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3998
CORRESPONDENCE
Oxygen Inhalation in Nonhypoxic Sickle Cell Patients During Vaso-Occlusive Crisis
To the Editor:
tions of oxygen suppress erythropoietin and erythropoiesis in patients
with sickle cell disease.' Yet oxygen inhalation improves rheologic
properties of bloodand diminishes reversible sickling invitro.'
Erythropoietin is unique in that serum levels reflect directly its production rate.'
We conducted a prospective randomized trial in which erythropoietin, reticulocytosis, and hemoglobin levels were determined in eight
nonhypoxic (initially determined by arterial blood gas measurement
and followed by pulse oxymetry) sickle cell patients during vasoocclusive crisis. Patients were divided into two groups: one group
(4 patients) breathing oxygen at 2 Wminbynasal prongs for 12
hours and the other group (4 patients) breathing room air. Patients
with renal, liver, or chronic lung disease were excluded.
In the oxygen group, erythropoietin levels and erythropoiesis,
reflected by reticulocytosis and hemoglobin levels, were comparable
to those in the roomair group (Fig l ) . The increase in erythropoietin
levels observed in two patients was preceded by a decrease in hemoglobin concentration, but not inreticulocyte count, with the evolving
sickling and hemolysis. All patients had low erythropoietin levels
for their degree of anemia.4Neither hospital stay nor duration of the
crises was shortened inthe group receiving oxygen. The limited
number of appropriate patients, the amplitude, andthe individual
variation of erythropoietin in response to hemolysis, combined with
the duration of the vaso-occlusive crisis, were the principal limiting
factors.
We conclude that inhalation of oxygen at low concentrations for
a limited period of time does not affect erythropoietin production
and erythropoiesis in nonhypoxic sickle cell patients during vasoocclusive crises; however, the benefitsof oxygen therapy in the
management of these patients still remain to be defined.
The role of oxygen in managing nonhypoxic sickle cell patients
during vaso-occlusive crises remains controversial. High concentra-
t
I
Hanna Khoury
Edwin Grimsley
Memorial Medical Center
Savannah, GA
REFERENCES
54
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a
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24
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Fig 1. Measurements of erythropoietin, reticulocyte count, and
hemoglobin levels in patients who were breathing oxygen IO) or
room air (01.At each point, the median value and the maximal and
minimal values (vertical lines) are shown. Differences were not significant at any point before, during, or after the administration of
oxygen.
1. Embury SH, Garcia JF, Mohandas N, Pennathur-Das R, Clark
MR: Effects of oxygen inhalation on endogenous erythropoietin kinetics, erythropoiesis, and properties ofblood cells in sickle-cell
anemia. N Engl J Med 31:291, 1984
2. Zipursky A, Robieux IC, Brown ET, Shaw D, O'Bradovich H,
Kellner JD, Coppes MJ, Koren G, Olivieri NF: Oxygen therapy in
sickle cell disease. Am J Pediatr Hematol Oncol 14:222, 1992
3. Ratcliffe PJ: Molecular biology of erythropoietin (clinical conference). Kidney Int 442387, 1993
4. Sherwood JB, Goldwasser E, Chilcote R, Carmichael LD,
Nagel RL: Sickle cell anemia patients have low erythropoietin levels
for their degree of anemia. Blood 67:46, 1986
From www.bloodjournal.org by guest on June 16, 2017. For personal use only.
1995 86: 3998
Oxygen inhalation in nonhypoxic sickle cell patients during vasoocclusive crisis [letter]
H Khoury and E Grimsley
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