PMID- 25705804
OWN - NLM
STAT- MEDLINE
DCOM- 20161012
LR  - 20220316
IS  - 1539-2570 (Electronic)
IS  - 0271-6798 (Print)
IS  - 0271-6798 (Linking)
VI  - 36
IP  - 2
DP  - 2016 Mar
TI  - Hemoglobin to Hematocrit Ratio: The Strongest Predictor of Femoral Head 
      Osteonecrosis in Children With Sickle Cell Disease.
PG  - 139-44
LID - 10.1097/BPO.0000000000000409 [doi]
AB  - BACKGROUND: Femoral head osteonecrosis (ON) secondary to sickle cell disease 
      (SCD) often progresses to femoral head collapse, requiring total hip 
      arthroplasty. However, this treatment has a limited durability and patients with 
      SCD have higher rates of complications, requiring multiple revision operations. 
      Identifying risk factors linked to ON in SCD can facilitate earlier precollapse 
      diagnosis and surgical treatment aimed at preservation of the native hip joint. 
      METHODS: Fifty-nine children treated at our institution between January 2001 and 
      April 2012 with SCD and ON, as diagnosed by magnetic resonance imaging or 
      radiographic imaging, were compared with age-matched and sickle cell 
      phenotype-matched (SS, SC, Sbeta, Sbeta) controls with no evidence of ON. Two sided 
      t-tests assuming unequal variances determined statistically risk factors and 
      threshold values were assigned to calculate odds ratios. RESULTS: Systolic blood 
      pressure (P=1.2x10, OR=3.68), diastolic blood pressure (P=0.0084, OR=1.41), 
      weight in the SCD-SS population (P=0.04, OR=1.85), and hemoglobin (Hb) in the 
      SCD-SS population (P=0.036, OR=2.56) were elevated in cases. Curiously, dividing 
      the Hb by the hematocrit to serve as a clinical proxy for the mean corpuscular Hb 
      concentration (MCHC) produced an excellent predictor of ON (P=2.06x10, OR=5.17), 
      which was especially pronounced in the SCD-SS subpopulation (P=2.28x10, OR=8.65). 
      Among children with SCD, the overall prevalence of ON was 9% (59/658) and the 
      phenotype with the highest prevalence of ON was Sbeta thalassemia with an ON 
      prevalence of 11.1%. There was no observed correlation between ON and height, 
      body mass index, cholesterol, mean corpuscular volume, hematocrit, or 
      glucocorticoid use. CONCLUSIONS: These data support a novel clinical marker, the 
      MCHC proxy, as the strongest predictor of ON in children with SCD. High-risk 
      children should receive hip magnetic resonance imaging to diagnose early ON and 
      facilitate interventions focused on hip preservation, forestalling, or possibly 
      preventing, the need for total hip arthroplasty.
FAU - Worrall, Douglas
AU  - Worrall D
AD  - The Children's Hospital of Philadelphia, Philadelphia, PA.
FAU - Smith-Whitley, Kim
AU  - Smith-Whitley K
FAU - Wells, Lawrence
AU  - Wells L
LA  - eng
GR  - T35 DK060441/DK/NIDDK NIH HHS/United States
GR  - 5T35-DK060441/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PL  - United States
TA  - J Pediatr Orthop
JT  - Journal of pediatric orthopedics
JID - 8109053
RN  - 0 (Hemoglobins)
SB  - IM
MH  - Adolescent
MH  - Anemia, Sickle Cell/*complications
MH  - Blood Pressure
MH  - Case-Control Studies
MH  - Child
MH  - Child, Preschool
MH  - Female
MH  - Femur Head Necrosis/*etiology
MH  - *Hematocrit
MH  - Hemoglobins/*analysis
MH  - Humans
MH  - Male
MH  - Phenotype
MH  - Retrospective Studies
MH  - Risk Factors
PMC - PMC4545485
MID - NIHMS653281
EDAT- 2015/02/24 06:00
MHDA- 2016/10/13 06:00
PMCR- 2017/03/01
CRDT- 2015/02/24 06:00
PHST- 2017/03/01 00:00 [pmc-release]
PHST- 2015/02/24 06:00 [entrez]
PHST- 2015/02/24 06:00 [pubmed]
PHST- 2016/10/13 06:00 [medline]
AID - 10.1097/BPO.0000000000000409 [doi]
PST - ppublish
SO  - J Pediatr Orthop. 2016 Mar;36(2):139-44. doi: 10.1097/BPO.0000000000000409.