Sickle Cell Disease and Leg Ulcer

Chronic Leg Ulcers (CLU) are wounds on the legs of individuals with Sickle Cell Disease that do not heal up within the normal natural time frame. CLU is a defect below the level of the knee and above the foot. They are a major cause of morbidity (incapacitation) in patients with sickle cell disease but rarely causes death in these patients. Sickle Cell Disease has a wide spectrum of presentation, and the effect of genetic variations may modify leg ulcer severity. They usually need the input of extra medical efforts to heal up. The duration of healing may be as short as 3 months and may also take up to 5 yrs. The size of the wounds may also extend to over 300cm2 in area depending on the age of the wound. A major issue with this unhealing wounds is that after much efforts and pain to get them healed up, they break up again a few weeks or months after. SCHAF in 2015 came to the rescue of about 19 patients using a more modern method of leg ulcer treatment known as compression therapy.

 

Chronic Leg Ulcers in individuals with Sickle Cell Disease have been attributed majorly to venous incompetence (inability of blood in the veins to drain back properly), hence causing oedema that then bursts out as ulcers. Microbial infections may also help to delay healing. Compression Therapy makes use of a four-layer coban bandaging system to create the pressure needed for adequate blood and nutrient flow in the wound area in order to enhance healing. The eighteen patients that were treated consistently for 3 months using compression bandaging had remarkable improvement in the healing of the ulcers with complete healing in four of them. The patients were also put on antibiotics during the first month of the study, in order to control infections.  However, after the intervention stopped, most of the wounds had a set back and 3 out of the 4 healed ulcers had broken out again (recurrence).

 

Haematological parameters in these patients were studied in order to have a better understanding of underlying causes and proffer interventions for better management. We found that those with low haemoglobin and elevated white blood cells and platelet counts at steady state were at higher risks of developing leg ulcers. Improvement in these parameters was observed with healing of the ulcers. Therefore, monitoring of haematological parameters for improvement while controlling infections may help in better ulcer management. The continuous application of pressure by regular wearing of compression stockings may also help to prevent wound recurrence.

 

CLU limits education, subsequent employment potential and social life. Many patients with Sickle Cell Anemia having CLU drop out of School due to prolonged hospital stay.

 

 

References

1.      Ogunkeyede A.O., Babalola O.A., Ilesanmi O.S., Odetunde A.B., Aderibigbe R., Adebayo W., Falusi A.G. Chronic Leg Ulcers in Patients with Sickle Cell Anemia: Compression Therapy Experience in Nigeria. Nigerian Journal of Plastic Surgery 2017;13:50-55

 

2.    Babalola O.A., Ogunkeyede A.O., Odetunde A.B., Fasola F.A., Oni A.A., Babalola C. P. and Falusi A.G. Hematological parameters in patients with sickle cell disease and chronic leg ulcers. African Journal of  Laboratory Medicine 2020; 9(1), a1037.   https://doi.org/10.4102/ajlm.v9i1.1037