SICKLE CELL : DIAGNOSIS, TREATMENT, PREVENTION AND CONTROL
DIAGNOSIS (LABORATORY DIAGNOSIS)
Sickle cell trait individual has no physical findings that can be attributed to sickle cell trait. The diagnosis of sickle cell trait is established by an electrophoresis, Isoelectric focusing or high performance liquid chromatography (HPLC) result that shows HbAS with about 55% HbA and 45% of Haemoglobins. Haemoglobin, reticulocyte count, and all laboratory tests are normal with sickle cell trait.
People who are known carriers of the disease often undergo genetic counseling before they have a child, A test to see if an unborn child has the disease takes either a blood sample from a foetus has greater risks, the later test is usually used.
SICKLE CELL TREATMENT
SICKLE CELL TREATMENT requires a complete evaluation to exclude other causes of hematuria including cystitis, bladder and renal tumors. Urine culture is always indicated. There is some evidence that medullary carcinoma of the kidney is more common in individuals with HbAS.
Initial treatment includes bed rest, vigorous oral hydration, administration of sodium bicarbonate to alkalinize the urine and diuretics and potassium if required. Individuals with persistent are admitted for strict bed rest and intravenous hydration with alkaline diuresis.
Urologic intervention may be beneficial however, nephrectomy to control bleeding is almost never indicated because of the high probability of recurrence in the contralateral kidney (Sheikha, 2005).
PREVENTION AND CONTROL
All individuals participating in sports, whether or not they have sickle cell trait should have adequate hydration before during and after exertion in hot condition and also by avoidance of excessive fluid loss in grade exercise.
Individuals with hematuria should actively hydrate themselves before and after physical exertion. Individuals who have frequent, severe or persistent hematuria may need to avoid activities that regularly cause episodes. Hydration and bed rest may abort episodes if done immediately. (Baldree, et al, 2009).
- Educate the carrier about the nature of sickle cell trait.
- Provide counseling of the risk of having children with sickle cell Hb disorders.
- Patients with hematuria should be monitor their fluid intake and output carefully, if fluid or sodium retention develops the doctor should order diuretics.
- Tell carriers to use caution during very strenuous exercise in hot weather or at high altitude.
Malaria and sickle cell are still major challenges to infections disease medicine and to hematology respectively and both are also major public health problems. One might have hoped that what we have learnt about the advantage of AS heterozygotes with respect to malaria would enable us to protect from malaria mortality.
Malaria resistance by the sickle cell trait (genotype HbAS) has served as the prime example of genetic selection for ever half a century. Nevertheless, the mechanism of this resistance remains the subject of considerable debate. While it probably involves innate factors such as the reduced ability of plasmodium falciparum parasites to grow and multiply in HbAS erythrocytes recent observations suggest that it might also involve the accelerated acquisition of malaria-specific immunity. Malaria protection by HbAS involves the enhancement of not only innate but also of acquired immunity to the parasite.