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    Preoperative management of sickle cell patients with hydroxyurea
    (Medi+World Int, 2015) Helvaci, Mehmet Rami; Hakimoglu, Sedat; Sariosmanoglu, Mehmet Oktay; Kardas, Suleyman; Bahar, Beray; Filoglu, Merve; Deler, Ibrahim Ugur
    Background: We tried to understand whether or not there are some beneficial changes of health parameters with hydroxyurea in sickle cell diseases (SCDs) cases. Methods: All SCDs cases were enrolled, and a hydroxyurea therapy was initiated. Results: We studied 337 patients, totally. Hydroxyurea was well-tolerated with a majority of patients (80.1%). Mean number (10.3 versus 1.7 crises per year, p<0.000) and mean severity of painful crises decreased, significantly (7.8 versus 2.2, p<0.001). Although body weight and mean hematocrit (Hct) value increased, white blood cell (WBC) and platelet (PLT) counts and total and direct bilirubin and lactate dehydrogenase (LDH) levels decreased, significantly (p<0.000 for all). On the other hand, there were avascular necrosis of bones in 18.9%, leg ulcers in 12.7%, pulmonary hypertension in 11.5%, chronic renal disease in 8.3%, coronary heart disease in 7.7%, digital clubbing in 6.5%, stroke in 6.5%, exitus in 5.3%, chronic obstructive pulmonary disease in 4.7%, and cirrhosis in 3.2% of the patients. Conclusion: SCDs are chronic inflammatory disorders initiating at birth. Hydroxyurea decreases frequency and severity of painful crises, WBC and PLT counts, and total and direct bilirubin and LDH levels, and it increases body weight and Hct value, all of which indicate a decreased inflammatory process in patients. Thus elective surgical procedures should be performed after a few months of treatment with hydroxyurea in non-users. By this way, beside decreased requirement of blood transfusions, perioperative morbidity and mortality will also be lowered due to decreased inflammatory process on capillary endothelium all over the body.