Elevated Homocysteine Levels and Disease Severity in Patients with Sickle Cell Anaemia: A Lagos cohort study (2014–2015) DOI: https://dx.doi.org/10.4314/ajhs.v38i1.10

Abstract

Background: Hyperhomocysteinemia has been linked to the pathogenesis and severity of several conditions. Recent studies suggest its potential role in the clinical course and severity of sickle cell anaemia (SCA). This study examines the possible relationship between elevated homocysteine levels and disease severity in Nigerian patients with sickle cell anaemia.

Methods: This was a descriptive cross-sectional study conducted among adult patients with SCA attending Lagos University Teaching Hospital. A total of 84 patients were recruited and categorised into three clinical groups: steady-state, vaso-occlusive crises (VOC) and hyperhemolytic crises (HHC). Each participant’s overall disease severity was assessed using a modified severity scoring system that incorporated both clinical and laboratory parameters. Data were collected using a structured study proforma. Serum homocysteine levels were measured using the enzyme-linked immunosorbent assay (ELISA) method. Statistical significance was set at p < 0.05.

Results: Participants' mean age was 24.9 (standard deviation 5.5) years. The mean serum homocysteine was higher among participants in HHC (13.1 ± 5.4 mol/L) than those in VOC (11.9 ± 4.5 mol/L) or
steady-state (10.3 ± 2.3 mol/L) (p = 0.073). About 20.0% of all participants had hyperhomocysteinemia.
There was a statistically significant association between hyperhomocysteinemia prevalence and disease severity scores (p = 0.046). None of the participants with mild disease had hyperhomocysteinemia, while 25.9% and 17.6% of participants with moderate and severe disease had hyperhomocysteinemia.

Conclusion: The findings of this study suggest that elevated homocysteine levels may have an unmeasured effect on disease severity in patients with SCA.

Recommendation: This phenomenon is worth further exploration in prospective studies, so homocysteine levels can be monitored and managed to prevent morbidity among patients with SCA.