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Sickle cell Vitamin D deficiency corrected with 160 K IU loading dose – July 2014

Vitamin D deficiency and its correction in children with sickle cell anaemia.

Ann Hematol. 2014 Jul 2
Wykes C1, Arasaretnam A, O'Driscoll S, Farnham L, Moniz C, Rees DC.
1Department of Paediatric Haematology, King's College Hospital, King's College London, Denmark Hill, London, SE5 9RS, UK.

Vitamin D deficiency is common in sickle cell anaemia (SCA, HbSS), although its significance and optimal means of correction are unknown. We conducted an audit to assess the clinical significance of 25-hydroxy vitamin D (25-OHD) deficiency in children with SCA and to evaluate two methods of vitamin D supplementation. We audited 25-OHD levels in 81 children with SCA and looked for statistical associations with biochemical, haematological and clinical parameters. In a separate group of regularly transfused children with SCA, we compared changes in 25-OHD blood concentrations following treatment with either high-dose intramuscular ergocalciferol (n = 15) or 4 days of high-dose oral cholecalciferol (n = 64). Ninety-one percent of children with SCA had 25-OHD levels <20 μg/L. The 25-OHD levels were negatively correlated with increasing age (P < 0.001) but showed no significant relationship to laboratory measurements, transcranial Doppler velocities or hospital attendance.
Both intramuscular ergocalciferol and oral cholecalciferol supplementations resulted in increases of 25-OHD blood concentration to normal levels. The mean dose of ergocalciferol was greater than that of cholecalciferol (7,729 versus 5,234 international units (IU)/kg, P < 0.001), but the increment in 25-OHD levels was significantly greater in the oral cholecalciferol group (6.44 versus 2.82 (ng/L)/(IU/kg), P < 0.001). Both approaches resulted in vitamin D sufficiency for about 120 days. Increased 25-OHD concentration was significantly associated with increased serum calcium concentration. Vitamin D deficiency is very common in SCA and can be effectively corrected with high-dose intramuscular ergocalciferol or 4 days of high-dose oral cholecalciferol. Prospective, randomised studies are needed to assess the clinical value of vitamin D supplementation.

PMID: 24981689

Many children had blood transfusions – which probably results in low level of vitamin D

Loading Dose Daily dose for 4 days Weight kgWeight lb
80,000 IU= 20,000 IU/day < 30 kg < 8lbs
160,000 IU = 40,000 IU/day > 30 kg > 8lbs

Comments by VitaminDWiki

  1. Should continue supplementing with vitamin D – not stop with loading dose
  2. Should consider loading dose again following blood transfusion
  3. Should consider especially supplementing those having low levels of vitamin D (dark skin)

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Items in both categories of Bone Health and Dark Skin are listed below

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