Vasculopathy, inflammation, and blood flow in leg ulcers of patients with sickle cell anemia

Caterina P. Minniti, Kara Marie H Delaney, Alexander M. Gorbach, Dihua Xu, Chyi Chia Richard Lee, Nitin Malik, Antony Koroulakis, Matthew Antalek, Jordan Maivelett, Marlene Peters-Lawrence, Enrico M. Novelli, Sophie M. Lanzkron, Karen C. Axelrod, Gregory J. Kato

Research output: Contribution to journalArticle

30 Citations (Scopus)

Abstract

Chronic leg ulcers are frequent and debilitating complications of sickle cell anemia. Inadequate blood supply has been postulated to be an important factor in their occurrence and delayed healing. Little is known about their microcirculatory and histopathological changes. We evaluated the microcirculation of lower extremity ulcers with laser speckle contrast imaging and infrared thermography and obtained clinical and laboratory characteristics in 18 adults with sickle cell anemia and chronic leg ulcers. Skin biopsies were obtained in four subjects. Subjects had markers of severe disease, anemia, high degree of hemolysis, inflammation, and thrombophilia. The highest blood flow was present in the ulcer bed, progressively less in the immediate periwound area, and an unaffected control skin area in the same extremity. Microscopic examination showed evidence of venostasis, inflammation, and vasculopathy. Blood vessels were increased in number, had activated endothelium and evidence of thrombosis/recanalization. High blood flow may be due to chronic inflammation, cutaneous vasodilatation, venostasis, and in situ thrombosis. These changes in skin microcirculation are similar to chronic venous ulcers in the non-sickle cell disease (SCD) population, thus suggesting that leg ulcers may be another end-organ complication with endothelial dysfunction that appears in patients with SCD at a younger age and with higher frequency than in the general population.

Original languageEnglish (US)
Pages (from-to)1-6
Number of pages6
JournalAmerican Journal of Hematology
Volume89
Issue number1
DOIs
StatePublished - Jan 2014
Externally publishedYes

Fingerprint

Leg Ulcer
Sickle Cell Anemia
Inflammation
Skin
Microcirculation
Ulcer
Thrombosis
Varicose Ulcer
Thrombophilia
Hemolysis
Vasodilation
Population
Endothelium
Blood Vessels
Anemia
Lower Extremity
Lasers
Extremities
Biopsy

ASJC Scopus subject areas

  • Hematology

Cite this

Vasculopathy, inflammation, and blood flow in leg ulcers of patients with sickle cell anemia. / Minniti, Caterina P.; Delaney, Kara Marie H; Gorbach, Alexander M.; Xu, Dihua; Lee, Chyi Chia Richard; Malik, Nitin; Koroulakis, Antony; Antalek, Matthew; Maivelett, Jordan; Peters-Lawrence, Marlene; Novelli, Enrico M.; Lanzkron, Sophie M.; Axelrod, Karen C.; Kato, Gregory J.

In: American Journal of Hematology, Vol. 89, No. 1, 01.2014, p. 1-6.

Research output: Contribution to journalArticle

Minniti, CP, Delaney, KMH, Gorbach, AM, Xu, D, Lee, CCR, Malik, N, Koroulakis, A, Antalek, M, Maivelett, J, Peters-Lawrence, M, Novelli, EM, Lanzkron, SM, Axelrod, KC & Kato, GJ 2014, 'Vasculopathy, inflammation, and blood flow in leg ulcers of patients with sickle cell anemia', American Journal of Hematology, vol. 89, no. 1, pp. 1-6. https://doi.org/10.1002/ajh.23571
Minniti, Caterina P. ; Delaney, Kara Marie H ; Gorbach, Alexander M. ; Xu, Dihua ; Lee, Chyi Chia Richard ; Malik, Nitin ; Koroulakis, Antony ; Antalek, Matthew ; Maivelett, Jordan ; Peters-Lawrence, Marlene ; Novelli, Enrico M. ; Lanzkron, Sophie M. ; Axelrod, Karen C. ; Kato, Gregory J. / Vasculopathy, inflammation, and blood flow in leg ulcers of patients with sickle cell anemia. In: American Journal of Hematology. 2014 ; Vol. 89, No. 1. pp. 1-6.
@article{4d0e80bbb6584ad890ca5b7f6e966be8,
title = "Vasculopathy, inflammation, and blood flow in leg ulcers of patients with sickle cell anemia",
abstract = "Chronic leg ulcers are frequent and debilitating complications of sickle cell anemia. Inadequate blood supply has been postulated to be an important factor in their occurrence and delayed healing. Little is known about their microcirculatory and histopathological changes. We evaluated the microcirculation of lower extremity ulcers with laser speckle contrast imaging and infrared thermography and obtained clinical and laboratory characteristics in 18 adults with sickle cell anemia and chronic leg ulcers. Skin biopsies were obtained in four subjects. Subjects had markers of severe disease, anemia, high degree of hemolysis, inflammation, and thrombophilia. The highest blood flow was present in the ulcer bed, progressively less in the immediate periwound area, and an unaffected control skin area in the same extremity. Microscopic examination showed evidence of venostasis, inflammation, and vasculopathy. Blood vessels were increased in number, had activated endothelium and evidence of thrombosis/recanalization. High blood flow may be due to chronic inflammation, cutaneous vasodilatation, venostasis, and in situ thrombosis. These changes in skin microcirculation are similar to chronic venous ulcers in the non-sickle cell disease (SCD) population, thus suggesting that leg ulcers may be another end-organ complication with endothelial dysfunction that appears in patients with SCD at a younger age and with higher frequency than in the general population.",
author = "Minniti, {Caterina P.} and Delaney, {Kara Marie H} and Gorbach, {Alexander M.} and Dihua Xu and Lee, {Chyi Chia Richard} and Nitin Malik and Antony Koroulakis and Matthew Antalek and Jordan Maivelett and Marlene Peters-Lawrence and Novelli, {Enrico M.} and Lanzkron, {Sophie M.} and Axelrod, {Karen C.} and Kato, {Gregory J.}",
year = "2014",
month = "1",
doi = "10.1002/ajh.23571",
language = "English (US)",
volume = "89",
pages = "1--6",
journal = "American Journal of Hematology",
issn = "0361-8609",
publisher = "Wiley-Liss Inc.",
number = "1",

}

TY - JOUR

T1 - Vasculopathy, inflammation, and blood flow in leg ulcers of patients with sickle cell anemia

AU - Minniti, Caterina P.

AU - Delaney, Kara Marie H

AU - Gorbach, Alexander M.

AU - Xu, Dihua

AU - Lee, Chyi Chia Richard

AU - Malik, Nitin

AU - Koroulakis, Antony

AU - Antalek, Matthew

AU - Maivelett, Jordan

AU - Peters-Lawrence, Marlene

AU - Novelli, Enrico M.

AU - Lanzkron, Sophie M.

AU - Axelrod, Karen C.

AU - Kato, Gregory J.

PY - 2014/1

Y1 - 2014/1

N2 - Chronic leg ulcers are frequent and debilitating complications of sickle cell anemia. Inadequate blood supply has been postulated to be an important factor in their occurrence and delayed healing. Little is known about their microcirculatory and histopathological changes. We evaluated the microcirculation of lower extremity ulcers with laser speckle contrast imaging and infrared thermography and obtained clinical and laboratory characteristics in 18 adults with sickle cell anemia and chronic leg ulcers. Skin biopsies were obtained in four subjects. Subjects had markers of severe disease, anemia, high degree of hemolysis, inflammation, and thrombophilia. The highest blood flow was present in the ulcer bed, progressively less in the immediate periwound area, and an unaffected control skin area in the same extremity. Microscopic examination showed evidence of venostasis, inflammation, and vasculopathy. Blood vessels were increased in number, had activated endothelium and evidence of thrombosis/recanalization. High blood flow may be due to chronic inflammation, cutaneous vasodilatation, venostasis, and in situ thrombosis. These changes in skin microcirculation are similar to chronic venous ulcers in the non-sickle cell disease (SCD) population, thus suggesting that leg ulcers may be another end-organ complication with endothelial dysfunction that appears in patients with SCD at a younger age and with higher frequency than in the general population.

AB - Chronic leg ulcers are frequent and debilitating complications of sickle cell anemia. Inadequate blood supply has been postulated to be an important factor in their occurrence and delayed healing. Little is known about their microcirculatory and histopathological changes. We evaluated the microcirculation of lower extremity ulcers with laser speckle contrast imaging and infrared thermography and obtained clinical and laboratory characteristics in 18 adults with sickle cell anemia and chronic leg ulcers. Skin biopsies were obtained in four subjects. Subjects had markers of severe disease, anemia, high degree of hemolysis, inflammation, and thrombophilia. The highest blood flow was present in the ulcer bed, progressively less in the immediate periwound area, and an unaffected control skin area in the same extremity. Microscopic examination showed evidence of venostasis, inflammation, and vasculopathy. Blood vessels were increased in number, had activated endothelium and evidence of thrombosis/recanalization. High blood flow may be due to chronic inflammation, cutaneous vasodilatation, venostasis, and in situ thrombosis. These changes in skin microcirculation are similar to chronic venous ulcers in the non-sickle cell disease (SCD) population, thus suggesting that leg ulcers may be another end-organ complication with endothelial dysfunction that appears in patients with SCD at a younger age and with higher frequency than in the general population.

UR - http://www.scopus.com/inward/record.url?scp=84892892383&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84892892383&partnerID=8YFLogxK

U2 - 10.1002/ajh.23571

DO - 10.1002/ajh.23571

M3 - Article

C2 - 23963836

AN - SCOPUS:84892892383

VL - 89

SP - 1

EP - 6

JO - American Journal of Hematology

JF - American Journal of Hematology

SN - 0361-8609

IS - 1

ER -