Carotid and femoral intima-media thickness in adults with sickle cell disease

Nakul B. Kadam, Nikhil O. Bansal, Sourya P. Acharya, Samarth A. Shukla


Background: This study was conducted to evaluate Carotid Intima Media Thickness (CIMT) and Femoral Intima Media Thickness (FIMT) in adults with SCD.

Methods: The present prospective cross-sectional study with control group was carried out in Department of Medicine at Acharya Vinoba Bhave rural hospital over a period of 6months from January to June 2018. A total of 100 (50 cases of SCD, 50 normal subjects) were studied. In the SCD group, 35 cases were patients regular follow up cases and 15 patients were in sickle cell crisis. CIMT of both left and right carotids were taken and the mean of the two values were recorded. The IMT was also measured in the right common femoral artery (RCFA) and left common femoral artery.

Results: SCD patients in steady state had significantly decreased Hb%, increased WBC counts and platelet counts as compared to healthy controls. The mean right FIMT, left FIMT, right CIMT and left CIMT the patients with SCD with crisis were significantly higher than that of the patients without SCD (P<0.001). One way showed that there were significant differences in duration of disease in mean level of Hb%, WBC count, platelet count of the patients in the three groups (p<0.01).

Conclusions: CIMT and FIMT can pick up the macrovascular involvement early and can be utilized as screening tools to predict vascular injury so that at risk individuals would be subjected to proper treatment protocols, especially hydroxyurea therapy early on.


CIMT, Crisis, FIMT, Hydroxyurea, SCD

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Platt OS, Brambilla DJ, Rosse WF, Milner PF, Castro O, Steinberg MH, et al. Mortality in sickle cell disease-life expectancy and risk factors for early death. New Eng J Med. 1994;330(23):1639-44.

Rao VR. Genetics and epidemiology of sickle cell anemia in India. Ind J Med Sci. 1988;42(9):218-22.

Jain DL, Sarathi V, Upadhye D, Gulhane R, Nadkarni AH, Ghosh K, et al. Newborn screening shows a high incidence of sickle cell anemia in Central India. Hemoglobin. 2012;36(4):316-22.

Hoflman R, Benz JE, Shattil SJ, Furie B, Cohen HJ, Silbertein LE. Methemoglobinemia in Haematology Basic Principle and Practice. 2nd ed. U.S.A: Churchill-Livingstone: 1995

Kato GJ, Hebbel RP, Steinberg MH, Gladwin MT. Vasculopathy in sickle cell disease: biology, pathophysiology, genetics, translational medicine, and new research directions. Am J Hematol. 2009;84(9):618-25.

Bode‐Thomas F, Hyacinth HI, Ogunkunle O, Omotoso A. Myocardial ischaemia in sickle cell anaemia: evaluation using a new scoring system. Ann Tropical Paediatrics. 2011;31(1):67-74.

Pannu R, Zhang J, Andraws R, Armani A, Patel P, Mancusi-Ungaro P. Acute myocardial infarction in sickle cell disease: a systematic review. Crit Pathways Cardiol. 2008;7(2):133-8.

Pavlů J, Ahmed RE, O'Regan DP, Partridge J, Lefroy DC, Layton DM. Myocardial infarction in sickle-cell disease. Lancet. 2007;369(9557):246.

Polak JF, Pencina MJ, Pencina KM, O'donnell CJ, Wolf PA, D'Agostino Sr RB. Carotid-wall intima-media thickness and cardiovascular events. New Eng J Med. 2011;365(3):213-21.

Polak JF, Pencina MJ, O'leary DH, D'agostino RB. Common carotid artery intima-media thickness progression as a predictor of stroke in multi-ethnic study of atherosclerosis. Stroke. 2011;42:3017-21.

Engelhorn CA, Engelhorn AL, Cassou MF, Zanoni CC, Gosalan CJ, Ribas E, et al. Intima-media thickness in the origin of right subclavian artery as an early marker of cardiovascular risk. Arq Bras Cardiol. 2006;87(5):609-14.

Giannoukas, Antoniou, Saleptsis, Baros, Griffin, Nicolaides. Common femoral artery intima-media thickness as marker for cardiovascular disease in asymptomatic adults. Vasa. 2009;38(2):147-54.

Kaddah NA, Saied DA, Alwakeel HA, Hashem RH, Rowizak SM, Elmonem MA. Plasma chitotriosidase and carotid intima–media thickness in children with sickle cell disease. Inter J Hematol. 2017;106(5):648-54.

Stein JH, Korcarz CE, Hurst RT, Lonn E, Kendall CB, Mohler ER, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force endorsed by the Society for Vascular Medicine. J Am Soc Echocardiography. 2008;21(2):93-111.

Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, et al. 2007 Guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Euro Heart J. 2007;28(12):1462-536.

Akinbami A, Dosunmu A, Adediran A, Oshinaike O, Adebola P, Arogundade O. Haematological values in homozygous sickle cell disease in steady state and haemoglobin phenotypes AA controls in Lagos, Nigeria. BMC. 2012;5(1):396.

Omoti CE. Haematological values in sickle cell anaemia in steady state and during vaso-occlusive crisis in Benin City, Nigeria. Ann Afr Med. 2005;4(2):62-7.

Ahmed SG, Umana J, Ibrahim UA. Haematological parameters of sickle cell disease patients with menstruation induced vaso-occlusive crises. Pak J Biol Sci. 2006;9(15):2912-5.

Kato GJ, McGowan V, Machado RF, Little JA, Taylor J, Morris CR, et al. Lactate dehydrogenase as a biomarker of hemolysis-associated nitric oxide resistance, priapism, leg ulceration, pulmonary hypertension, and death in patients with sickle cell disease. Blood. 2006;107(6):2279-85.

Boggs DR, Hyde F, Srodes C. An unusual pattern of neutrophil kinetics in sickle cell anemia. Blood. 1973;41(1):59-65.

Okpala I. The intriguing contribution of white blood cells to sickle cell disease–a red cell disorder. Blood Rev. 2004;18(1):65-73.

Okpala I, Daniel Y, Haynes R, Odoemene D, Goldman J. Relationship between the clinical manifestations of sickle cell disease and the expression of adhesion molecules on white blood cells. Euro J Haematol. 2002;69(3):135-44.

Litos M, Sarris I, Bewley S, Seed P, Okpala I, Oteng-Ntim E. White blood cell count as a predictor of the severity of sickle cell disease during pregnancy. Euro J Obstetrics Gynecol Reproductive Biol. 2007;133(2):169-72.

Naprawa JT, Bonsu BK, Goodman DG, Ranalli MA. Serum biomarkers for identifying acute chest syndrome among patients who have sickle cell disease and present to the emergency department. Pediatrics. 2005;116(3):e420-5.

Castro O, Brambilla DJ, Thorington B, Reindorf CA, Scott RB, Gillette P, et al. The acute chest syndrome in sickle cell disease: incidence and risk factors. The Cooperative Study of Sickle Cell Disease. Blood. 1994;84(2):643-9.

Liem RI, O'Gorman MR, Brown DL. Effect of red cell exchange transfusion on plasma levels of inflammatory mediators in sickle cell patients with acute chest syndrome. Am J Hematol. 2004;76(1):19-25.

Freedman ML, Karpatkin S. Elevated platelet count and mega thrombocyte number in sickle cell anemia. Blood. 1975;46(4):579-82.

Villagra J, Shiva S, Hunter LA, Machado RF, Gladwin MT, Kato GJ. Platelet activation in patients with sickle disease, hemolysis-associated pulmonary hypertension, and nitric oxide scavenging by cell-free hemoglobin. Blood. 2007;110(6):2166-72.

Tantawy AA, Adly AA, Ismail EA, Abdelazeem M. Clinical predictive value of cystatin C in pediatric sickle cell disease: a marker of disease severity and subclinical cardiovascular dysfunction. Clinical Applied Thrombosis/Hemostasis. 2017;23:1010-7.

Belizna C, Loufrani L, Ghali A, Lahary A, Primard E, Louvel JP, et al. Arterial stiffness and stroke in sickle cell disease. Stroke. 2012;43(4):1129-30.

Abo-Zenah H, Moharram M, El Nahas AM. Cardiorenal risk prevalence in sickle cell hemoglobinopathy. Nephron Clin Prac. 2009;112(2):c98-106.