People with sickle cell disease who have a history of severe pain episodes and coexisting organ conditions have an increased risk for severe COVID-19 illness, a new study suggests.
"This study tells us that all individuals with sickle cell disease are not at equal levels of risk," said study author Dr. Lana Mucalo, of the Medical College of Wisconsin. "Patients with a history of pain, as well as individuals with coexisting organ conditions, need to be even more careful to avoid COVID-19 infection than those without any co-morbidities."
"This means individuals with sickle cell disease who come to the hospital presenting with pain should also be tested for COVID-19," Mucalo said.
Sickle cell disease is the most common inherited red blood cell disorder in the United States. It affects about 100,000 people, most of them Black or Hispanic. The disease can cause severe pain, joint and organ damage and stroke.
Previous research has shown sickle cell patients with COVID-19 are at greater risk for hospitalization compared with Black individuals without the disease who are infected with COVID.
The new study draws data from SECURE-SCD, an international registry that collects information about COVID infections in people with sickle cell disease.
Researchers assessed reports on 750 children and adults submitted to the registry between March 2020 and March 2021. About half were children. Adults had a median age of 31.
A history of pain events was found to be a risk factor for hospitalization. Kids who had previously experienced more than two pain events requiring acute care were more than twice as likely to be hospitalized for COVID-19. They were more than three times likely to have severe COVID illness.
Adults with more than two prior acute care visits for pain were about two times more likely to be hospitalized with COVID-19 and to have severe COVID-19 illness.
Heart, lung or kidney conditions related to sickle cell in children were associated with a higher risk of severe illness. Heart and lung conditions in children were also associated with a higher risk of hospitalization.
These conditions did not have the same effect in adults, according to the study. The findings were published July 1 in the journal Blood Advances.
About half of the patients studied were taking the medication hydroxyurea. In adults, this was associated with lower risk of presenting with pain during COVID-19. But it did not affect whether an individual would develop a serious case of COVID-19 or need to be hospitalized in children or adults.
"Early in the COVID-19 pandemic, physicians were worried about whether to use hydroxyurea simply because we did not yet know the effects," Mucalo said in a journal news release. "Now we can see that while it does not affect COVID-19 severity, it does help to lower the incidence of pain episodes in adults with sickle cell disease, so those who are using it for treatment of their sickle cell conditions should not stop using it."
The U.S. Centers for Disease Control and Prevention has more about sickle cell disease.
SOURCE: American Society of Hematology, news release, July 1, 2021