Avaliação clínica e laboratorial de pacientes com Anemia falciforme em uso de Hidroxiureia em hospitais de referência

Abstract

Sickle cell disease is a term used to designate genetic alterations that are characterized by the presence of hemoglobin S (HbS). Sickle cell anemia (SCA) represents a severe form among sickle cell diseases. It is a genetic disease that has an autosomal recessive character, originating from a point mutation in the gene that encodes the β-globin chain, resulting in the production of an abnormal hemoglobin, hemoglobin S (HbS). Among the main clinical complications in patients with SCA, pain crises, acute chest syndrome, osteonecrosis, malleolar ulcers, renal failure, priapism, dactylitis, splenic sequestration and stroke stand out. Currently, the drug for the treatment of AF is hydroxyurea (HU). The present study aimed to investigate the influence of treatment using HU on the appearance of clinical signs in patients with SCA in Reference Hospitals in Ceará. A cross-sectional, population-based study was carried out. Data for the study were obtained from the medical records of 89 patients, over 18 years old, assisted by the Center for Hematology and Hemotherapy of Ceará (HEMOCE) and Hospital Universitário Walter Cantídio (HUWC) in Fortaleza - Ceará, in order to obtain data sociodemographic data, occurrence and frequency of complications of sickle cell anemia, and laboratory test results. For statistical analysis, means were compared using Student's t test and the frequencies of categorical variables were compared using the chi-square test. For these analyses, p < 0.05 was considered. Of the patients treated, 55 (62%) were female and 34 (38%) were male. The overall mean age, including all participants, was 31.66 ± 10.73 years. The frequency of occurrence of complications in patients with sickle cell anemia was verified, which were: pain crisis (97.8%), pneumonia (61.8%), cholelithiasis (53.9%), heart disease (44.9% ), hepatomegaly (43.8%), dyspnea (40.4%), renal alterations (37.1%), acute chest syndrome (30.3%), limb ulcers (30.3%) and recurrent infections (28 ,1%). Of the patients monitored, 63 were undergoing treatment with the drug hydroxyurea. Regarding the association between the use of hydroxyurea and the prevalence of complications, there was a correlation between the use of HU and seizures, in which of the 9 (14.3%) patients being treated with this drug, all of them had seizures . The association of hematological data with the use of hydroxyurea showed differences between the following variables: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), leukocytes, neutrophils and serum iron. The result of these analyzes in patients who were using hydroxyurea showed a higher value in relation to the parameters VCM, HCM and serum iron and a lower value for leukocytes and neutrophils when compared to patients who were not undergoing treatment with the referred drug. It is concluded that hydroxyurea has numerous benefits, having a safe profile of short-term toxicity, and is currently the drug indicated for treatment in order to reduce complications. However, even in treatment, it can be seen that morestudies are needed to evaluate the long-term treatment and the relationship with the complications of sickle cell anemia.