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VITAMIN D IN SPANISH CHILDREN WITH HEMOGLOBINOPATHIES.
Author(s):
Alejandro M. Bobes Fernández
,
Alejandro M. Bobes Fernández
Affiliations:
Hospital Clínico San Carlos,Madrid,Spain;Hospital Gregorio Marañón,Madrid,Spain;Facultad de medicina,Universidad Complutense de Madrid,Madrid,Spain
Beatriz Ponce
,
Beatriz Ponce
Affiliations:
Hospital Gregorio Marañón,Madrid,Spain;Facultad de medicina,Universidad Complutense de Madrid,Madrid,Spain
Yurena Aguilar
,
Yurena Aguilar
Affiliations:
Hospital Gregorio Marañón,Madrid,Spain;Facultad de medicina,Universidad Complutense de Madrid,Madrid,Spain
Carmen Garrido
,
Carmen Garrido
Affiliations:
Hospital Gregorio Marañón,Madrid,Spain;Facultad de medicina,Universidad Complutense de Madrid,Madrid,Spain
Marina García-Morín
,
Marina García-Morín
Affiliations:
Hospital Gregorio Marañón,Madrid,Spain;Facultad de medicina,Universidad Complutense de Madrid,Madrid,Spain
Cristina Beléndez
,
Cristina Beléndez
Affiliations:
Hospital Gregorio Marañón,Madrid,Spain;Facultad de medicina,Universidad Complutense de Madrid,Madrid,Spain
Elena Cela
Elena Cela
Affiliations:
Hospital Gregorio Marañón,Madrid,Spain;Facultad de medicina,Universidad Complutense de Madrid,Madrid,Spain
(Abstract release date: 05/18/17) EHA Library. M. Bobes A. 05/18/17; 182862; PB2149
Alejandro M. Bobes
Alejandro M. Bobes
Contributions
PDF Abstract
Abstract

Abstract: PB2149

Type: Publication Only

Background
Although vitamin D deficiency has been documented as a frequent problem in studies of children, there are limited data on the prevalence of this nutritional deficiency among children who suffer from sickle cells disease (SCD) or thalassemia.

Vitamin D homeostasis is important to prevent osteopenia. Furthermore vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, hypertension, and infectious diseases.
Vitamin D deficiency is now recognized as a pandemic. The major cause of vitamin D deficiency is the lack of sun. Although Spain has a high rate of sunny hours, we have found low levels of vitamin D in our patients with SCD or thalassemia.

Aims
The purpose of this work is to assess the status of vitamin D in children with SCD and thalassemia in our setting.

Methods
We have recruited children diagnosed with SCD and thalassemia between 1998 and 2016 and we have reviewed their vitamin D levels. We have chosen the first vitamin value we obtained and the last one till today.

Vitamin D was measured by quantitative determination of 25(OH) D. Deficit of vitamin D was defined by< 30 ng/ml.
The study enrolled 114 children. Most of them, with SCD diagnosis ( 94%). The type of anaemia was Hb SS (94 patients), Hb SC (8 patients), Hb Sß0 (3 patients) and HbSß+ (2 patients). The remaining 6% were diagnosed with Thalassemia Maior.
Mostly of the children were African or Central-South American.
In our centre, vitamin D prophylaxis is made since the first year of life.

Results
60% of the children had vitamin D deficiency.

We have divided children into 4 groups depending on the age. When considering vitamin D first determination: mean vitamin D levels in children below 2 years old were 39.5±13.3 ng/dl. The group between two and five years old had a mean serum vitamin D of 35.5±14.8 ng/dl. Children aged between five and ten had 26.1±13.5 ng/dl of mean 25(OH)D. Finally in the group older than 10, we observed mean of 7.4±14 ng/dl.
When having these low levels of vitamin D, we strongly recommend to start treatment with Cholecalciferol 25000U/month. Regarding second levels of vitamin D, we have divided patients into those who presumably have the treatment against children who do not. We present the results in the following table:
< 2 years old
2-5 years old
5-10 years old
>10 years old
Vit D treatment
33.7±9.02ng/dl
35.5±12.3ng/dl
34.3±7.3 ng/dl
26.4±11.2ng/dl
No Vit D treatment
-
33.8±1.5 ng/dl
27.3±4.9 ng/dl
6.6±2 ng/dl

Conclusion
The study found a high prevalence of vitamin D deficiency in children older than five years old(in the first determination) with SCD or Thalassemia Maior and significant decrease of levels in those not having vitamin D therapy.

It is not well known the physiopathology of this factor deficiency, although it is supposed to be multifactorial. However we confirm that living in a sunny geographical situation with a healthy diet is not enough to maintain an adequate 25(OH)D levels.
Although it is difficult to reach correct levels of vitamin with oral treatment, vitamin D levels increase when having correct doses.
We have also checked that older children have lower levels of vitamin D than younger boys. This could be explained by the fact that pre-teenagers spend lot of time at home instead of going out.
If prophylaxis is made not only the vitamin levels will increase but bone growth also.

Session topic: 25. Sickle cell disease

Keyword(s): Pediatric, Hemoglobinopathy, Sickle cell anemia

Abstract: PB2149

Type: Publication Only

Background
Although vitamin D deficiency has been documented as a frequent problem in studies of children, there are limited data on the prevalence of this nutritional deficiency among children who suffer from sickle cells disease (SCD) or thalassemia.

Vitamin D homeostasis is important to prevent osteopenia. Furthermore vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, hypertension, and infectious diseases.
Vitamin D deficiency is now recognized as a pandemic. The major cause of vitamin D deficiency is the lack of sun. Although Spain has a high rate of sunny hours, we have found low levels of vitamin D in our patients with SCD or thalassemia.

Aims
The purpose of this work is to assess the status of vitamin D in children with SCD and thalassemia in our setting.

Methods
We have recruited children diagnosed with SCD and thalassemia between 1998 and 2016 and we have reviewed their vitamin D levels. We have chosen the first vitamin value we obtained and the last one till today.

Vitamin D was measured by quantitative determination of 25(OH) D. Deficit of vitamin D was defined by< 30 ng/ml.
The study enrolled 114 children. Most of them, with SCD diagnosis ( 94%). The type of anaemia was Hb SS (94 patients), Hb SC (8 patients), Hb Sß0 (3 patients) and HbSß+ (2 patients). The remaining 6% were diagnosed with Thalassemia Maior.
Mostly of the children were African or Central-South American.
In our centre, vitamin D prophylaxis is made since the first year of life.

Results
60% of the children had vitamin D deficiency.

We have divided children into 4 groups depending on the age. When considering vitamin D first determination: mean vitamin D levels in children below 2 years old were 39.5±13.3 ng/dl. The group between two and five years old had a mean serum vitamin D of 35.5±14.8 ng/dl. Children aged between five and ten had 26.1±13.5 ng/dl of mean 25(OH)D. Finally in the group older than 10, we observed mean of 7.4±14 ng/dl.
When having these low levels of vitamin D, we strongly recommend to start treatment with Cholecalciferol 25000U/month. Regarding second levels of vitamin D, we have divided patients into those who presumably have the treatment against children who do not. We present the results in the following table:
< 2 years old
2-5 years old
5-10 years old
>10 years old
Vit D treatment
33.7±9.02ng/dl
35.5±12.3ng/dl
34.3±7.3 ng/dl
26.4±11.2ng/dl
No Vit D treatment
-
33.8±1.5 ng/dl
27.3±4.9 ng/dl
6.6±2 ng/dl

Conclusion
The study found a high prevalence of vitamin D deficiency in children older than five years old(in the first determination) with SCD or Thalassemia Maior and significant decrease of levels in those not having vitamin D therapy.

It is not well known the physiopathology of this factor deficiency, although it is supposed to be multifactorial. However we confirm that living in a sunny geographical situation with a healthy diet is not enough to maintain an adequate 25(OH)D levels.
Although it is difficult to reach correct levels of vitamin with oral treatment, vitamin D levels increase when having correct doses.
We have also checked that older children have lower levels of vitamin D than younger boys. This could be explained by the fact that pre-teenagers spend lot of time at home instead of going out.
If prophylaxis is made not only the vitamin levels will increase but bone growth also.

Session topic: 25. Sickle cell disease

Keyword(s): Pediatric, Hemoglobinopathy, Sickle cell anemia

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