Sickle Cell

Sickle cell disease (SCD) is a group of inherited blood disorders characterized by abnormal hemoglobin, the protein responsible for carrying oxygen in the red blood cells. The most common and severe form of SCD is sickle cell anemia. This article aims to provide an in-depth understanding of sickle cell disease, its causes, symptoms, and management strategies.

Causes and Genetics:

Sickle cell disease is caused by a mutation in the HBB gene responsible for producing hemoglobin. This mutation leads to the production of an abnormal form of hemoglobin called hemoglobin S (HbS). When red blood cells containing HbS release oxygen, abnormal hemoglobin can cause the cells to change into a sickle or crescent shape. These misshapen cells can become rigid and sticky, leading to various complications.

SCD is inherited in an autosomal recessive manner, meaning a person must inherit two copies of the mutated HBB gene, one from each parent, to develop the disease. If a person inherits one normal HBB gene and one mutated HBB gene, they will be a sickle cell trait (SCT) carrier. Carriers usually do not show symptoms of SCD, but they can pass the mutated gene to their offspring.

Symptoms:

Sickle cell disease can manifest a wide range of symptoms that may vary in severity from person to person. Some of the most common symptoms include:

1. Anemia: Due to the shortened lifespan of sickle-shaped red blood cells (10-20 days compared to 120 days for healthy cells), patients with SCD often experience chronic anemia, which can cause fatigue, pallor, and shortness of breath.
2. Pain crises: The abnormal red blood cells can obstruct blood vessels, leading to episodes of sudden, severe pain known as vaso-occlusive crises. Pain can occur in any part of the body but is most commonly experienced in the chest, abdomen, and joints.
3. Infections: SCD can impair the immune system, making patients more susceptible to infections, especially in the lungs, bones, and urinary tract. Pneumonia is a common and potentially life-threatening infection in people with SCD.
4. Swelling of hands and feet: Blocked blood vessels can cause painful swelling of the hands and feet, a condition known as dactylitis, which is often one of the first symptoms of SCD in infants.
5. Acute chest syndrome: This life-threatening complication occurs when sickle cells block the blood vessels in the lungs, causing chest pain, fever, and difficulty breathing.
6. Stroke: SCD increases the risk of stroke due to sickle-shaped red blood cells obstructing blood vessels in the brain.
7. Vision problems: Sickle cells can block blood vessels in the eyes, leading to vision problems and, in severe cases, retinal detachment and blindness.

Diagnosis:

Sickle cell disease is usually diagnosed through blood tests that check for abnormal hemoglobin. In many countries, newborn screening programs are in place to identify SCD in infants; genetic counseling and prenatal testing options are available for carriers or couples at risk of having a child with SCD.

Sickle cell disease (SCD) can pose several challenges and complications for pregnant women, both the mother and the baby. The effects of SCD on pregnancy include:

1. Increased risk of maternal complications: Pregnant women with SCD have a higher risk of developing various health complications, such as preeclampsia (a condition characterized by high blood pressure and damage to organs like the liver and kidneys), gestational hypertension, and venous thromboembolism (blood clots). These complications can potentially harm the mother and the baby.
2. Pain crises: Pregnant women with SCD may experience more frequent and severe pain crises due to the increased oxygen demand during pregnancy. Proper pain management and close monitoring by healthcare providers are essential to ensure the well-being of the mother and the baby.
3. Anemia: Pregnancy can worsen the anemia commonly experienced by individuals with SCD, as the body requires more red blood cells to support the growing fetus. This increased demand can lead to a higher risk of fatigue, shortness of breath, and other anemia-related symptoms.
4. Infections: Pregnant women with SCD are more susceptible to infections due to the disease’s impact on the immune system. Infections can pose risks to both the mother and the baby, and it is essential to take preventive measures like vaccinations and proper prenatal care to minimize these risks.
5. Increased risk of fetal complications: Pregnant women with SCD have a higher risk of miscarriage, preterm birth, low birth weight, and intrauterine growth restriction (IUGR), which can result in long-term health issues for the baby. The baby may also inherit SCD or sickle cell trait, depending on the genetic makeup of both parents.
6. Placental complications: SCD can cause placental insufficiency or other complications that may affect the baby’s growth and development. The reduced blood flow and oxygen delivery can lead to complications such as stillbirth or other fetal complications.

In vitro fertilization (IVF) treatment, combined with preimplantation genetic testing (PGT), can be a valuable option for couples affected by sickle cell disease (SCD) who want to have children without passing on the disease to their offspring. Here’s how IVF and PGT can help SCD patients:

1. Genetic testing of embryos: PGT allows for the genetic screening of embryos created through IVF before they are implanted in the uterus. This process can identify embryos that carry the sickle cell mutation and select only healthy embryos without the mutation for transfer. As a result, couples with SCD or sickle cell trait can significantly reduce the risk of having a child with the disease.
2. Ensuring a healthy donor: If one partner has SCD and the other has sickle cell trait, the couple may use donor eggs or sperm from a donor without the sickle cell mutation. This approach reduces the child’s risk of inheriting SCD or sickle cell trait. IVF with donor gametes can be suitable for couples with a high chance of passing on the disease.
3. Compatibility with bone marrow transplant: In some cases, when a couple already has a child with SCD, they may choose to undergo IVF and PGT for their subsequent pregnancy to ensure that the new child is not only free from SCD but also a compatible bone marrow donor for their affected child. A bone marrow transplant from a healthy sibling can potentially cure SCD in the affected child.

IVF and PGT offer hope to couples affected by sickle cell disease by enabling them to have healthy children without the risk of passing on the condition. It is essential to consult with a fertility specialist and a genetic counselor to understand the available options and make informed decisions about pursuing IVF treatment to prevent sickle cell disease.