Talk:Sickle cell disease

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Wiki Education Foundation-supported course assignment

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older entries

Just as a comment for further discussion, I did hemoglobin research for about 4 and a half years. I recall a conversation (ca 1993 or 1994) with Professor Gary Ackers (at the time, chair of biochemistry and molecular biophysics at Washington University in St Louis Medical School, and one of the leading experts on hemoglobin cooperativity) about a paper, in which they mapped the site of action of the digestive enzyme the malaria parasite used on hemoglobins (as Hb is what they eat). It turns out that in the process of polymerization (HB S now, the sickle cell Hb), the polymerization caps the site of digestion, making Hb a poor meal for the parasite. That, to my understanding, was the way that in heterozygous individuals the mutation had selective pressure against the parasite. It slowed the rate of growth, because they couldn't feed as effectively on heterozygous individuals. Inter-cell death seems to be a poor mechanism for selective pressure, as few cells are sickled in heterozygous individuals. dwmyers

Simple test for sickle cell carriers

I read this in a test on genetics in GCSE Biology. If a sample of a carrier's blood is kept in low oxygen conditions, a few cells with become sickle shaped. This is roughly what the test said:

A couple are worried that they might pass on sickle cell anaemia to their children, so they had blood samples taken for a test. The father's sample developed sickle cells in low oxygen conditions whereas the mother's didn't. What does this mean?

Of course, it meant that the couple's children would a half chance of becoming a carrier, but won't develop the disease. But since I can't obtain the paper, I can't prove that it was there, but I doubt that it's a lie.

Cerebral vasculopathy

doi:10.1111/bjh.12300 Br J Haem 14:54, 25 April 2013 (UTC)

More treatment, vicar?

doi:10.1111/bjh.12413 JFW | T@lk 19:28, 17 June 2013 (UTC)

Vaso-occlusion

doi:10.1182/blood-2013-05-498311 - review in Blood. JFW | T@lk 16:08, 8 December 2013 (UTC)

Transition of care

Children become adults doi:10.1111/bjh.12700 JFW | T@lk 16:13, 24 December 2013 (UTC)

Another: doi:10.1097/MPH.0b013e3182847483 JFW | T@lk 17:12, 14 September 2014 (UTC)

Eurocentrism!

Why are sickle type red blood cells "abnormal", and disc type red blood cells "normal"?

is the evolutionary immunity to plague and smallpox abnormal?

grabba 68.98.131.130 (talk) 07:49, 17 January 2014 (UTC)

I don't see where Eurocentrism comes into play, but if you read any of the article you'd see that infarcts to vital organs, severe pain, a shortened lifespan, and the fact that most people in the world do not have sickling cells would likely be the reason sickle cells are considered abnormal.MartinezMD (talk) 23:05, 17 January 2014 (UTC)

Yes. what the IP was referring to - and was apparently confused about - is the biology of a person who carries one copy of the sickle cell allele, with the other copy of the gene inherited from the other parent being the 'normal' variant. having both copies of the sickle cell variant causes illness, but having only one copy renders a person immune to malaria, and maybe also plague and smallpox? But while one copy is advantageous, inheriting two copies is most definitely pathological; and, as we all know, every child born to two parents that each have one copy has a 1 in 4 chance of inheriting both copies Firejuggler86 (talk) 13:52, 6 January 2021 (UTC)

Guidelines

... in JAMA: doi:10.1001/jama.2014.10517 JFW | T@lk 21:33, 9 September 2014 (UTC)

And NICE: National Institute for Health and Clinical Excellence. Clinical guideline 143: Sickle cell acute painful episode. London, 2012. JFW | T@lk 08:54, 14 September 2014 (UTC)

Some other recent secondary sources (MESH "Anemia, Sickle Cell"[MAJR] with "Review"):

• doi:10.1111/bjh.12879 Br J Haem 2014 - pain control and safety (opioids)
• doi:10.1111/bjh.12950 Br J Haem 2014 - splenic pathology
• doi:10.1161/STROKEAHA.114.005144 Stroke 2014 - role in stroke
• doi:10.3810/pgm.2014.03.2748 Postgrad Med 2014 - psychological and pathological aspects of pain control in children
• doi:10.1136/bmj.g1765 - BMJ 2014 - management in the community
• doi:10.1182/blood-2013-12-542076 Blood 2014 - sickle hepatopathy and transplantation
• doi:10.1182/blood-2013-01-435776 Blood 2014 - status of HSCT for haemoglobinopathy

For the epidemiology and the management in resource-poor settings we might need to refer to the WHO literature.

There's plenty more, so any expansion will have to be selective. Subarticles may be required. JFW | T@lk 11:08, 14 September 2014 (UTC)

doi:10.1586/ehm.12.20 is about the research into histone deacetylase inhibition, for the "research" section. JFW | T@lk 22:21, 28 October 2014 (UTC)

Updating

Having identified some sources (previous section) I am planning to update this article and bring it to GA status reasonably soon. It gets the basics right but there's a fair number of sources that don't meet WP:MEDRS and at places it is difficult to understand for the lay reader. Some other WP:MEDMOS problems were also present. There's a total of 29 Cochrane reviews (link), but we're only citing four Cochrane reviews currently.

My views for each section:

• Signs and symptoms: currently a little bit chaotic and doesn't separate acute from chronic problems
• Genetics: a fair bit of jargon needs "opening up"
• Pathophysiology: should be maximally up to date according to current understanding (needs 2-3 solid sources)
• Diagnosis: screening/case finding should be separated from diagnostics in the setting of complications (e.g. stroke) and surveillance; we need to talk about neuroimaging and echocardiography
• Prevention: there is currently no section that discusses prevention strategies; I haven't yet seen sources that discuss premarital screening and counseling in the same way Cyprus attempts to reduce unions that might lead to thalassaemia major
• Management: again we need to separate prophylaxis, acute care, and long-term disease management
• Prognosis: this needs strong sources to be reliable for the average reader
• Epidemiology: good sources needed, perhaps less on a country-by-country basis
• History: the current section needs consolidating with a better secondary source as support
• Research directions: needs to be written

As always, assistance would always be appreciated. JFW | T@lk 16:50, 14 September 2014 (UTC)

As far as the history section, the most recent dates are from the 1940's-50's. I'm sure something has happened or been discovered about sickle-cell disease since then. Wulf.174 (talk) 00:04, 2 October 2014 (UTC)

OK, but what? JFW | T@lk 23:13, 6 October 2014 (UTC)

Suggestion for Prognosis Section

In this article, it states that "the estimated mean survival for sickle-cell patients was 53 years old for men and 58 years old for women with homozygous SCD." Throughout the entire article it also talks about much lower life expectancies are for individuals that have SCD. My question is, should this life expectancy be compared to the typical European/American life expectancies (which would be relatively high) or the life expectancy of people living in areas where SCD is much more common? These areas are typically much more impoverished and likely have much lower life expectancies as it is. In this case, 53 years of age for men and 58 years of age for women does not seem like it would be too far removed from the life expectancies of the people living in these traditionally malaria-stricken countries. Their average life expectancy at least be given in order to have a good reference point for how people with SCD compare. — Preceding unsigned comment added by Haynes.239 (talk • contribs) 03:32, 1 October 2014 (UTC)

Sources are needed. JFW | T@lk 23:13, 6 October 2014 (UTC)

I will get back to you on this one.

Haynes.239 (talk) 01:11, 15 October 2014 (UTC)

Origin of SCD

In the article, it says that "Sickle-cell gene mutation probably arose spontaneously in different geographic areas, as suggested by restriction endonuclease analysis. These variants are known as Cameroon, Senegal, Benin, Bantu and Saudi-Asian." A study done in 1988 only traces the origins of mutation back to three places, namely Benin, Senegal, and Central African Republic (Nigon, 1988). This is information appears to be inconsistent with what is known about the origin of SCD. — Preceding unsigned comment added by Haynes.239 (talk • contribs) 03:44, 1 October 2014 (UTC)

Can you point us to a source? JFW | T@lk 23:13, 6 October 2014 (UTC)

Yes. Nigon, V. "Structural Analysis of the 5 Prime Flanking Region of The. Beta. Globin Gene in African Sickle Cell Anemia Patients: Further Evidence for Three Origins of the Sickle Cell Mutation in Africa." (1988). Print. Haynes.239 (talk) 01:09, 15 October 2014 (UTC)

Print where? A journal? A book? Looks like a primary source too. JFW | T@lk 17:01, 19 October 2014 (UTC)

PMID 2898142 is definitely a primary source. JFW | T@lk 21:52, 19 October 2014 (UTC)

Sicklemic Belt

The name of the area that has the highest frequency of persons infected with SCD is called the "Sicklemic Belt" (Lehman and Huntsman, 1974). I think this needs to be mentioned, as the particular region does have a more specific name. — Preceding unsigned comment added by Haynes.239 (talk • contribs) 03:51, 1 October 2014 (UTC)

Never heard of the term, and I don't think we need to mention it. JFW | T@lk 23:13, 6 October 2014 (UTC)

Sickle-cell disease's relation to malaria

There should be more ties to how sickle-cell disease is shaping certain African populations, and how these populations no longer have a high rate of malaria like they previously did. There are only brief areas on the page that mention how malaria and sickle-cell disease relate to each other, but I believe there should be a bigger section that ties it together. Wulf.174 (talk) 23:48, 1 October 2014 (UTC)

Point us to a source that looks into this, and we can have that conversation. JFW | T@lk 23:13, 6 October 2014 (UTC)

No access

The following source was temporarily removed:

Malowany JI, Butany J (February 2012). "Pathology of sickle cell disease". Seminars in Diagnostic Pathology. 29 (1): 49–55. doi:10.1053/j.semdp.2011.07.005. PMID 22372205.

It looks very useful, but I had no access and it was being used for a statement that could be backed up with other sources as well. JFW | T@lk 22:05, 28 October 2014 (UTC)

History section

I have removed the content that I could not trace to secondary sources. It is reproduced here for reference:

“ An association with pigmented gall stones was noted in 1911 by Washborn. A genetic basis for this disease was proposed in 1915 by Cook and Meyer. The disease was named sickle-cell anaemia in 1922 by Verne Mason after several additional cases were reported. All the known cases had been reported in blacks and he concluded that this disease was confined to those of black African descent. The heterozygous condition was independently recognised in 1923 by Huck and Syndestrickler. Syndestrickler also was the first to note the splenic atrophy that occurs in this condition. It was recognised as a Mendelian autosomal characteristic by Taliaffero and Huck also in 1923. A predisposition to pneumonia was noted in 1924 by Graham. The concept of progressive splenic atrophy was proposed by Hahn and Gilespie in 1927. Pneumococcal meningitis in this condition was first reported in 1928 by Wollstein and Kriedel but it was not until 1966 that the association between splenic atrophy and infection was made by Robinson and Watson.

In 1927 Vernon Hahn and Elizabeth Biermann Gillespie showed that sickling of the red cells was related to low oxygen. In some individuals this change occurs at partial pressures of O
₂ prevalent in the body, and produces anemia and other disorders, termed sickle-cell disease. In other persons sickling occurs only at very low O
₂ partial pressures; these are asymptomatic sickle-cell trait carriers.

The association with kidney and lung infarcts was noted in 1931 by Yater and Mollari and Baird in 1934 respectively. The term sickle-cell trait was coined by Samuel Diggs in Memphis in 1933 to distinguish heterozygotes from those with sickle-cell anaemia. Diggs also reported the association with splenic fibrosis in 1935. The pathological mechanism of vaso-occlusion was proposed by Ham and Castle in 1940.

In 1946, E A Beet, a British medical officer stationed in Southern Rhodesia (Zimbabwe), observed that blood from malaria patients who had sickle-cell trait had fewer malarial parasites than blood from patients without the trait and suggested that this might be a protective feature. In 1947 Beet published that the incidence of enlarged spleens in sickle-cell patients was much lower than in non sickle-cell and suggested that this was due to recurrent thromboses which resulted in fibrosis and shrinkage of the spleen. In 1949 Lehmann and Raper published a map of Uganda and showed that the presence of sickle-cell anaemia correlated with the presence of malaria. In 1950 Singer et al. noted the abrupt cessation of marrow activity that may occur and coined the term aplastic crisis. The role of parvovirus in aetiology of this condition was not recognised until 1981. P. Brain also while working in Northern Rhodesia confirmed the lower incidence of splenomegaly and suggested that while homozygotes for the sickle-cell gene suffered from several problems heterozygotes might be protected against malaria.

”

It can be reintroduced if secondary sources can be found. JFW | T@lk 23:41, 28 October 2014 (UTC)

References

Addition about evolution

Haynes.239 made an addition about the evolutionary aspects of sickle cell disease.[1] The main problem is that it is based on primary sources (see WP:PSTS). JFW | T@lk 06:58, 18 November 2014 (UTC)

Reproductive issues

doi:10.1182/blood-2014-07-577619 - from Blood JFW | T@lk 22:24, 4 December 2014 (UTC)

Hemoglobin/haemoglobin

In the first sentence, the word hemoglobin is spelled haemoglobin. This is the British spelling, but shouldn't both spellings be placed or the U.S. version? After all, in the spell checker, haemoglobin is said to be not spelled correctly (in my editor). Gr8vince - Vincent Tang (talk) 04:16, 25 February 2015 (UTC)

No, otherwise you'd have to do it for every single article written in English. see WP:ENGVAR and WP:MOSS. MartinezMD (talk) 16:24, 25 February 2015 (UTC)

Acute chest syndrome guideline

UK doi:10.1111/bjh.13348 JFW | T@lk 09:40, 3 May 2015 (UTC)

Epidemiology: India and Nepal

Replaced tribe with Ethnic group, changed 'the African race' to African communities. This doesn't resolve the need for a citation but at least avoids a meaningless use of race. I suspect that the numbers for prevalence confuses the presence of the genetic markers linked to SCD with the disease itself but don't feel qualified to edit this bit. — Preceding unsigned comment added by 143.52.88.69 (talk) 14:00, 18 November 2015 (UTC)

Blood theme issue

Blood has a theme issue on sickle cell disease table of contents. JFW | T@lk 15:25, 21 February 2016 (UTC)

Depression

... increases health care utilisation in sickle cell disease doi:10.1111/bjh.14023 (weak association, small sample sizes). JFW | T@lk 23:04, 22 March 2016 (UTC)

HSCT

doi:10.1111/bjh.14167 JFW | T@lk 22:18, 9 June 2016 (UTC)

Transfusion

UK guidelines:

• Principles and laboratory aspects
• Indications for transfusion

JFW | T@lk 10:57, 17 January 2017 (UTC)

Epidemiology

This is not exactly true " and is most common in people of African American descent." and the topic is in paragraph 4 of the lead. Doc James (talk · contribs · email) 20:38, 23 January 2017 (UTC)

I had overlooked that "American" part of the editor's additions. No objection to your change here.MartinezMD (talk) 23:21, 23 January 2017 (UTC)

HbSC

doi:10.1111/bjh.14444 JFW | T@lk 16:04, 22 February 2017 (UTC)

This page needs some work - copy-editing and dead links

I just wanted to flag this page as requiring some work - scanning it as a reference for a project, I noticed quite a few typos and grammar errors, some content duplication/mismatch, and at least one dead reference link. I don't have the bandwidth to fix at the moment, but can return in a month or so if it hasn't been addressed.

Kevbonham (talk) 15:06, 22 March 2017 (UTC)

Thanks for the offer. Not sure if anyone will have done it by that time! JFW | T@lk 10:54, 23 March 2017 (UTC)

NEJM review

doi:10.1056/NEJMra1510865 JFW | T@lk 13:40, 20 April 2017 (UTC)

Inducing fetal haemoglobin as a therapeutic strategy doi:10.1111/bjh.15021 JFW | T@lk 15:37, 22 November 2017 (UTC)

Folic

Was still recommended by WHO in 2016.[2] Just because they no longer have that webpage does not mean it is no longer recommended. Doc James (talk · contribs · email) 00:08, 20 November 2017 (UTC)

Without them publishing a web page, we cannot say what they recommend, no? The Cochrane review came out the same year their page was taken down. Perhaps it was the reason? Any ideas? MartinezMD (talk) 20:24, 2 December 2017 (UTC)

Novel mechanisms for pain control

doi:10.1182/blood-2017-05-782003 JFW | T@lk 20:01, 2 December 2017 (UTC)

Use of hydroxycarbamide: UK guideline

doi:10.1111/bjh.15235 JFW | T@lk 21:42, 8 May 2018 (UTC)

Conspiracy theories

deleted this:

Sickle cell disease is not a genetic disorder it was chemical and biological warfare by communist such as Stalin and other satanic dictators to kill Christian's. The North African and middle eastern muslims and jews did it to South African Christian's, the atheist Satanist Muslim Jew armies that went to Vietnam did it to the Vietnamese people and Irish Soilders that were fighting to help the Vietnamese, the Russians did it to the East Indians and the spainards did it to Christian missionaries. The put glass and chemicals in the water supply and food source thus is where the sickle shape comes from. It causes tears and holes in veins and arteries which causes a great deal of pain and internal bleeding which causes the anemia. I know because I had it. The cure for it is a chemical compound that breaks down the glass in your system and can be excreted through urine as well as feces. Secondary to sickle cell anemia would be gall stones as the glass that is fibrous makes it's way to the kidneys and thus a ultrasound lipotrithy can break down the matter so it can be expelled from the system. Many Christian's have had sickle cell anemia due to tainted food and water.it is in no way genetic.it is chemical and biological.

Wathiik (talk) 08:17, 10 August 2020 (UTC)

The removal is appreciated. In obvious vandalism, such as this, it's alright not to put it in the talk page. We can see what you did in the article's history. MartinezMD (talk) 14:44, 10 August 2020 (UTC)

Wiki Education assignment: Composition II

This article was the subject of a Wiki Education Foundation-supported course assignment, between 24 August 2022 and 30 November 2022. Further details are available on the course page. Student editor(s): JyquanJ (article contribs).

— Assignment last updated by Kvauls (talk) 04:23, 3 October 2022 (UTC)

info-box "mutation"

I want the info-box to say something more informative than the one word "genetic", but I'm struggling to come up with something both accurate and succinct. At a minimum I want to say that it's homozygous and which gene is involved. I have used the word "mutation" for now, technically it's more often an inherited "polymorphism" but that is a word that would be much less recognizable to a non specialist audience? Also, recent research shows that de novo mutations in that gene are surprisingly common, but that's a bit too cutting edge and controversial for the info box… on balance I just went with "mutation". Irtapil (talk) 05:10, 23 February 2023 (UTC)

Name of the disease

I would like to ask for some sources on how the disease usually referred to as,

1. Sickle cell or Sickle-cell?

2. disease or anemia?

I don't want to change it until I get more comments to prevent sparking an edit war. —Mint Keyphase (Did I mess up? What have I done?) 04:00, 15 July 2024 (UTC)

Hemolytic crisis

I propose to delete this paragraph. Reasons:

• It's not mentioned in current primary or secondary sources
• Recent evidence that G6PD deficiency does not interact with SCD.

Bob (talk) 20:50, 27 October 2024 (UTC)