Oxidative stress markers and disease severity among children with Sickle Cell Anaemia

ISSN: 2476-8642 (Print) ISSN: 2536-6149 (Online) www.annalsofhealthresearch.com Indexed in: African Index Medicus, Index Copernicus & Google Scholar Member of C.O.P.E and D O.A.J Annals of Health Research IN THIS ISSUE Diabetes mellitus in Tuberculosis VOL. 5 NO. 2 JULY - DEC., 2019 Oxidative Stress in Sickle Cell Anaemia Childhood Diabetic Ketoacidosis Haemostatis in Hypertension Research and Publication Ethics Prostate Carcinoma Bone scan in Breast Cancer Exercise and Basal Insulin levels Rheumatic Heart Diseases Paediatric Cytopathology PUBLISHED BY THE MEDICAL AND DENTAL CONSULTANTS ASSOCIATION OF NIGERIA, OOUTH, SAGAMU, NIGERIA. Annals of Health Research Volume 5, Issue No 2: 193-202 July-December 2019 doi:10.30442/ahr.0502-21-51 CC BY-NC ORIGINAL RESEARCH Oxidative stress markers and disease severity among children with Sickle Cell Anaemia Smith OS*1, Adegoke SA2, Akinlosotu MA3, Ajose OA4 1Department of Chemical Pathology, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria of Paediatrics and Child Health, Obafemi Awolowo University, Ile-Ife, Nigeria 3Department of Paediatrics, University of Medical Sciences, Ondo, Nigeria 4Department of Chemical Pathology, Obafemi Awolowo University, Ile-Ife, Nigeria 2Department *Correspondence: Dr. OS Smith, Department of Chemical Pathology, Obafemi Awolowo University Teaching Hospitals Complex, P. M. B 5538, Ile-Ife, Nigeria; Email: ; ORCID – https://orcid.org/0000-0002-9293-8885 Abstract Background: Sickle cell anaemia has been associated with oxidative stress. Total Antioxidant Capacity (TAC), Total Oxidant Status (TOS) and Oxidative Stress Index (OSI) are cumulative markers of oxidative stress. Objective: To evaluate the serum levels of oxidative stress markers in children with sickle cell anaemia (SCA) and determine the relationship between these markers and disease severity. Method: One hundred and fifty-six children, comprising 78 with SCA, aged 1 - 15 years and 78 age- and sex-matched Haemoglobin AA controls were studied. Serum TOS, OSI, and TAC were determined using ELISA kits. The severity of the SCA was determined using clinical and laboratory parameters. Result: Children with SCA had lower mean serum TAC (0.83±0.31UAE) than controls (1.19±0.24UAE) with p<0.001. However, the mean serum TOS and OSI of children with SCA was higher than among the controls (13.33±4.64U/ml vs. 9.70±2.72U/ml and 20.95±16.75 vs. 8.68±3.76 respectively) with p<0.001. SCA subjects with mild disease had higher mean serum TAC (0.91 ± 0.27UAE) than those with moderate disease (0.54±0.27UAE) (p<0.001). On the other hand, the mean TOS and OSI were lower in children with mild disease compared to those with moderate disease (12.64±4.32U/ml vs. 15.63±5.07U/ml, p = 0.016 and 16.26±10.25 vs. 36.61±23.89 p<0.001 respectively). Sickle cell disease severity score had negative correlation with TAC (r = -0.60, p < 0.001) but positive correlation with TOS (r = 0.3, p = 0.008) and OSI (r = 0.6, p < 0.001). Conclusion: Children with SCA had lower TAC but higher TOS and OSI than matched controls. Oxidative stress markers had a significant relationship with SCD severity. Keywords: Children, Oxidative Stress Index, Severity Score, Sickle Cell Anaemia, Total Antioxidant Capacity, Total Oxidant Status. Introduction Sickle cell anaemia (SCA) is the most common haematological disorder globally and it is found more frequently in sub-Saharan Africa. [1] It is a homozygous genetic disorder with approximately 150,000 to 300,000 individuals born with the disease every year in Africa and Annals of Health Research. Volume 5, Issue No 2, 2019________________________________193 Oxidative stress markers in Sickle Cell Anaemia_________________________________________ Nigeria has one of the highest burdens of SCA with a prevalence of 2-3%. [2] Vaso-occlusive crisis is the commonest clinical phenotypic expression in children with SCA in Nigeria and its frequency has been used as a marker of disease severity.[3] However, other devastating clinical manifestations such as acute chest syndrome, stroke, priapism, osteomyelitis, cholecystitis, leg ulcer, and socio-demographic factors have cumulative lifetime effects that determine the severity of disease in these patients. [4] crises and rate of haemolysis, [16] no report has examined the relationship of the oxidative stress markers with the overall sickle cell disease severity. In addition to evaluating the serum levels of oxidative stress markers (TOS, TAC, and OSI), this study determined the relationship between them and steady-state sickle cell disease severity using a validated scoring system. [4] Individuals with SCA are prone to oxidative damage as a result of excessive generation of reactive oxygen species such as hydrogen peroxide, superoxide, hydroxyl radicals, and malondialdehyde. This is associated with lower levels of human antioxidant vitamins and enzyme activities leading to chronic redox imbalance in their red blood cell metabolic activities. [5-9] The resultant oxidative stress has been implicated in the pathophysiologic mechanism of SCA. [10] Individual oxidants and antioxidants usually interact in cells and body fluids of humans, leading to cumulative effects that can be measured directly in plasma, with the use of serum Total Oxidative Status (TOS) and Total Antioxidant Capacity (TAC) respectively. [11-13] These parameters measure all the biological components of plasma with oxidant and antioxidant activity at once and represent a dynamic equilibrium that occurs as a result of various synergistic interactions between individual oxidants and antioxidants, giving an insight into the delicate balance between them. [14,15] Previous workers on oxidative stress used the ratio of total oxidative status to total antioxidant capacity (oxidative stress index, OSI) as another measure of oxidative stress in their various studies. [11,12] Study design and location This study was a descriptive, cross-sectional comparative study conducted at the Children Sickle cell Disease Clinic of the Wesley Guild Hospital Ilesa, one of the two tertiary units of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. Although some studies have assessed the effect of oxidative stress markers on individual clinical manifestations of SCA such as vaso-occlusive Methods Study Population The haemoglobin genotype of each participant was confirmed using alkaline hemoglobin electrophoresis on cellulose acetate, before recruitment into the study. Steady-state in SCA was defined as a period without acute illness, pain, and infection for at least four weeks and no blood transfusion in the preceding three months. [17] Children whose parents failed to give consent, those on antioxidants and hydroxyurea were excluded from the study since these agents could modify the severity of sickle cell anaemia. [1] Data collection Socio-demographic and clinical information such as age, gender, frequency of v (...truncated)