drugs being introduced. It is essential to analyze the genetic makeup of SCD regionally to anticipate the effectiveness of management modalities. This systematic review's main objectives are (a) to combine the existing knowledge of the genetic composition of SCD in the Arab population and (b) to analyze the various phenotypes of SCD prevalent in the Arab population. Methods We will perform a systematic review and search multiple electronic databases predefined search terms to identify eligible articles. Eligible studies should report findings on the genetic testing of Sickle Cell disease in the 22 Arab countries. Case reports, case series, observational studies with cross‐sectional or prospective research design, case‐control studies, and experimental studies will be included. Study quality will be independently evaluated by two reviewers using the statistical methodology and categories guided by the Cochrane Collaboration Handbook and PRISMA guidelines. Discussion This review will explore and integrate the evidence available on the various genotypes and phenotypes of SCD in the Arab population. By acquiring and summarizing data about the genetic and phenotypic variants of the SCD patient population, this study will add to the knowledge and help find more precise treatments. Systematic review registration The protocol is registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD42020218666).
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Affiliation(s)
- Fateen Ata
- Department of Internal Medicine Hamad General Hospital, Hamad Medical Corporation Doha Qatar
| | - Zohaib Yousaf
- Department of Internal Medicine Hamad General Hospital, Hamad Medical Corporation Doha Qatar
| | - Sundus Sardar
- Department of Internal Medicine Hamad General Hospital, Hamad Medical Corporation Doha Qatar
| | - Saad Javed
- Department of Internal Medicine Allama Iqbal Medical College Lahore Pakistan
| | - Phool Iqbal
- Department of Internal Medicine Hamad General Hospital, Hamad Medical Corporation Doha Qatar
| | - Ibraheem Khamees
- Department of Internal Medicine Hamad General Hospital, Hamad Medical Corporation Doha Qatar
| | - Lujain Salahaldeen Malkawi
- Department of Internal Medicine, Faculty of Medicine Jordan University of Science and Technology Irbid Jordan
| | - Mohamed A Yassin
- Department of Medical Oncology/Hematology National Centre for Cancer Care and Research, Hamad Medical Corporation Doha Qatar
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Rozi W, Ali EAH, Al-Mashdali AF, Abdelrazek M, Yassin MA. Use of rivaroxaban in sickle cell disease and venous thromboembolism: A case report. Medicine (Baltimore) 2021; 100:e27988. [PMID: 34941038 PMCID: PMC8702265 DOI: 10.1097/md.0000000000027988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/07/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Sickle cell disease (SCD) is a hematological disorder characterized by sickling of red blood cells. Patients are at increased risk of venous thromboembolism. There are no guidelines for the management of venous thromboembolism in sickle cell disease specifically in terms of the anticoagulant of choice. PATIENT CONCERNS Here, we report a case of a 30-year-old lady with past medical history of sickle cell disease who came with chest pain and shortness of breath. DIAGNOSIS We found that she has bilateral pulmonary embolism (PE). INTERVENTION She was started on rivaroxaban. OUTCOME The patient was followed for 18 months, she did not suffer from recurrence of PE, and she did not develop any complications related to rivaroxaban. CONCLUSION We concluded that rivaroxaban is effective in treating PE in sicklers and also it is safe.
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Affiliation(s)
- Waail Rozi
- Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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12
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Kirkham FJ, Lagunju IA. Epidemiology of Stroke in Sickle Cell Disease. J Clin Med 2021; 10:4232. [PMID: 34575342 PMCID: PMC8469588 DOI: 10.3390/jcm10184232] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/26/2021] [Accepted: 07/26/2021] [Indexed: 12/18/2022] Open
Abstract
Sickle cell disease is the most common cause of stroke in childhood, both ischaemic and haemorrhagic, and it also affects adults with the condition. Without any screening or preventative treatment, the incidence appears to fall within the range 0.5 to 0.9 per 100 patient years of observation. Newborn screening with Penicillin prophylaxis and vaccination leading to reduced bacterial infection may have reduced the incidence, alongside increasing hydroxyurea prescription. Transcranial Doppler screening and prophylactic chronic transfusion for at least an initial year has reduced the incidence of stroke by up to 10-fold in children with time averaged mean of the maximum velocity >200 cm/s. Hydroxyurea also appears to reduce the incidence of first stroke to a similar extent in the same group but the optimal dose remains controversial. The prevention of haemorrhagic stroke at all ages and ischaemic stroke in adults has not yet received the same degree of attention. Although there are fewer studies, silent cerebral infarction on magnetic resonance imaging (MRI), and other neurological conditions, including headache, epilepsy and cognitive dysfunction, are also more prevalent in sickle cell disease compared with age matched controls. Clinical, neuropsychological and quantitative MRI screening may prove useful for understanding epidemiology and aetiology.
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Affiliation(s)
- Fenella Jane Kirkham
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, Faculty of Population Health Sciences, 30 Guilford Street, London WC1N 1EH, UK
- Child Health, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton SO16 6YD, UK
- Paediatric Neurosciences, King’s College Hospital, London SE5 9RS, UK
| | - Ikeoluwa A. Lagunju
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan PMB 3017, Nigeria;
- Department of Paediatrics, University College Hospital, Ibadan PMB 5116, Nigeria
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Abd El-Ghany SM, Tabbakh AT, Nur KI, Abdelrahman RY, Etarji SM, Almuzaini BY. Analysis of Causes of Hospitalization Among Children with Sickle Cell Disease in a Group of Private Hospitals in Jeddah, Saudi Arabia. J Blood Med 2021; 12:733-740. [PMID: 34408522 PMCID: PMC8364845 DOI: 10.2147/jbm.s318824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Sickle cell anemia (SCA) is a chronic hematologic condition that requires frequent hospitalization representing a significant economic burden on the health services. The aim of this study was to explore the causes and underlying factors of hospitalization among children with SCA, as well as the factors affecting their length of hospital stay. Patients and Methods This retrospective study included children and adolescents less than 16 years old who were admitted in a group of private hospitals in Jeddah, Saudi Arabia, during the period from January 2018 to December 2019. Results A total of 94 patients were included in this study, 59.6% were males, with a mean age 7.29 ± 3.82 years. The majority of the patients (91.5%) had sickle cell disease. The most common cause of hospital admission was vaso-occlusive crises (VOC) (64.9%) followed by infection (24.5%), acute chest syndrome (ACS) (18.1%), and acute hemolytic crisis (12.8%). We found no significant difference between gender and different causes of admissions (p > 0.05). While in relation to age group, limb pain and back pain were found to be significantly more frequent among children ≥ 7 years old (p = 0.03,0.04), while infections were significantly more frequent among children < 7 years old (p = 0.003). We analyzed the length of hospital stay and different factors, and we found that the mean length of hospital stay was significantly higher among children who were admitted with infections (p = 0.01) and ACS (p < 0.001) and among children who are non-compliant on hydroxyurea (p = 0.04). Conclusion The most common cause of hospitalization among children with SCD in Jeddah, Saudi Arabia, was VOC followed by infection, ACS and acute anemia. The length of hospital stay was more prolonged among children with infection and ACS, as well as children who were non-compliant to hydroxyurea.
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Affiliation(s)
- Shereen M Abd El-Ghany
- Department of Pediatrics, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia.,Department of Pediatrics, Hematology and Oncology Unit, Ain Shams University, Cairo, Egypt
| | - Aisha T Tabbakh
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Khulud I Nur
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Rayan Y Abdelrahman
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Sara M Etarji
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
| | - Bayan Y Almuzaini
- College of Medicine, Ibn Sina National College for Medical Studies, Jeddah, Kingdom of Saudi Arabia
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14
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Khamees I, Rozi W, Yassin MA. Acute chest syndrome in sickle cell disease/HBE patient, A case report. Clin Case Rep 2021; 9:e04575. [PMID: 34457278 PMCID: PMC8380073 DOI: 10.1002/ccr3.4575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 06/04/2021] [Accepted: 06/16/2021] [Indexed: 12/03/2022] Open
Abstract
The presented case will shed some light on one of the rarest complications of HBSE disease, which is acute chest syndrome, and will highlight the management of that complication.
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Affiliation(s)
- Ibrahim Khamees
- Department of Internal medicineHamad Medical CorporationDohaQatar
| | - Waail Rozi
- Department of Internal medicineHamad Medical CorporationDohaQatar
| | - Mohamed A. Yassin
- Department of Medical Oncology/Hematology SectionHamad Medical CorporationDohaQatar
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15
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Khamees I, Ata F, Choudry H, Soliman AT, De Sanctis V, Yassin MA. Manifestations of HbSE sickle cell disease: a systematic review. J Transl Med 2021; 19:262. [PMID: 34134694 PMCID: PMC8207785 DOI: 10.1186/s12967-021-02931-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/28/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Sickle cell disease (SCD) is commonly encountered in Africa and Middle Eastern countries. The causative mutation in the gene encoding the hemoglobin subunit β (HBB) leads to various genotypic variants of the disease. This results in varied phenotypes, with a spectrum of complications, from benign to fatal. Hemoglobin SS (HBSS) genotype is associated with most of these complications; hence, it is a severe form of SCD. On the other hand, rare genotypes such as hemoglobin SE (HBSE) are considered benign. There is limited literature about the clinical manifestations and characteristics of patients with HBSE. We pooled all available data describing the phenotypic manifestations of HBSE heterozygote worldwide to perform a systematic review. METHODS We performed a systematic review according to PRISMA guidelines using PubMed, SCOPUS, and Google Scholar databases. Two independent reviewers (FA and IK) evaluated studies for eligibility and extracted data. We synthesized data on demographics, manifestations, and management of HBSE disease. PROSPERO Registration Number: CRD42021229877. RESULTS We found 68 HBSE patients reported in the literature. 24 cases were extracted from case reports whereas 44 cases from case series and retrospective studies. Turkey reported the highest number of patients (n = 22). 32 (47%) of the patients were males. The mean age was 20.9 ± 18.26 years. The mean HBS and HBE percentages were 61.1% ± 7.25% and 32.3% ± 5.06%, respectively, whereas the mean hemoglobin was 11.64 ± 1.73 g/dl. Reported manifestations of HBSE disease included acute vaso-occlusive pain crisis (n = 22, 32.3%), splenomegaly (n = 11, 16.1%), hemolytic anemia (n = 10, 14.7%), infections (n = 8. 11.7%), bone infarction (n = 4, 5.8%), gallstones (n = 3, 4.4%), venous thromboembolism (VTE) (n = 2, 2.9%) and stroke (n = 2, 2.9%), and hematuria (n = 2, 2.9%). Death due to HBSE complications was reported in three patients. CONCLUSION HBSE is a rare genotypic variant of SCD. It has been considered a benign form; however, there are multiple reports of severe complications. Severe complications observed in HBSE disease include vaso-occlusive crisis, acute chest syndrome, stroke, bone marrow embolism, and death.
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Affiliation(s)
- Ibrahim Khamees
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, PO BOX 3050, Doha, Qatar
| | - Fateen Ata
- Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, PO BOX 3050, Doha, Qatar.
| | - Hassan Choudry
- Department of Internal Medicine, Faisalabad Medical University, Faisalabad, Pakistan
| | - Ashraf T Soliman
- Department of Paediatrics, University of Alexandria, Alexandria, Egypt
| | - Vincenzo De Sanctis
- Paediatric and Adolescent Outpatient Clinic, Quisisana Hospital, Ferrara, Italy
| | - Mohamed A Yassin
- Department of Medical Oncology/Hematology, National Centre for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
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16
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Okar L, Rezek M, Gameil A, Mulikandayhil Y, Yassin MA. Severe hemolysis and vaso-occlusive crisis due to COVID-19 infection in a sickle cell disease patient improved after red blood cell exchange. Clin Case Rep 2021; 9:2117-2121. [PMID: 33821186 PMCID: PMC8013421 DOI: 10.1002/ccr3.3960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/23/2021] [Accepted: 02/08/2021] [Indexed: 01/07/2023] Open
Abstract
Even though most data suggest favorable outcome in patients with SCD and COVID‐19 infection, close monitoring remains essential as acute complication may develop unexpectedly. Offering RBC exchange early in the course of infection might improve prognosis.
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Affiliation(s)
- Lina Okar
- Department of medical education Hamad Medical Corporation Doha Qatar
| | - Mohamad Rezek
- Department of medical education Hamad Medical Corporation Doha Qatar
| | - Amna Gameil
- Department of medical education Hamad Medical Corporation Doha Qatar
| | | | - Mohamed A Yassin
- Department of medical oncology, hematology Section National Center for Cancer Care & Research Hamad Medical Corporation Doha Qatar
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17
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Ali M, Okar L, Omar NE, Parengal J, Soliman A, Yassin MA. Sickle Cell Anemia Presenting with Vaso-Occlusive Pain: Should We Screen for COVID-19? DUBAI MEDICAL JOURNAL 2021. [PMCID: PMC7900454 DOI: 10.1159/000513232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Despite the widespread of coronavirus disease-19 (COVID-19) infection around the world, there are very scarce reported literature about the care of patients with a known diagnosis of hemoglobin disorders such as sickle cell disease (SCD) or thalassemia and confirmed COVID-19 infection. Thalassemia International Federation issued a position statement to include patients with thalassemia and SCD among the high-risk groups of patients. Here, we present an interesting case of a 42-year-old patient know to have SCD presenting with Vaso-occlusive (VOC) pain episode in the absence of COVID-19 signs and symptoms, who tested positive for COVID-19 infection and had a smooth recovery. This case highlights the importance of screening SCD patients presenting with VOC-related events even in the absence of COVID-19 signs and symptoms.
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Affiliation(s)
- Mohammad Ali
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Lina Okar
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
- *Lina Okar, Family Medicine Department, Hamad Medical Corporation, PO Box 3050, Al Rayan Street, Doha (Qatar),
| | - Nabil E. Omar
- Department of Pharmacy, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar
| | - Jabeed Parengal
- Department of Medicine, Infectious Disease Section, Hamad Medical Corporation, Doha, Qatar
| | - Ashraf Soliman
- Department of Pediatrics, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed A. Yassin
- Department of Medical Oncology, Hematology Section, National Center for Cancer Care & Research, Hamad Medical Corporation, Doha, Qatar
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18
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Okar L, Aldeeb M, Yassin MA. The role of red blood cell exchange in sickle cell disease in patient with COVID-19 infection and pulmonary infiltrates. Clin Case Rep 2021; 9:337-344. [PMID: 33362923 PMCID: PMC7753272 DOI: 10.1002/ccr3.3526] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/26/2020] [Indexed: 02/02/2023] Open
Abstract
Due to the overlap between ACS and COVID-19 pneumonia, we recommend close monitoring for those patients and offering them RBC exchange early in the course of the disease to avoid clinical deterioration.
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Affiliation(s)
- Lina Okar
- Department of Medical EducationHamad Medical CorporationDohaQatar
| | - Maya Aldeeb
- Department of Medical EducationHamad Medical CorporationDohaQatar
| | - Mohamed A. Yassin
- Department of Medical Oncology, Hematology SectionNational Center for Cancer Care & ResearchHamad Medical CorporationDohaQatar
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