Prognostic
significance of plasma bilirubin in sickle cell
diseases
......................................................................................................................................................................
Mehmet
Rami Helvaci (1)
Atilla Yalcin (1)
Zeki Arslanoglu (2)
Mehmet Duru (3)
Abdulrazak Abyad (4)
Lesley Pocock (5)
(1) Specialist
of Internal Medicine, MD
(2) Specialist of Dentistry, Ph
(3) Specialist of Emergency Medicine, MD
(4) Middle-East Academy for Medicine of Aging,
MD
(5) medi+WORLD International
Corresponding author:
Prof Dr Mehmet Rami Helvaci
07400, ALANYA, Turkey
Phone: 00-90-506-4708759
Email: mramihelvaci@hotmail.com
Received September 2020. Accepted
October 2020. Published December 1, 2020.Please
cite this article as: Mehmet Rami Helvaci et al.
Prognostic significance of plasma bilirubin in
sickle cell diseases. Middle East J Intern Med
2020; 13(3): 7-13 DOI: 10.5742/MEJIM2020.93792
.....................................................................................................................................
ABSTRACT
Background:
Total bilirubin value of the plasma may have
prognostic significance in sickle cell diseases
(SCD).
Methods: All patients
with the SCD were included between March 2007
and June 2016.
Results: We studied 253
patients (128 females) with a plasma bilirubin
value of lower than 5.0 mg/dL and 109 patients
(43 females) with a value of 5.0 mg/dL and higher.
There were 31 deaths during the ten-year period
(14 females with a mean age of 33.3 and 17 males
with a mean age of 30.2 years, p>0.05). Although
the similar mean ages (30.2 versus 31.7 years,
p>0.05), male ratio (60.5% versus 49.4%, p<0.05),
ileus (3.9% versus 10.0%, p<0.01), digital
clubbing (6.3% versus 26.6%, p<0.001), leg
ulcers (12.2% versus 20.1%, p<0.05), pulmonary
hypertension (9.4% versus 23.8%, p<0.001),
cirrhosis (1.5% versus 15.5%, p<0.001), chronic
renal disease (CRD) (6.7% versus 12.8%, p<0.05),
and exitus (4.7% versus 11.9%, p<0.001) were
all higher in patients with the plasma bilirubin
value of 5.0 mg/dL and higher.
Conclusion: SCD are severe
inflammatory processes on vascular endothelium,
particularly at the capillary level and terminate
with accelerated atherosclerosis induced end-organ
failures in early years of life. Total bilirubin
value of the plasma may have prognostic significance
due to the higher prevalence of ileus, digital
clubbing, leg ulcers, pulmonary hypertension,
cirrhosis, CRD, and exitus in patients with the
plasma bilirubin value of 5.0 mg/dL and higher.
The higher bilirubin values may either show the
severity of hemolytic process initiated at birth
or an advanced hepatic involvement in such cases.
Key words: Sickle cell
diseases, plasma bilirubin, chronic endothelial
damage, accelerated atherosclerosis, end-organ
failure, metabolic syndrome, early aging
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