Significance of Pain in Children with Sickle Cell Anaemia and Ischaemia-induced Cardiac Injury
Published: 2021-06-07
Page: 100-108
Issue: 2021 - Volume 4 [Issue 2]
Nlemadim, Anthony Chibueze *
Department of Paediatrics, University of Calabar Teaching Hospital (UCTH), P.M.B. 1278, Calabar, Cross-River State, Nigeria.
Okpara, Henry Chima
Department of Chemical Pathology, Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria.
Uzomba, Chigozie Ikechukwu
Department of Paediatrics, University of Calabar Teaching Hospital (UCTH), P.M.B. 1278, Calabar, Cross-River State, Nigeria.
Anah, Maxwell Udo
Department of Paediatrics, University of Calabar Teaching Hospital (UCTH), P.M.B. 1278, Calabar, Cross-River State, Nigeria.
Odey, Friday Akwagiobe
Department of Paediatrics, University of Calabar Teaching Hospital (UCTH), P.M.B. 1278, Calabar, Cross-River State, Nigeria.
Meremikwu, Martin Madu
Department of Paediatrics, University of Calabar Teaching Hospital (UCTH), P.M.B. 1278, Calabar, Cross-River State, Nigeria.
*Author to whom correspondence should be addressed.
Abstract
Aims: To determine the relationships between ischaemic cardiac injury (ICI) evidenced by ischaemic electrocardiogram (ECG) with raised cardiac troponin T (cTnT), pain intensity and frequency in children with sickle cell anaemia (SCA).
Study Design: Case-control.
Place and Duration of Study: Department of Paediatrics, University of Calabar Teaching Hospital over a 6-month period.
Methodology: Children with SCA aged 4 – 17 years with vaso-occlusive painful crises (VOC) were enrolled. Cases were those with ICI while controls were those without ICI. VOC was diagnosed by history and examination with Faces Pain Scale – Revised. Electrocardiography and cTnT estimation were done. Cut-off level (97.5th percentile) of cTnT was obtained from age and sex-matched healthy children with haemoglobin genotype-AA. Serum cTnT analysis was by electrochemiluminescence immunoassay. Ischaemic ECG assessment was according to World Heart Federation criteria.
Results: Fifty-six children with SCA participated among who 27(48.2%) were cases and 29(51.8%) controls. Ischaemic ECG (71.4%) and elevated cTnT (57.2%) were significantly related (P=.01). All cases had severe pain (P=.02) and accounted for >50% of those with chest pain (P=.25). Controls had more < 3 pain episodes per annum than cases while frequent VOC (≥3 pain episodes per annum) occurred more in the cases though the differences were not statistically significant.
Conclusion: Severe pain with frequent VOC is associated with ICI even in the absence of chest pain in children with SCA. Regular electrocardiography and cTnT measurement will identify at-risk children for adequate management.
Keywords: Pain, ischaemia, cardiac, troponin, injury