Hydroxyurea and fetal hemoglobin effect on leg ulcers in patients with sickle cell disease

Seda S. Tolu, Andrew Crouch, Jaeun Choi, Qi Gao, Moramaya Reyes-Gil, Ugochi O. Ogu, Giacomo Vinces, Caterina P. Minniti

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


The presence of leg ulcers in individuals with sickle cell disease often represents an early sign of vasculopathy and future end organ damage. Pathophysiological mechanisms of formation and evolution of leg ulcers are poorly understood; nevertheless, HbF has been associated with lower incidence of leg ulcers, while hydroxyurea has been correlated with high risk of leg ulcers. As a result, there is hesitation regarding hydroxyurea use in patients with SCD and leg ulcers. In this study, we aim to define (1) a target of HbF that offers protection against leg ulcer development and (2) the impact of hydroxyurea therapy on leg ulcer prevalence. Our study demonstrated that in order to reduce leg ulcer incidence by one-third, a HbF > 25% is needed, a threshold not commonly reached and maintained in the adult SCD population. Importantly, leg ulcer incidence appears to be independent of HU use (p = 0.50). Our interpretation of this data is that the use of HU in a patient with SCD and leg ulcers should be guided by a careful assessment of risks and benefits of this therapeutic modality.

Original languageEnglish (US)
Pages (from-to)541-548
Number of pages8
JournalAnnals of Hematology
Issue number3
StatePublished - Mar 2022


  • Hemoglobin F
  • Hemoglobinopathy
  • Hydroxyurea
  • Leg ulcers
  • Sickle cell Anemia
  • Sickle cell disease

ASJC Scopus subject areas

  • Hematology


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