for fighting life-altering disease.
sickle cell disease
SCD is much more than pain.
Sickle cell disease (SCD) is a serious genetic disease. The condition is present throughout a person’s entire life and gets progressively worse over time. While most people associate SCD with frequent episodes of excruciating pain, people living with this disease also face an increased risk of stroke, severe infections, progressive organ damage and sadly, even death at a young age.
In SCD, pain onset can be sudden and unpredictable, often requiring hospitalization. It can be triggered by stress, illness, dehydration, temperature changes, wind speed, altitude, and barometric pressure, but often there is no detected factor. The symptoms of SCD often begin in childhood, with many children suffering from significant events, such as stroke and acute chest syndrome, in addition to pain crises. As many as 70% of children with SCD who experience a first stroke will experience stroke recurrence, necessitating chronic monthly red blood cell transfusions to prevent future occurrences. Even children who are pain free between crises can experience disease progression.
The cumulative effect of progressive organ damage becomes apparent in adulthood, and approximately 50% to 60% of adults (median age of approximately 30) with SCD have end-organ disease due to chronic complications, with 24% experiencing damage in multiple organs.
Over time, SCD can lead to infections, delayed growth and unpredictable episodes of vaso-occlusive events (VOEs) such as acute pain, priapism, acute chest syndrome (a condition characterized by chest pain, cough, fever, low oxygen level and breathing problems), stroke and organ failure that can lead to sudden death. Tragically, one in four people living with sickle cell disease experience a stroke by age 45.
People living with SCD have a genetic mutation which impacts their red blood cells.
Typically, red blood cells (RBCs) are flexible and round allowing them to move easily through blood vessels. SCD is caused by a single mutation in the β-globin (HBB) gene which results in the production of abnormal sickle hemoglobin (HbS). HbS causes RBCs to become fragile, rigid, and crescent—or sickle—shaped, which makes movement through blood vessels difficult, painful, and damaging to the body.
This can result in severe anemia, blockage of blood vessels and progressive damage to the blood vessel walls (called vasculopathy).
Patients with SCD can feel invisible.
Many people living with SCD often feel unseen, misunderstood and mistreated because many of their symptoms are on the inside.
It has been shown that the stigma associated with SCD can lead to sufferers not actively seeking medical care or to the undermanagement of symptoms. There may be some reluctance to seek medical treatment because of suspicions of drug dependence arising from the chronic, frequent, and severe pain episodes that require use of stronger analgesics and/or opioids.
HCPs with experience in SCD can help improve the management of symptoms and navigate the racial and social inequalities of the disease. However, there is unfortunately a lack of specialists available to patients.
Widespread education and an understanding of the physical and social impacts of sickle cell can help improve patient experiences.
Change for SCD is long overdue.
Despite recent investment and innovations, the life expectancy of people living with SCD is too short. In the U.S., the median age of death for people with sickle cell disease is 43-46 years.
The current standard of care and management of SCD relies on the lifelong use of acute and chronic therapies that do not address the underlying cause of disease. The only curative option, allogeneic hematopoietic stem cell transplantation (allo-HSCT), is limited to younger patients with a matched sibling donor.
The current treatments include:
- Prescriptions: They aim to lessen the frequency and severity of pain crises, improve hemoglobin levels and reduce blood transfusions and hospitalizations.
- Blood transfusions: For some patients, transfusions can help relieve symptoms and potentially prevent stroke and other complications. The risks can include an immune response to the donated blood, infection, and excess iron build up in the body.
- HSCT (hematopoietic stem cell transplant): More commonly known as a “bone marrow transplant,” it is currently the only treatment that can lead to a cure. However, HSCTs are usually limited to people under the age of 18 who have a matched sibling donor available.
Despite these therapies, most patients continue to experience clinical symptoms, progressive organ damage, and other substantial morbidities, which contribute to decreased quality of life, sociopsychological challenges, and early mortality.
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