Hemoglobin Desaturation in Sickle Cell Disease
キーワード
概要
説明
In SCD, exertional hypoxia and nocturnal hemoglobin desaturation (NHD, or hemoglobin deoxygenation during sleep) are common, treatable, and associated with bad outcomes in children and young adults15,16. The median life-expectancy of SCD has risen dramatically in the last 40 years. One consequence of this is an expanding young adult population in whom the comorbidities are not yet fully characterized. The prevalence, clinical consequences, and treatment outcomes of exertional hypoxia and NHD are poorly described in adults with SCD. Therefore, it is important to identify and better understand any clinically significant hypoxia (during exercise or sleep or at rest) in this expanding adult population. The investigators will study whether RBC adhesion at baseline and when exposed to hypoxia in vitro is significantly increased in adult HbSS patients with baseline hypoxia, exertional hypoxia or nocturnal NHD due to RBC membrane changes arising from prolonged in vivo exposure to hypoxia, which may be mitigated by oxygen therapy.
Hypotheses: The investigators hypothesize that disease activity and RBC adhesion (under normoxia) will be greater in subjects with HbSS plus baseline in vivo hypoxia, exertional hypoxia, or NHD, due to RBC membrane damage from prolonged hypoxia in vivo. Successful treatment with therapeutic oxygen, at baseline, with exertion, or during sleep, may decrease RBC adhesion in vitro.
Specific Aim 1: To evaluate for resting hypoxia, exertional hypoxia or NHD, and its clinical associations, in adults with HbSS.
Specific Aim 2: To examine baseline RBC adhesion under normoxia or hypoxia in vitro in adults with HbSS, with and without in vivo resting or exertional hypoxia or NHD.
Specific Aim 3: To examine serial changes in S-RBC adhesion at baseline and with hypoxia in vitro, in adults with HbSS and resting or exertional hypoxia or NHD, before and after therapeutic intervention with oxygen.
The investigators are testing whether:
1. Subjects with Hb desaturation at baseline, with exertion, or during sleep (NHD), compared to those without, will have increased disease activity (exertional or nocturnal symptoms, priapism, WBC activation, reticulocytosis, and/or hemolysis).
2. S-RBCs from subjects with clinical Hb desaturation at rest, with exertion, or during sleep, compared to those without, will have increased adhesion at baseline and when exposed to hypoxia in vitro.
2.A. Treatment of baseline hypoxia, exertional hypoxia, and/or NHD with supplemental oxygen will decrease S-RBC adhesion and HEA, and may decrease symptoms, especially night- time symptoms.
日付
| 最終確認済み: | 03/31/2019 |
| 最初に提出された: | 03/20/2019 |
| 提出された推定登録数: | 04/04/2019 |
| 最初の投稿: | 04/08/2019 |
| 最終更新が送信されました: | 04/04/2019 |
| 最終更新日: | 04/08/2019 |
| 実際の研究開始日: | 03/22/2018 |
| 一次完了予定日: | 11/30/2021 |
| 研究完了予定日: | 11/30/2022 |
状態または病気
段階
適格基準
| 研究の対象となる年齢 | 18 Years に 18 Years |
| 研究に適格な性別 | All |
| サンプリング方法 | Non-Probability Sample |
| 健康なボランティアを受け入れる | はい |
| 基準 | Inclusion Criteria: 1. Male or Female > 18 year of age at the time of consent. 2. Documentation of Sickle Cell Disease, phenotypically HbSS (including S-Beta 0 thalassemia) 3. Written informed consent (and assent when applicable) obtained from subject or subject's legal representative and ability for subject to comply with the requirements of the study. 4. English speaking patient Exclusion Criteria: 1. Ongoing Oxygen therapy. 2. active pregnancy, due to complex pathophysiology during that interval. 3. Presence of a condition or abnormality that in the opinion of the Investigator would compromise the safety of the patient or the quality of the data. - |
結果
主な結果の測定
1. Evaluation for resting hypoxia [Through study completion, up to approximately 4 years]
2. Evaluation for exertional hypoxia [Through study completion, up to approximately 4 years]
3. Evaluation of hypoxia and its effect on CBC [Through study completion, up to approximately 4 years]
4. Evaluation of hypoxia and its effect on reticulocyte count [Through study completion, up to approximately 4 years]
5. Evaluation of hypoxia and its effect on LDH [Through study completion, up to approximately 4 years]
6. Evaluation of hypoxia and its effect on serum chemistry [Through study completion, up to approximately 4 years]
7. Evaluation of patient's incidence of hypoxia-related symptoms [Through study completion, up to approximately 4 years]
8. Evaluation of hypoxia and its effect on echocardiogram results [Through study completion, up to approximately 4 years]
9. Evaluation of patient's incidence of hypoxia-related nocturnal symptoms [Through study completion, up to approximately 4 years]
10. Examination of amount of baseline RBC adhesion and HEA in vitro in adults with HbSS [Through study completion, up to approximately 4 years]
11. Examination of baseline FACS results in adults with HbSS [Through study completion, up to approximately 4 years]
12. Examination of amount of baseline RBC adhesion and HEA in vitro in adults with HbSS [Through study completion, up to approximately 4 years]
13. Examination of serial changes in incidence of nocturnal symptoms at baseline and with hypoxia, in adults with HbSS and resting or exertional hypoxia or NHD, before and after therapeutic intervention with oxygen. [2 months]
14. Examination of serial changes in amount of S-RBC adhesion at baseline and with hypoxia in vitro, in adults with HbSS and resting or exertional hypoxia or NHD, before and after therapeutic intervention with oxygen [2 months]
15. Examination of serial changes in incidence of hypoxia-related symptoms at baseline and with hypoxia, in adults with HbSS and resting or exertional hypoxia or NHD, before and after therapeutic intervention with oxygen. [2 months]
16. Examination of serial changes in Hb saturation at baseline and with hypoxia in vitro, in adults with HbSS and resting or exertional hypoxia or NHD, before and after therapeutic intervention with oxygen [2 months]
17. Examination of serial changes in amount of S-RBC adhesion at baseline and with hypoxia in vitro, in adults with HbSS and resting or exertional hypoxia or NHD, before and after therapeutic intervention with oxygen. [2 months]
18. Examination of serial changes in amount of WBC activation at baseline and with hypoxia in vitro, in adults with HbSS and resting or exertional hypoxia or NHD, before and after therapeutic intervention with oxygen [2 months]
19. Examination of serial changes in CBC at baseline and with hypoxia in vitro, in adults with HbSS and resting or exertional hypoxia or NHD, before and after therapeutic intervention with oxygen. [2 months]
20. Examination of serial changes in reticulocyte count at baseline and with hypoxia in vitro, in adults with HbSS and resting or exertional hypoxia or NHD, before and after therapeutic intervention with oxygen. [2 months]
21. Examination of serial changes in LDH at baseline and with hypoxia in vitro, in adults with HbSS and resting or exertional hypoxia or NHD, before and after therapeutic intervention with oxygen. [2 months]
22. Examination of serial changes in serum chemistry at baseline and with hypoxia in vitro, in adults with HbSS and resting or exertional hypoxia or NHD, before and after therapeutic intervention with oxygen. [2 months]
