Contributions
Abstract: PB2402
Type: Publication Only
Background
Sickle cell disease is the most frequent genetic disorder in France with an incidence of 1/2364 birth in 2010. It is a multisystemic disease with various clinical presentations, with the vaso-occlusive crisis being the most common. Several therapeutic strategies have already been tested, such as the use of hydroxycarbamide, red cell exchange, bone marrow transplantation, and recently, gene therapy. All the progress made, contributed to lower the morbimortality of the disease. Sickle cell leg ulcer (SCLU) is a common complication affecting almost 1/5th of patients Europe and has a major impact on patients’ quality of life, mainly due to the chronic pain it induces and its slow healing process, leading eventually to social marginalization and occupational deprivation. However, there is no clear recommendation regarding the specific treatment of SCLU. Hemolytic anemia-induced phenotypes, tend to have low nitric oxide bioavailability which alters vasoreactivity, and thus encourages endothelial activation and the development of an ischemic vasculopathy.
Aims
The purpose of our study was to evaluate Glyceryl Trinitrate efficacy in the treatment of leg ulcers.
Methods
We conducted a retrospective study in adult patients with sickle cell disease, presenting a SCLU of more than 1 cm2, treated in our center from January 2015 till December 2017. Patients with other potential causes of leg ulcers (Diabetes, arterial insufficiency, systemic diseases, venous insufficiency) were excluded. Ulcers were either treated using a regular dressing or with an additional puff of Trinitrate 0.30 mg sprayed on the ulcer on a weekly basis, at each wound dressing change, and photographic follow up was implemented for and was analyzed with Pictzar software. Our primary endpoint was healing speed (decrease of ulcer surface/day) and secondary endpoint was the total duration of healing. Mann-Withney test was used to compare medians.
Results
Seventeen patients were included: 16 had homozygous Sickle cell disease (SS) and 1 heterozygous patient (Sβ0 thalassemia). Six SS patients (2 men et 4 women) with a mean age of 47 years old received Trinitrate spray. Ten homozygous and one heterozygous patients (10 men) with a mean age of 47 years old, didn’t receive topical Trinitrate. There was no significant difference (p value=0.3) between median leg ulcer size at the inclusion (5.75 vs 2.4 cm2). Faster healing was seen in the Trinitrate group but did not attain statistical significance (0.11 cm2/day vs 0.005 cm2/day; p value=0.08,). Median duration of ulcer healing was 100 days in the control group, and 56 days in the Trinitrate group, although one patient still had a persistent ulcer by the end of the follow-up.
Conclusion
Our retrospective study, on a small number of patients, shows a tendency towards leg healing hastening when spraying Trinitrate on the ulcer during wound care. A randomized controlled study on a larger scale of patient is necessary to confirm this result. Other vasodilatory treatments may also be tested following a similar methodology.
Session topic: 27. Sickle cell disease
Keyword(s): Hemolytic anemia, Sickle cell
Abstract: PB2402
Type: Publication Only
Background
Sickle cell disease is the most frequent genetic disorder in France with an incidence of 1/2364 birth in 2010. It is a multisystemic disease with various clinical presentations, with the vaso-occlusive crisis being the most common. Several therapeutic strategies have already been tested, such as the use of hydroxycarbamide, red cell exchange, bone marrow transplantation, and recently, gene therapy. All the progress made, contributed to lower the morbimortality of the disease. Sickle cell leg ulcer (SCLU) is a common complication affecting almost 1/5th of patients Europe and has a major impact on patients’ quality of life, mainly due to the chronic pain it induces and its slow healing process, leading eventually to social marginalization and occupational deprivation. However, there is no clear recommendation regarding the specific treatment of SCLU. Hemolytic anemia-induced phenotypes, tend to have low nitric oxide bioavailability which alters vasoreactivity, and thus encourages endothelial activation and the development of an ischemic vasculopathy.
Aims
The purpose of our study was to evaluate Glyceryl Trinitrate efficacy in the treatment of leg ulcers.
Methods
We conducted a retrospective study in adult patients with sickle cell disease, presenting a SCLU of more than 1 cm2, treated in our center from January 2015 till December 2017. Patients with other potential causes of leg ulcers (Diabetes, arterial insufficiency, systemic diseases, venous insufficiency) were excluded. Ulcers were either treated using a regular dressing or with an additional puff of Trinitrate 0.30 mg sprayed on the ulcer on a weekly basis, at each wound dressing change, and photographic follow up was implemented for and was analyzed with Pictzar software. Our primary endpoint was healing speed (decrease of ulcer surface/day) and secondary endpoint was the total duration of healing. Mann-Withney test was used to compare medians.
Results
Seventeen patients were included: 16 had homozygous Sickle cell disease (SS) and 1 heterozygous patient (Sβ0 thalassemia). Six SS patients (2 men et 4 women) with a mean age of 47 years old received Trinitrate spray. Ten homozygous and one heterozygous patients (10 men) with a mean age of 47 years old, didn’t receive topical Trinitrate. There was no significant difference (p value=0.3) between median leg ulcer size at the inclusion (5.75 vs 2.4 cm2). Faster healing was seen in the Trinitrate group but did not attain statistical significance (0.11 cm2/day vs 0.005 cm2/day; p value=0.08,). Median duration of ulcer healing was 100 days in the control group, and 56 days in the Trinitrate group, although one patient still had a persistent ulcer by the end of the follow-up.
Conclusion
Our retrospective study, on a small number of patients, shows a tendency towards leg healing hastening when spraying Trinitrate on the ulcer during wound care. A randomized controlled study on a larger scale of patient is necessary to confirm this result. Other vasodilatory treatments may also be tested following a similar methodology.
Session topic: 27. Sickle cell disease
Keyword(s): Hemolytic anemia, Sickle cell