PURPOSE: Sickle cell disease (SCD) is an inherited blood disorder that affects the hemoglobin protein of red blood cells and has a significant impact on morbidity, mortality, and quality of life. Hydroxyurea has been FDA approved since 1998 as a disease-modifying therapy for SCD. However, hydroxyurea has not been optimally utilized for those with SCD. The purpose of this study was to evaluate reasons for hydroxyurea use, from the perspectives of providers, adults with SCD, and parents/caregivers of children with SCD, as well as perceived barriers to its use. We examined indications and reasons for being “on hydroxyurea,” defined by patients as currently taking hydroxyurea, and reported on pain frequency, perceptions of barriers, hydroxyurea adherence, and health care access for patients with SCD who were either on and not on hydroxyurea. METHODS: We conducted a cross sectional analysis of data collected within the Pacific Sickle Cell Regional Collaborative (PSCRC), a consortium of nine western U.S. states. Individuals were eligible for this study if they 1) had a confirmed diagnosis of SCD, 2) were followed at one of the PSCRC sites, and 3) were eligible for hydroxyurea therapy. Parents/caregivers of children with SCD less than 18 years and adults with SCD 18 years and older completed a brief survey about hydroxyurea use, indications, side effects, pain frequency, number of hospital and emergency department (ED) admissions per year, and individual and family perceptions of barriers to hydroxyurea use. Participants completed a follow-up survey annually, but we reported only on baseline data. Data collection occurred between February 2016 and May 2018. RESULTS: Individuals with SCD (n = 413) included 1) children (n=178; 6.7 ± 3.4 years), 2) adolescents (n=66; 15.0 ± 1.4 years), 3) young adults (n=57; 21.4 ± 2.6 years), and 4) adults (n=112; 39.2 ± 10.6 years). The majority were predominantly female (51.6%), African American (93.2%), and had HgbSS (74.1%) genotype. The majority of children (65.2%), adolescents (62.1%), and young adults (54.4%) were on hydroxyurea; fewer adults (39.3%) were on hydroxyurea. The majority with HgbSS (65.5%) were adherent to hydroxyurea. There was no significant difference in hospitalizations for pain, ED visits, and pain severity in the previous 12 months between individuals who were and were not on hydroxyurea, and between individuals who were and were not adherent to hydroxyurea. For those with a current prescription for hydroxyurea, the majority (66.5%) were receiving hydroxyurea for recurrent pain episodes or acute chest syndrome (19.9%). Hydroxyurea was discontinued because of patient/family preference (34.5%), chronic transfusions (31.1%), and side effects (24.1%). Patients prescribed hydroxyurea for empiric use (n=21) had fewer hospitalizations for pain, ED visits, and severe pain interfering with daily activities. The major barriers to hydroxyurea use, from the perspective of individuals with SCD or their caregivers, were 1) forgetting to take the medicine (19.4%), 2) worried about side effects (16.4%), and 3) lack of knowledge about hydroxyurea (13.6%). Fewer young adults (49.1%) and adults (50.0%) had primary care providers than children (78.1%) and adolescents (65.2%). CONCLUSIONS: Barriers to hydroxyurea use persist with emerging solutions to alleviate these barriers. For this sample, while hydroxyurea prescription rates by sickle cell specialists were similar to what has been seen in some other studies, neither hydroxyurea use nor adherence were associated with decreased frequency of hospitalizations for pain, ED visits, and severe acute pain episodes in the previous 12 months. Future studies need to evaluate hydroxyurea prescription patterns, duration on hydroxyurea, and adherence to hydroxyurea. Healthcare providers are recommended to prescribe hydroxyurea for eligible individuals who may benefit from it, such as those HgbSS or HgbS-β0 thalassemia genotype, and prescribe for empiric use to minimize complications. Provider and patient education about hydroxyurea could reduce common barriers experienced by individuals with SCD. It is important to customize educational resources to specific concerns for different age groups. Individuals 18 years and older with SCD have been documented with more ED visits and hospitalizations due to pain, most likely because they did not have a primary care provider and an adult hematologist with expertise in SCD. Future studies need to evaluate whether primary care providers who receive SCD education may promote hydroxyurea use and adherence. Dedicating time and resources for shared decision making between providers and patients/families can address concerns about hydroxyurea and increase patient/family confidence when deciding about hydroxyurea. As more disease-modifying therapies become available for individuals with SCD, strategies for shared decision making facilitate standardization and optimize the use of hydroxyurea and emerging therapies.

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La drépanocytose ou anémie falciforme est la maladie génétique la plus répandue dans le monde. Elle affecte plus particulièrement les populations des régions africaines sub-sahariennes, du sous-continent Indien et celles issues de ces populations. La Guadeloupe, archipel des Antilles françaises est une zone à forte prévalence drépanocytaire. La drépanocytose se caractérise par des anomalies de l’hémoglobine et du globule rouge qui mènent à des complications aigues et chroniques pouvant toucher tous les organes, dont les yeux. Récemment, plusieurs auteurs ont rapporté une prévalence importante de la maculopathie dans la drépanocytose mais la physiopathologie reste très mal comprise. Ainsi, nous avons réalisé deux études. La première, consistait à étudier la prévalence de la rétinopathie et de la maculopathie drépanocytaires et de tester l’association entre ces deux complications. De plus, nous avons recherché un éventuel lien avec différentes anomalies biologiques. Nous avons montré que la rétinopathie et la maculopathie étaient deux complications fréquentes mais indépendantes dans la drépanocytose. Les résultats de cette première étude ne supportent pas un lien éventuel entre les anomalies hématologiques, hémorhéocarlogiques ou le génotype et ces deux complications. Dans une deuxième étude nous avons essayé de mieux caractériser la maculopathie drépanocytaire en réalisant un électrorétinogramme multifocal (mfERG) et une tomographie en cohérence optique spectral domain (SD-OCT) chez des patients SS et SC sans signe clinique de maculopathie. Nous avons pu mettre en évidence des altérations maculaires électrophysiologiques chez les patients drépanocytaires paraissant exempt de toute maculopathie à l’examen clinique. Par ailleurs, nous avons retrouvé que la maculopathie drépanocytaire est aussi fréquente chez les SS que chez les SC.Notre travail confirme le caractère fréquent des complications rétiniennes drépanocytaires. Cependant, elles apparaissent comme complètement indépendantes l’une de l’autre et les mécanismes physiopathologiques sous-jacents restent mal compris / Sickle cell disease (SCD) also known as sickle cell anemia is the most common genetic affection in the world. Most of SCD cases occur in sub-Saharan Africa, india and among people of African and indian descent living in other parts of the world. SCD is common in Guadeloupe, French West indies. It results in an abnormal hemoglobin leading to rigid sickle like shape red blood cells responsible for a great number of acute and chronical systemic complications including ophthalmic affections. Recently, a wild prevalence of maculopathy has been reported by several authors but its pathophysiology remains unclear.We performed two studies. The aim of the first one was to investigate the prevalence of SCD retinopathy and maculopathy and to test the association between these two conditions. Moreover, we looked for a possible link with biological abnormalities. Our study confirmed that SCD maculopathy and retinopathy are common but they remain two independent affections. Nevertheless, we found no association with hematological parameters, blood rheology of genetic.In the second study, we described and compared spectral domain ocular coherence tomography (SD-OCT) and multifocal electroretinogram (mfERG) findings in patients with SCD without clinical sign of maculopathy, according to the hemoglobin genotype. We found electrophysiological macular dysfunction in SCD patients with no clinical maculopathy. Furthermore, maculopathy was as frequent in SCA than in SCC patients.Our work confirms that retinal affections are common in SCD. Nevertheless, retinopathy and maculopathy seem to be two independent complications and their pathophysiology remains misunderstood.

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This project focused on identifying the best evidence available on the use of cognitive behavior therapy (CBT) for pediatric patients and families with sickle cell disease (SCD) to improve their coping skills with pain management. This resulted from an identified gap in nursing practice regarding psychosocial support for this subset of hospitalized pediatric patients. The practice-focused question was whether there was evidence in the literature on the use of CBT techniques to improve parental coping skills with children who have chronic and life-threatening illness that could be utilized with sickle cell disease. The theory of stress and coping guided the underpinnings of the study process. The Johns Hopkins Nursing evidence-based practice model (JHNEBP) was the framework for this project. A systematic review was conducted utilizing research-based articles from the major healthcare databases. The original search resulted in over 12,000 articles. This pool was further refined based upon a link between the pediatric population with chronic or life-threatening conditions and family coping skills. This was further narrowed down based on the use of social-cognitive therapy and coping skills. This process resulted in 6 research articles on the use of CBT with the target population. An evaluation of these studies found evidence that CBT can improve parental coping skills. Nursing support for parental coping with SCD has the positive social impact of decreased parental stress and improved quality of life for both the child and the family unit.

Sickle cell disease (SCD) is the most common group of genetic, chronic hematologic disorders, and is characterized by chronic pain resulting from vaso-occlusive episodes. As such, youth with SCD utilize a disproportionately high amount of health care resources. Youth with frequent health care utilization (HCU) are at increased risk for psychosocial consequences, including disruptions in family functioning and decreased academic performance. While studies have separately examined HCU, family functioning, and academic achievement in this population, there is a dearth of research examining the association between these variables. The present study aimed to: (1) examine associations between family environment and patterns of HCU, (2) examine associations between patterns of HCU and academic achievement scores in math and reading, and (3) evaluate the indirect effect of family environment on academic achievement scores in math, as explained by patterns of HCU. This study included 41 youth with HbSS or HbS beta-thalassemia. Youth were administered the Woodcock-Johnson III Achievement, and caregivers completed the Family Environment Scale. Sociodemographic characteristics were collected, and medical history information was obtained via retrospective medical chart review. Overall, participants reported a more positive family environment, demonstrated less pain-related ED visits and hospital admissions, and obtained below average scores on academic achievement in math and reading. The present study did not provide evidence of associations between family environment, HCU, and academic achievement. Unique characteristics of the study sample, as well as clinical implications and next steps for future research are discussed.

No description available.

No description available.

Sickle cell disease (SCD) is a monogenic disorder with multi-organ involvement(1). Patients with SCD suffer from recurrent vaso-occlusive crisis (VOC) resulting from sickling of red blood cells, which is induced by polymerization of deoxy-sickle hemoglobin (HbS)(1,2). Fetal hemoglobin (HbF) can ameliorate symptoms of SCD by inhibiting deoxy-HbS polymerization(3). Hydroxyurea (HU) is approved by FDA for the treatment of SCD(4). It induces HbF synthesis through multifactorial and still not well understood mechanisms(4-7). However, approximately 5-15% of patients show no significant clinical improvement(8). Additionally, numerous patient and physician-related factors limit its utilization(9). Therefore, it is important to identify additional HbF-inducing therapeutic agents, particularly those that act by mechanisms different from HU to allow potential combination therapy in the future. Previously, peroxisome proliferator-activated receptor gamma coactivator 1-alpha (PGC-1α) was shown to activate γ-globin gene transcription(10). Forced overexpression of PGC-1α in erythroid progenitors obtained from Lin- cells from SCD transgenic mice induces γ-globin expression(10), suggesting that PGC-1α represents a new molecular target for potential therapeutic intervention in treating SCD. In the present study, the effect of PGC-1α upregulation in primary human CD34+ derived erythroid cells was explored; an increase in γ-globin mRNA and the percent of F-cells was observed. Through literature search, ZLN005 and SR-18292 were identified as potential PGC-1α agonists(11,12). Both compounds increase the percentage of F-cells in primary human CD34+ derived erythroid cell culture. Combined treatment with HU led to a significantly higher increase in F-cell % than the increase observed under treatment with either HU, ZLN005 or SR-18292 alone. Results from those studies add to the understanding of PGC-1α and its effects on primary human erythroid cell differentiation, maturation, and HbF induction. Additionally, the results show proof of principle for combination therapy to treat SCD patients to ameliorate their disease severity by up-regulating HbF expression. Together, the knowledge gained through these studies is novel and will potentiate the development of a new class of compounds to induce HbF synthesis in adults.

No description available.