Inflammatory Markers Correlated with SCA Pain Intensity

Sickle cell anemia (SCA) is a hereditary hemolytic anemia where the synthesis of hemoglobin (Hb) is abnormal and the inheritance can be heterozygous (HbS) or homozygous (HbSS). Homozygous patients with SCA often develop vaso-occlusive crises (VOCs) and recurrent episodes of hemolysis causing multi-organ infarction and dysfunction.

Bone pain in patients with SCA varies from acute clinical painful VOC or osteomyelitis to more chronic and debilitating disease, such as osteoporosis, osteopenia and osteonecrosis, and chronic infections with impaired growth. Inflammatory markers are increased during VOC in adult patients with SCA, but this is not clear in clinical steady state.

Scientists at the Arabian Gulf University (Manama, Bahrain) studied 46 patients of whom 27 were females with SCA who age ranged from 12 to 40 years and they were compared with 46 patients with bone pain but proven to be with no SCA. Patients were included if they were diagnosed with sickle cell disease (SCD) with homozygous hemoglobin (HbSS) using Hb electrophoresis and solubility screening test for sickling.

Blood samples were obtained at base line, one month and three months after enrollment to determine the level of tumor necrosis factor-α (TNF-α), interleukin-1 (IL-1), C-reactive protein (CRP), Hb, reticulocyte count, lactate dehydrogenase (LDH), vitamin D3, parathormone (PTH) and serum ferritin. Patients were examined clinically for bone pain or tenderness in the peripheral joints, chest or vertebrae within the last two days prior to assessment. Serum TNF-α and IL-1 levels were measured using the enzyme-linked immunosorbent assay technique (enzyme-amplified sensitivity immunoassay kits; BioSource Europe SA, Nivelles, Belgium). Quantification of PTH in serum was performed by enzyme-linked immunosorbent assay (Creative Diagnostics, Shirley, NY, USA).

The investigators found vitamin D3 and Hb were lower in SCA patients, 17.04 ± 5.77 versus 37.6 ± 4.83 ng/L and 7.96 ± 0.3 versus 8.44±0.27 g/dL, respectively. The inflammatory markers showed significantly higher level of TNF-α (56.52 ± 5.43 pg/mL), IL-1 (44.17 ± 4.54 pg/mL and CRP 3.20 ± 0.72 mg/L. WBC, LDH and reticulocyte count were also significantly higher. There was a significant positive correlation between serum levels of TNF-α and bone pain frequency and serum level of IL-1.

The authors concluded that there was a strong positive correlation between the inflammatory biomarkers, TNF-α, IL-1 and WBC, and bone pain frequency in steady state in adult patients with SCA. QT dispersion (QTd), a marker of ventricular recovery times, was significantly longer among patients with SCA who had more than three hospitalizations over a 6-month interval. The study was published on October 31, 2016, in the Journal of Blood Medicine.

Related Links:
Arabian Gulf University
BioSource Europe
Creative Diagnostics