Assessment of Ankle-Brachial Pressure Index in Sickle Cell Patients: An Approach through Spectral Waveform Analysis
Abstract Background: Sickle cell patients suffer from a plethora of vascular complications. Assessment of Ankle-Brachial Pressure Index (ABPI) using ultrasonographic Spectral Wave Analysis (SWA) serves as an effective method for screening vascular complications. However, this has been the least studied in the sickle cell population to date. This study was conducted to assess ABPI in sickle cell disease (SCD) and sickle cell trait (SCT) using SWA. In addition, the correlation between ABPI and duration of hydroxyurea (HU) therapy was also evaluated in SCD. Materials and Methods: This cross-sectional study included 124 subjects (62 SCD and 62 SCT) aged between 16 and 30 years. ABPI was assessed by USG color Doppler SWA. Subjects were categorized into four groups: normal, acceptable, some arterial disease, and moderate arterial disease, based on ABPI cutoff values, and into three subgroups according to waveforms: triphasic, biphasic, and monophasic. Statistical analysis was performed using appropriate methods. Results: The mean ABPI was lower in SCD than SCT (0.98 ± 0.11 vs. 1.03 ± 0.03, P < 0.001). Among SCD, 6.4% of patients had monophasic waves with ABPI ranging from 0.5–0.9, and 53.2% of patients had biphasic waves with ABPI ranging from 0.8–1.0. Among SCTs, 11.2% of patients had biphasic waves with an ABPI of 0.9–1. We found a negative correlation between the duration of HU and ABPI in SCD (r = −0.194). Conclusions: SWA was able to detect subclinical peripheral arterial disease in both SCD and SCT, despite the ABPI being within an acceptable range. The potential vascular risk of long-term HU should not be overlooked.
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To describe the family-related characteristics of young adults with sickle-cell disease or sickle-cell trait prior to taking part in a randomised controlled trial on sickle-cell reproductive health education. There is a critical need for educational programmes that target the reproductive needs of young adults with sickle-cell disease or trait. However, little is known about the family-related characteristics (i.e., demographic attributes and reproductive health behaviours) in which these young adults live. A descriptive cross-sectional analysis. At study enrolment, 234 young adults (mean age=25·9years, 65% female) completed the SCKnowIQ questionnaire. Descriptive statistics depict the demographic attributes and reproductive health behaviours of young adults with sickle-cell disease (n=138) or trait (n=96). For group comparisons, independent t tests or Fisher's tests were used, as appropriate. Young adults with sickle-cell trait had significantly higher education, income and health insurance than those with sickle-cell disease. Both groups believed that sickle-cell disease was a severe condition. A majority of young adults with sickle-cell disease (65%) had no children compared to 42% of those with sickle-cell trait. Most young adults (85% sickle-cell disease, 82% sickle-cell trait) were not planning a pregnancy in the next six months, and many used condoms, withdrawal or oral contraceptives. Socioeconomic disparities exist between young adults with sickle-cell disease and sickle-cell trait. Future research that advances education about how and when to communicate appropriate genetic risk information to partners and children especially for young adults with sickle-cell trait would be beneficial. Awareness of the similarities and differences in the family-related characteristics among young adults with sickle-cell disease or trait can allow for more tailored reproductive education.
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2
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Children with sickle cell anemia and sickle cell trait are at an increased risk of invasive pneumococcal disease compared to children with normal hemoglobin. We assessed and compared pneumococcal vaccination status among these three groups. Children with sickle cell anemia and sickle cell trait were identified using Michigan newborn screening records (1997-2014); each child was matched to four children with normal hemoglobin based on age, Medicaid enrollment (at least 1 year from 2012-2014), race, and census tract. Vaccination records were obtained from the state's immunization system. Pneumococcal vaccine coverage (PCV7 or PCV13 depending on date of administration) was assessed at milestone ages of 3, 5, 7, and 16 months. The proportion of children with vaccine coverage at each milestone was calculated overall and compared among children with sickle cell anemia, sickle cell trait, and normal hemoglobin using chi-square tests. The study population consisted of 355 children with sickle cell anemia, 17,319 with sickle cell trait, and 70,757 with normal hemoglobin. The proportion of children with age-appropriate pneumococcal vaccination coverage was low at each milestone and generally decreased over time. Children with sickle cell anemia were more likely to be covered compared to children with sickle cell trait or normal hemoglobin. Despite higher pneumococcal vaccination coverage among children with sickle cell anemia, opportunities for improvement exist among all children. Targeted interventions will benefit from mechanisms to identify children with increased risks such as sickle cell anemia or trait to improve pneumococcal vaccination coverage among these groups.
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1
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