Markers of severe vaso-occlusive painful episode frequency in children and adolescents with sickle cell anemia

Deepika S. Darbari, Onyinye Onyekwere, Mehdi Nouraie, Caterina P. Minniti, Lori Luchtman-Jones, Sohail Rana, Craig Sable, Gregory Ensing, Niti Dham, Andrew Campbell, Manuel Arteta, Mark T. Gladwin, Oswaldo Castro, James G. Taylor VI, Gregory J. Kato, Victor Gordeuk

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Abstract

Objective: To identify factors associated with frequent severe vaso-occlusive pain crises in a contemporary pediatric cohort of patients with sickle cell anemia (SCA) enrolled in a prospective study of pulmonary hypertension and the hypoxic response in sickle cell disease. Study design: Clinical and laboratory characteristics of children with SCA who had ≥3 severe pain crises requiring health care in the preceding year were compared with those of subjects with <3 such episodes. Results: Seventy-five children (20%) reported ≥3 severe pain episodes in the preceding year, and 232 (61%) had none. Frequent pain episodes were associated with older age (OR, 1.2; 95% CI, 1.1-1.3; P <.0001), α-thalassemia trait (OR 3.5; 1.6-6.7; P =.002), higher median hemoglobin (OR 1.7; 95% CI: 1.2-2.4; P <.003), and lower lactate dehydrogenase concentration (OR 1.82; 95% CI: 1.07-3.11; P =.027). Children with high pain frequency also had an increased iron burden (serum ferritin, 480 vs 198 μg/L; P =.006) and higher median tricuspid regurgitation jet velocity (2.41 vs 2.31 m/s; P =.001). Neither hydroxyurea use nor fetal hemoglobin levels were significantly different according to severe pain history. Conclusions: In our cohort of children with SCA, increasing age was associated with higher frequency of severe pain episodes as were α-thalassemia, iron overload, higher hemoglobin and lower lactate dehydrogenase concentration, and higher tricuspid regurgitation velocity.

Original languageEnglish (US)
Pages (from-to)286-290
Number of pages5
JournalJournal of Pediatrics
Volume160
Issue number2
DOIs
StatePublished - Feb 1 2012

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ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Darbari, D. S., Onyekwere, O., Nouraie, M., Minniti, C. P., Luchtman-Jones, L., Rana, S., Sable, C., Ensing, G., Dham, N., Campbell, A., Arteta, M., Gladwin, M. T., Castro, O., Taylor VI, J. G., Kato, G. J., & Gordeuk, V. (2012). Markers of severe vaso-occlusive painful episode frequency in children and adolescents with sickle cell anemia. Journal of Pediatrics, 160(2), 286-290. https://doi.org/10.1016/j.jpeds.2011.07.018