Adjei George O, Sulley Abdul M, Goka Bamenla Q, Enweronu-Laryea Christabel, Amponsah Seth K, Alifrangis Michael, Kurtzhals Jorgen A L
Centre for Tropical Clinical Pharmacology and Therapeutics, University of Ghana Medical School, Accra, Ghana.
Department of Child Health, University of Ghana Medical School, Accra, Ghana.
J Blood Med. 2020 Nov 3;11:421-427. doi: 10.2147/JBM.S275150. eCollection 2020.
Individuals with sickle cell disease (SCD) are susceptible to infective conditions that predispose them to hemolysis and anemia. Folic acid is recommended as a preventative measure against anemia in SCD patients; however, there is scarce literature on the implications of this practice.
Plasma concentrations of folate were measured in acutely ill pediatric SCD patients presenting with malaria or bacteremia and compared with those of SCD patients in steady state, or acutely ill non-SCD patients with confirmed malaria.
The proportion of individuals with high (>45.3 nmol/L) folate concentrations was 29.5% (13/44), 18.2% (8/44), 33.3% (6/18), and 0% in the SCD-malaria, SCD steady state, SCD bacteremia, and the non-SCD malaria groups, respectively. The proportion of SCD patients with high folate levels did not vary significantly at steady state and during confirmed malaria ( = 0.216), and during acute bacteremia ( = 0.20). The median (interquartile range) plasma folate levels were 34.50 (24.40-52.00 nmol/L), 33.40 (15.83-60.85 nmol/L), 30.85 (24.68-39.65 nmol/L), and 13.30 (10.03-17.18 nmol/L), respectively, in the SCD malaria, SCD bacteremia, SCD steady state, and the non-SCD malaria sub-groups. The median folate levels of SCD steady state, SCD malaria, and SCD bacteremia sub-groups differed significantly ( < 0.0001) when compared with non-SCD patients, but the levels in the SCD bacteremia and malaria groups were not significantly different from the SCD steady state group.
Elevated levels of plasma folate were found in a high proportion of pediatric SCD patients. The implications of such elevated folate levels in pediatric SCD patients are unknown but may suggest a need for review of current recommendations for prophylactic doses of folic acid in SCD patients.
镰状细胞病（SCD）患者易受感染性疾病影响，这些疾病使他们易发生溶血和贫血。叶酸被推荐作为预防SCD患者贫血的措施；然而，关于这种做法的影响的文献很少。
对患有疟疾或菌血症的急性病儿科SCD患者的血浆叶酸浓度进行测量，并与处于稳定状态的SCD患者或确诊为疟疾的急性病非SCD患者的血浆叶酸浓度进行比较。
SCD-疟疾组、SCD稳定状态组、SCD菌血症组和非SCD疟疾组中叶酸浓度高（>45.3 nmol/L）的个体比例分别为29.5%（13/44）、18.2%（8/44）、33.3%（6/18）和0%。SCD患者叶酸水平高的比例在稳定状态和确诊疟疾期间（P = 0.216）以及急性菌血症期间（P = 0.20）没有显著差异。SCD疟疾组、SCD菌血症组、SCD稳定状态组和非SCD疟疾亚组的血浆叶酸水平中位数（四分位间距）分别为34.50（24.40 - 52.00 nmol/L）、30.85（24.68 - 39.65 nmol/L）、33.40（15.83 - 60.85 nmol/L）和13.30（10.03 - 17.18 nmol/L）。与非SCD患者相比，SCD稳定状态组、SCD疟疾组和SCD菌血症亚组的叶酸水平中位数有显著差异（P < 0.0001），但SCD菌血症组和疟疾组的水平与SCD稳定状态组没有显著差异。
在很大比例的儿科SCD患者中发现血浆叶酸水平升高。儿科SCD患者中这种升高的叶酸水平的影响尚不清楚，但可能表明需要重新审视目前关于SCD患者叶酸预防剂量的建议。
