The Impact of Fetal Hemoglobin Levels on Some Inflammatory Markers in Steady State Sickle Cell Anemia Patients

Background

Sickle cell anemia (SCA) is a multifaceted disease characterized by both acute and chronic inflammation. Even in the steady state; inflammatory oxidative stress gradually destroys tissues. Studies have shown that a higher fetal hemoglobin is associated with mild disease but there is no evidence of an association between inflammatory markers and HbF levels in our environment. The purpose of this study was to determine fetal hemoglobin levels and the plasma levels of some inflammatory markers in adult sickle cell anemia patients in steady state and to correlate these inflammatory markers with the fetal hemoglobin level.

Methods

This was a cross-sectional comparative study involving sickle cell anemia patients in steady state and apparently healthy hemoglobin AA individuals. Blood samples were collected and analysed for complete blood count using hematology autoanalyser. Interleukin 17 (IL-17), interferon-gamma (IFN-γ), monocyte chemoattractant protein-1 (MCP-1) and C-reactive protein (CRP) were analysed using enzyme linked immunosorbent assay methods. Fetal hemoglobin (HbF) level was quantified using high performance liquid chromatography. Statistical analysis was done with SPSS software, version 25.

Results

One hundred participants comprising 50 adults with sickle cell anemia and 50 healthy controls (HbAA) adults, with age range 18-59 years, were studied.Platelets and white blood cell count were significantly higher while hematocrit was lower in SCA compared to the control population. HbF levels in SCA ranged from 2% to 21%. IL-17, IFN-γ, MCP-1 and CRP, were all significantly higher in patients with SCA compared to HbAA controls. There was a significant negative correlation between HbF and MCP-1 while the correlation of HbF with CRP, IL-17 and IFN-γ were not significant.There was a statistically significant negative correlation between HbF level and platelet count.

Conclusion

Patients with sickle cell anemia in steady state have higher levels of interleukin 17, interferon-gamma, monocyte chemoattractant protein-1 and C-reactive protein compared to HbAA individuals. Fetal hemoglobin has a significant negative relationship with monocyte chemoattractant protein-1 and platelet count in sickle cell anemia.

No relevant conflicts of interest to declare.