Hematology Reports (Feb 2023)

Leg Ulcers in Sickle Cell Disease: A Multifactorial Analysis Highlights the Hemolytic Profile

  • Edvan do Carmo Santos,
  • Paulo Vinícius Bispo Santana,
  • Laíne Lopes Silva de Jesus,
  • Gabriela Imbassahy Valentim Melo,
  • Sètondji Cocou Modeste Alexandre Yahouédéhou,
  • Caroline Conceição da Guarda,
  • Rayra Pereira Santiago,
  • Luciana Magalhães Fiuza,
  • Suéllen Pinheiro Carvalho,
  • Liz Oliveira dos Santos,
  • Elisângela Vitória Adorno,
  • Augusto Cezar Magalhães Aleluia,
  • Luciene Cristina Gastalho Campos Luiz,
  • Teresa Cristina Cardoso Fonseca,
  • Marilda de Souza Gonçalves,
  • Milena Magalhães Aleluia

DOI
https://doi.org/10.3390/hematolrep15010013
Journal volume & issue
Vol. 15, no. 1
pp. 119 – 129

Abstract

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Sickle cell disease (SCD) is characterized by the presence of the variant S hemoglobin (HbS). The homozygous genotype (HbSS) is sickle cell anemia (SCA), while the double heterozygous of HbS and HbC (HbSC) is defined as SC hemoglobinopathy. The pathophysiology is based on chronic hemolysis, inflammation, endothelial dysfunction, and vaso-occlusion, which results in vasculopathy and serious clinical manifestations. Sickle leg ulcers (SLUs) are cutaneous lesions around the malleoli frequent in 20% of Brazilian patients with SCD. SLUs present a variable clinical and laboratory pattern modulated by several characteristics that are not fully understood. Hence, this study aimed to investigate laboratory biomarkers and genetic and clinical parameters associated with the development of SLUs. This descriptive cross-sectional study included 69 SCD patients, 52 without SLU (SLU−) and 17 with active or previous SLU history (SLU+). The results showed a higher incidence of SLU in SCA patients and there was no observed association of α-3.7 Kb thalassemia in SLU occurrence. Alterations in NO metabolism and hemolysis were associated with clinical evolution and severity of SLU, in addition to hemolysis modulating the etiology and recurrence of SLU. Our multifactorial analyses demonstrate and extend the role of hemolysis driving the pathophysiological mechanism of SLU.

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