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Prospective evaluation of haemoglobin oxygen saturation at rest and after exercise in paediatric sickle cell disease
Andrew Campbell1, Caterina P Minniti, Mehdi Nouraie
1University of Michigan, Ann Arbor, MI, USA.
Insights
In sickle cell disease, low oxygen saturation is linked to anemia and hemolysis, not lung issues. This impacts children and adolescents, highlighting key factors affecting their oxygen levels.
Area of Science:
- Hematology
- Pediatric Medicine
- Pulmonology
Background:
- Low steady-state hemoglobin oxygen saturation is common in sickle cell anemia.
- The contribution of pulmonary dysfunction to this phenomenon is not well understood.
Purpose of the Study:
- To investigate the relationship between pulmonary function, anemia, hemolysis, and oxygen saturation in pediatric sickle cell disease patients.
Main Methods:
- Prospective study of 391 children and adolescents with sickle cell disease (ages 3-20) and matched controls.
- Measured steady-state and exercise-induced oxygen saturation, hemoglobin concentration, hemolysis markers, pulmonary function tests, and tricuspid regurgitation velocity.
Main Results:
- 52% of patients had low steady-state oxygen saturation (<99%) compared to 24% of controls.
- Lower hemoglobin and increased hemolysis independently predicted lower oxygen saturation and exercise-induced desaturation.
- Pulmonary function tests did not predict oxygen saturation levels.
- Higher tricuspid regurgitation velocity correlated with lower oxygen saturation.
Conclusions:
- Low oxygen saturation in pediatric sickle cell disease is primarily associated with anemia and hemolysis.
- Pulmonary function abnormalities are not significant independent predictors of reduced oxygen saturation in this population.
Abstract:
Low steady state haemoglobin oxygen saturation in patients with sickle cell anaemia has been associated with the degree of anaemia and haemolysis. How much pulmonary dysfunction contributes to low saturation is not clear. In a prospective study of children and adolescents with sickle cell disease aged 3-20 years at steady state and matched controls, 52% of 391 patients versus 24% of 63 controls had steady state oxygen saturation <99% (P < 0.0001), 9% of patients versus no controls had saturation <95% (P = 0.008) and 8% of patients versus no controls had exercise-induced reduction in saturation > or =3%. Decreasing haemoglobin concentration (P < or = 0.001) and increasing haemolysis (P < or = 0.003) but not pulmonary function tests were independent predictors of both lower steady-state saturation and exercise-induced reduction in saturation. Neither history of stroke nor history of acute chest syndrome was significantly associated with lower steady-state oxygen saturation or exercise-induced reduction in saturation. Tricuspid regurgitation velocity was higher in patients with lower steady state haemoglobin oxygen saturation (P = 0.003) and with greater decline in oxygen saturation during the six-minute walk (P = 0.022). In conclusion, lower haemoglobin oxygen saturation is independently associated with increasing degrees of anaemia and haemolysis but not pulmonary function abnormalities among children and adolescents with sickle cell disease.
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