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Bone marrow in sickle cell anaemia at time of anaemic crisis
Insights
Nutritional deficiencies like iron and folate can complicate sickle cell anemia in Ghanaian children. Bone marrow studies revealed aplastic crises, erythroid hyperplasia, and megaloblastic changes, highlighting these co-occurring issues.
Area of Science:
- Hematology
- Pediatrics
- Nutritional Science
Background:
- Sickle cell anemia is a significant health issue in children, particularly in regions with high nutritional deficiency prevalence.
- Profound anemia in sickle cell anemia patients can stem from various bone marrow and splenic complications.
- Understanding the interplay between sickle cell anemia and nutritional status is crucial for effective management.
Purpose of the Study:
- To investigate the bone marrow findings in Ghanaian children with homozygous sickle cell anemia presenting with severe anemia.
- To identify the prevalence of erythropoiesis depression (aplastic crisis) and erythroid hyperplasia.
- To assess the incidence of iron and folate deficiency in these patients.
Main Methods:
- Bone marrow samples were collected from 33 Ghanaian children diagnosed with homozygous sickle cell anemia.
- Patients presented with profound anemia (hemoglobin < 5 g/dl).
- Bone marrow aspirates were analyzed for erythropoiesis, iron stores, and megaloblastic changes.
Main Results:
- Aplastic crisis (erythropoiesis depression) was observed in 14 children.
- Erythroid hyperplasia was present in 17 children.
- Splenic sequestration crisis was diagnosed in 2 children.
- Iron deficiency was noted in 19 children (absent in 14, reduced in 5).
- Folate deficiency (megaloblastic changes) was identified in 8 children.
Conclusions:
- Iron and folate deficiencies are common complications in Ghanaian children with sickle cell anemia.
- Nutritional deficiencies can exacerbate the severity of sickle cell anemia, particularly in endemic areas.
- Screening for and addressing iron and folate deficiencies are recommended for children with sickle cell anemia in resource-limited settings.
Abstract:
Samples of bone marrow from 33 Ghanaian children with homozygous sickle cell anaemia who presented with profound anaemia (haemoglobin less than 5 g/dl) were studied. The principal finding was depression of erythropoiesis (aplastic crisis) in 14 children and erythroid hyperplasia in 17. A splenic sequestration crisis was clinically diagnosed in the remaining two children. Stainable iron was absent in the marrow of 14 children and reduced in another five. Megaloblastic changes compatible with folate deficiency were present in 8 children. It is suggested that iron and folate deficiencies may complicate sickle cell anaemia in children living in geographical areas where nutritional deficiencies are prevalent.