Environmental Factors of Climate, Air Quality and Altitude in Sickle Cell Pain Events: Defining the Paradigm




Rcih, Alisa
Njesada, Ndolembai


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Objective: The purpose of this present review is to give a general overview of research concerning the role of environmental factors on sickle cell disease and determine whether these factors are consistently associated with Sickle Cell Disease (SCD). Materials and Methods: Evidence suggests that the recurrent pain episodes experienced by SCD patients are associated with the polymerization of the deoxygenated hemoglobin (HbS), and this process is dependent on hypoxia, PH, temperature and the hydration of red blood cells which could be influenced by environmental factors. Sickle cell disease (SCD), a hereditary red blood disorder, is a global health problem, and more than 100,000 babies are born with it annually. There are more than 300 million carriers of the sickle cell trait worldwide. In the USA, the average lifetime cost of sickle cell disease per patient is $460,151with higher mortality rates among adults. There were 96 articles identified from the online databases (PubMed, Google Scholar, Medline (National Library of Science), Web of Science, Scopus and Science Direct) based on the following words: “Environment”, “sickle cell disease”, “environmental factors”, “environmental determinants”, “risk factors”, “sickle cell anemia”, “air quality”, “climate”, “altitude”, “infection”, “housing”, and “socioeconomic status”. 38 studies met the inclusion criteria of peer reviewed, conducted among human subjects and written in English. Most of the studies were associated with the impact of environmental factors on SCD crises. Results: Climate has been strongly implicated as a trigger for pain crises in sickle cell. 3 studies linked wind speed to pain crises. 2 Studies associated low temperature with SCD crises while 12 other studies linked high temperature to the same crises. Additionally, 3 studies found no relationship between pain and high temperature. 5 studies associated pressures to pain (4 at high pressure and 1 at low pressure). 3 studies associated humidity to pain (1 high, 1 low humidity) and 3 others found no association. For rain, 3 found associations while 3 others found no association. Conclusions: The following conclusion can be drawn: although some results are contradictory, climate determines the complication rates among SCD patients, and there is need for further research to establish a causal relationship.