Abstract
Background: Sickle cell disease (SCD) is characterized by a wide variation in the clinical manifestations and severity of the associated complications despite the molecular abnormality leading to sickle gene is similar in all haplotypes.
Aim: This study aimed to evaluate the clinical manifestations patterns of children affected by homozygous SS SCD.
Methods: It was a hospital-based, cross-sectional study carried out on 147 pediatric patients from the time of birth up to 12 years. It was conducted at Saudi Hospital Hajjah (SHH) over a period of a year (2020).
Results: The mean age was 7.32 ± 3.5 years, 57.1% of them were males. Two children (1.3%) had their symptoms started at the first year of age. The most frequent symptoms were vaso-occlusive crises (VOC), generalized bone pain (38.0%), fever (34.0%), bone pain and fevers (9.5%), anemic crises (7.5%) and hand-foot-syndrome (6.1%). Splenomegaly was detected in 28.5% and cerebrovascular accident (CVA) in one child (0.7%). Splenomegaly as well as bone pain were significantly observed among children older than five years (P < 0.05).
Conclusion: SCD is characterized by a marked variations in the clinical manifestations. The symptoms started as early as the first year of life and VOC remain the most frequent clinical presentation. Genetic counseling, premarital screening as well as early infant screening are urgently required in our country to reduce the magnitude of disease and to improve the quality of care.
Keywords: Sickle Cell Disease, Yemen, Vaso-Occlusive Crises
References
- da Guarda CC, Yahoue´de´hou SCMA, Santiago RP, Neres JSdS, Fernandes CFdL, Aleluia MM, et al. Sickle cell disease: A distinction of two most frequent genotypes (HbSS and HbSC). PLoS ONE. 2020; 15(1): e0228399. https://doi.org/1371/journal.pone.0228399.
- Hoban MD, Orkin SH, Bauer DE. Genetic treatment of a molecular disorder: gene therapy approaches to sickle cell disease. Blood. 2016 Feb 18;127(7):839-48. doi: 10.1182/blood-2015-09-618587.
- Elsayid M, Al‑Shehri MJ, Alkulaibi YA, Alanazi A, Qureshi S.Frequency distribution of sickle cell anemia, sickle cell trait and sickle/beta‑thalassemia among anemic patients in Saudi Arabia. J Nat Sci Biol Med. 2015;6:S85‑8.
- Kato GJ, Steinberg MH, Gladwin MT. Intravascular hemolysis and the pathophysiology of sickle cell disease. J Clin Invest. 2017;127:750‑60.
- Piel FB, Steinberg MH, Rees DC. Sickle cell disease. N Engl J Med. 2017;376:1561‑73
- Abu-Shaheen A, Munshi H, Nofal A, Abdelmoety DA, Riaz M, AlFayyad I. Epidemiology of sickle cell disease in gulf cooperation council countries: A systematic review (July 31, 2019). Available at SSRN: https://ssrn.com/abstract=3429912 or http://dx.doi.org/10.2139/ssrn.3429912.
- El Hazmi MAF, Al-Hazmi AM, Warsy AS. Sickle cell disease in Middle East Arab countries. Indian J. Med. Res. 2011;134:597–610.
- Al-Saqladi AW, Cipolotti R, Fijnvandraat K, Brabin BJ. Growth and nutritional status of children with homozygous sickle cell disease. Ann Trop Paediatr. 2008;28(3):165–89.
- Al-Saqladi AW, Brabin BJ, Bin-Gadeem HA, Kanhai WA,Phylipsen M, Harteveld CL. Beta-globin gene cluster haplotypes in Yemeni children with sickle cell disease. Acta Haematol. 2010;123:182-5.
- El-Hazmi MA, Warsy AS. Molecular studies on Yemeni sickle cell-disease patients: Xmn I polymorphism. East Mediterr Health J. 1999;5: 1183-7.
- El-Hazmi MA, Warsy AS. Pattern for alpha-thalassaemia in Yemeni sickle-cell-disease patients. East Mediterr Health J. 1999;5:1159-64.
- Shinde S, Bakshi AP, Shrikhande AV. Infections in sickle cell disease. IAIM. 2015;2(11)26-34.
- Al-Jafar H, AlFadhli S, Al-Feeli M, Ali A, Alhajri F. Effects of age and sex on sickle cell disease avascular necrosis. J Hematol Blood Disord. 2016;2(1):1-4.
- Telfer P, Coen P, Chakravorty S,Wilkey O, Evans J, Newell H, et al. Clinical outcomes in children with sickle cell disease living in England: a neonatal cohort in East London. Haematologica. 2007;92:905–12.
- Kanter J, Kruse-Jarres R. Management of sickle cell disease from childhood through adulthood. Blood Rev. 2013;27:279–87.
- Hazzazi AA, Ageeli MH, Alfaqih AM, Jaafari AA, Malhan HM, Bakkar MM. Epidemiology and characteristics of sickle cell patients admitted to hospitals in Jazan region, Saudi Arabia. J Appl Hematol. 2020;11:10-4.
- Memish ZA, Saeedi MY . Six-year outcome of the national premarital screening and genetic counselling program for sickle cell disease and β-thalassemia in Saudi Arabia". Annals of Saudi Medicine. 2011; 31(3):229-35.
- Inusa BPD, Hsu LL, Kohli N, Patel A, Ominu-Evbota K, Anie KA, Atoyebi W. Sickle cell disease-genetics, pathophysiology, clinical presentation and treatment. Int J Neonatal Screen. 2019 May 7;5(2):20. doi: 10.3390/ijns5020020.
- Al‑Saqladi AW, Delpisheh A, Bin‑Gadeem H, Brabin BJ. Clinical profile of sickle cell disease in Yemeni children. Ann Trop Paediatr. 2007;27:253‑9.
- De Montalembert M. Management of children with sickle cell anemia: A collaborative work. Arch. Pediatr. 2002;9:1195–201.
- Sidieg Sheikheldin Elobied, Ismail A. Ramadan, Ghada S. Abdelmotaleb, Abd elmoniem A.Younis. Study of Common Infections among children with sickle cell anaemia in Saudi Arabia. BMFJ. 2021;38(1): 65-78. DOI: 10.21608/bmfj.2020.25172.1226
- McCavit TL, Xuan L, Zhang S, Flores G, Quinn CT. Hospitalization for invasive pneumococcal disease in a national sample of children with sickle cell disease before and after PCV7 licensure. Pediatric blood & cancer. 2012;58(6):945-9.
- Manwani D, Frenette PS. Vaso-occlusion in sickle cell disease: pathophysiology and novel targeted therapies. Blood. 2013 Dec 5;122(24):3892-8. doi: 10.1182/blood-2013-05-498311.
- Mulumba LL, Wilson L. Sickle cell disease among children in Africa: An integrative literature review and global recommendations. International Journal of Africa Nursing Sciences. 2015;3:56–64. https://doi.org/10.1016/j.ijans.2015.08.002.
- Ballas SK, Kesen MR, Goldberg MF, Lutty GA, Dampier C, Osunkwo I, Wang WC, Hoppe C, Hagar W, Darbari DS, Malik P. Beyond the definitions of the phenotypic complications of sickle cell disease: an update on management. ScientificWorldJournal. 2012;2012:949535. doi: 10.1100/2012/949535. Epub 2012 Aug 1. Erratum in: ScientificWorldJournal. 2013;2013:861251.
- Tubman VN, Makani J. Turf wars: Exploring splenomegaly in sickle cell disease in malaria-endemic regions. Br. J. Haematol. 2017;177:938–46.
- Komba, AN, Makani J, Sadarangani M, Ajala-Agbo T, Berkley JA, Newton CR, et al. Malaria as a cause of morbidity and mortality in children with homozygous sickle cell disease on the coast of Kenya. Clinical Infectious Diseases. 2009;49(2):216–22. http://dx.doi.org/10.1086/599834.
- Luzzatto L. Sickle cell anaemia and malaria. Mediterr J Hematol Infect Dis. 2012;4(1): e2012065, DOI 10.4084/MJHID.2012.065
- Chiabi A, Moyo GK, Ngone I, Kago DAT, Tchouamou A, Obadeyi B. Persistent spleen enlargement in sickle cell disease: An unresolved dilemma. ARC Journal of Pediatrics. 2020;6(1):8-14. doi:dx.doi.org/10.20431/2455-5711.0601003.
- Alsultan A, Aleem A, Ghabbour H, AlGahtani FH, Al-Shehri A, Osman ME, et al. Sickle cell disease subphenotypes in patients from southwestern province of Saudi Arabia. J Pediatr Hematol Oncol. 2012;(2):79-84. doi: 10.1097/MPH.0b013e3182422844.
- DeBaun MR, Jordan LC, King AA, Schatz J, Vichinsky E, Fox CK, et al. American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. Blood Adv. 2020 Apr 28;4(8):1554-88. doi: 10.1182/bloodadvances.2019001142.
- Jastaniah W. Epidemiology of sickle cell disease in Saudi Arabia. Annals of Saudi Medicine. 2011;31(3);289–93.
- Al-Saqladi AM, Maddi DM, Al-Sadeeq AH. Blood transfusion frequency and indications in Yemeni children with sickle cell disease. anemia. 2020 Aug 24;2020:7080264. doi: 10.1155/2020/7080264.
- Ceglie G, Di Mauro M, Tarissi De Jacobis I, de Gennaro F, Quaranta M, Baronci C, et al. Gender-related differences in sickle cell disease in a pediatric cohort: A single-center retrospective study. Front. Mol. Biosci.2019; 6:140.doi: 10.3389/fmolb.2019.00140.
- Al-Nood, Hafiz Abdul Hamid. Prevalence of sickle cell gene in Yemen. thesis, Swansea University. 2004. http://cronfa.swan.ac.uk/Record/cronfa42767.
- El Hazmi MAF, Al-Hazmi AM, Warsy AS. Sickle cell disease in Middle East Arab countries. Indian J. Med. Res. 2011;134:597–610.