Association of Hyponatremia, Hypochromia and Microcytosis in Sickle Cell Patients from Chhattisgarh: Possible Interplay Determining Less Severe Clinical Presentation.

Backgrounds and objectives:- Clinical presentation of sickle cell disease (SCD) in India shows reduced episode of crisis and severity unlike reported elsewhere. Sickle hemoglobin (HbS) polymerizes upon deoxygenation causing RBC dehydration and consequently increases corpuscular hemoglobin concentration which in turn accelerates more HbS polymerization precipitating episodes of crisis. Any factor affecting reduced haemoglobin synthesis or changes in low serum osmolality may affect disease outcome by altering cellular hemoglobin concentration. The aim of this study was to elucidate the peculiar disease presentation by evaluating hematological and blood electrolyte alterations in the SCD patients from Chhattisgarh, central India. Methods:- For the present study 100 SCD, 100 traits and 100 normal were selected from CG, India. Genotypes were determined by Hb variant HPLC. Hematological and biochemical test were performed using auto-analyzer. Results:- Mean MCV and MCHC in SCD group was significantly lowered compared to control and trait. Significant reduction of serum sodium and potassium level (125.6?3.4 and 3.2?0.86 mEq/l respectively) were observed in SCD group compared to control and trait (137.4?3.25, 4?0.37 and 134.0?5, 3.7?0.84mEq/l respectively), (p<0.001). Patients in stable and crisis state do not show any significant difference in serum sodium and potassium level. Interpretation and Conclusion:- Hyponatremia in the SCD study group might rehydrate RBC and could be an additional contributing factor along with increase HbF response and co-existing microcytic anaemia for fewer vaso-occlusive episodes in this geographical region. Mechanism and significance of simultaneous Hyponatremia and hypokalaemia as well hypochromic microcytic anaemia, the unusual finding in the SCD study population, need to be elucidate further in future study.