Sickle Cell and Vitamin D: Friend or Foe

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Introduction: Sickle cell disease (SCD) is one of the most common genetic diseases, with an estimated 100,000 people living with SCD in the United States. Due to limited therapeutic options and poor management of chronic pain, the quality of life for these patients is significantly reduced and the burden on medical system has become extremely high (Haykal et al. 2019). Individuals with sickle cell disease have a high prevalence of vitamin D deficiency, estimates ranging from 56.4% to 96.4% in both children and adults. At the intersection of Vitamin D deficiency and SCD, clinical studies have demonstrated a pattern of SCD patients being more susceptible to Vitamin D deficiency and an associated relationship between Vitamin D deficient SCD patients and chronic pain crises (Osunkwo et al. 2011). Vitamin D deficiency has been further associated with decreased bone health, cardiovascular disease, asthma and nephropathy, all pathologies that SCD patients are particularly susceptible to. Current guideline treatments for SCD treatment recommend bone marrow transplant as the only potential cure, while blood transfusions, vaccines, antibiotics, pain relievers and hydroxyurea are all designed to prevent and decrease vaso occlusive crises. In contrast with these recommended treatments, although the role of Vitamin D deficiency as a contributing factor is not entirely clear, Vitamin D deficiency can be easily and inexpensively treated with minimal risk (Nolan et al. 2015).

Objective: To determine if there are significant differences in occurrences and severity of sickle cell crises, number of ED visits and sickle cell complications in pediatric Camden patients who are diagnosed with Sickle Cell Anemia and are treated with Vitamin D supplementation between 2016 and 2019.

Methods: Patients between the ages of birth and 21 years, diagnosed with SCD and residing in Camden county were included. The patient had to be seen under Cooper University Hospital Pediatric Hematology Department, be prescribed Vitamin D and have routine labs drawn including CBC, Hg electrophoresis, CMP, and Vitamin D levels Patients were excluded if they had other comorbid conditions or had not taken Vitamin D supplementation.

Results: In the consolidated analysis, vitamin D had a significant relationship to hemoglobin (r=0.364, p = .001) demonstrating a moderate and positive relationship. There was also significant relationship between vitamin D levels and the number of visits to the ED (r = 0.268, p = 0.019) and hospitalizations (r = 0.284, p = 0.013), both indicating a positive correlation. 

Discussion/Conclusion: As the level of hemoglobin in sickle cell patients is highly indicative of traditional symptomatology, we believe that these results demonstrate that Vitamin D has the potential to be a major actor in the treatment of SCD. While the study was limited by sample size, it indicates that the topic of Vitamin D and sickle cell deserves further study.

Cooper Medical School of Rowan University

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