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Risk of avascular necrosis of the femoral head in children with sickle cell disease on hydroxyurea: MRI evaluation
Author(s) -
Adekile Adekunle D.,
Gupta Renu,
AlKhayat Abdullah,
Mohammed Ahmed,
Atyani Said,
Thomas Diana
Publication year - 2019
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.27503
Subject(s) - medicine , avascular necrosis , femoral head , magnetic resonance imaging , thalassemia , prospective cohort study , cohort , disease , sickle cell anemia , hemoglobinopathy , surgery , pediatrics , radiology
Background There are conflicting reports on the role of hydroxyurea (HU) in the pathogenesis of avascular necrosis of the femoral head (AVNFH) in patients with sickle cell disease (SCD). Procedure The present study is a prospective cohort study of Kuwaiti children with SCD who were treated with HU. They had magnetic resonance imaging of the hips before starting HU and at regular intervals during a follow‐up period, ranging from 1 to 15 years. Results There were 40 patients (18 SS, 19 Sβ0‐thalassemia, and three SD genotypes), aged 6–20 years. Pre‐HU, 11 (27.5%) had varying grades of AVNFH, while post HU, the prevalence was 32.5%. Two patients developed new lesions during the study, while five (45.5%) that had lesions pre‐HU remained static, another five (45.5%) progressed, and one (9%) improved radiologically. The older patients who had been on HU the longest were more likely to deteriorate. The only hematological parameter that was consistently associated with AVNFH was the reticulocyte count. Conclusions The frequency and rate of progression of AVNFH in this study is much less than that previously reported for our patients not treated with HU. There is no evidence that HU therapy is a risk factor for AVNFH. It may, in fact, prevent new lesions and deter the progression of existing AVNFH.