Advanced clinical parameters: A complementary hydroxyurea adherence evaluation in sickle cell anemia treatment

Area of Science:

• Hematology
• Clinical Chemistry
• Immunology

Background:

• Sickle cell anemia (SCA) presents complex pathology, often complicated by low adherence to hydroxyurea (HU) treatment.
• Identifying early indicators of treatment adherence is crucial for managing SCA patients effectively.
• Advanced clinical parameters (ACPs) offer a potential avenue for early hematopoiesis analysis.

Purpose of the Study:

• To characterize the demographic profile of SCA patients non-adherent to HU.
• To evaluate the utility of ACPs in monitoring HU treatment adherence in SCA.
• To identify specific ACPs indicative of non-adherence.

Main Methods:

• A cross-sectional study involving 83 SCA patients undergoing HU treatment.
• Patients were stratified into children (<12 years) and adolescents/adults (≥12 years).
• Analysis included hemograms with ACPs, electronic medical records, and pharmacy claims data.

Main Results:

• Non-adherent adolescents/adults exhibited significantly higher WBC, neutrophil, lymphocyte, monocyte, basophil, RBC, RET, RDW, and PLT counts.
• Non-adherent patients showed significantly decreased MCV and MCH.
• An immature granulocyte count (IG†) ≥0.035 cells/mm³ increased the risk of non-adherence by 4.6 times (p=0.014); SII was also higher in non-adherent patients (p=0.042).

Conclusions:

• Immature granulocyte counts (IG†) demonstrate clinical utility in the early detection of HU non-adherence in SCA.
• Combining IG† with other ACPs enhances the identification of non-adherent patients.
• The routine evaluation of ACPs in laboratory settings is recommended due to their ease of implementation and potential clinical impact.