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 kg | Weight lb |
| 80,000 IU | = 20,000 IU/day | < 30 kg | < 8lbs |
| 160,000 IU | = 40,000 IU/day | > 30 kg | > 8lbs |
Comments by VitaminDWiki
- Should continue supplementing with vitamin D – not stop with loading dose
- Should consider loading dose again following blood transfusion
- Should consider especially supplementing those having low levels of vitamin D (dark skin)
See also VitaminDWiki
- Sickle Cell Anemia: 64 percent had less than 10ng of vitamin D – April 2012
- Overview Loading of vitamin D
- Overview Sickle Cell and Vitamin D
Items in both categories of Bone Health and Dark Skin are listed below
- Vitamin D should be an almost universal feature of the care of young adults with sickle cell disease – May 2018
- Vitamin D paradox – Blacks need Vit D for health, but not as much D for strong bones – May 2018
- Sickle Cell clinical trial will inject 300,000 IU of vitamin D – RCT due 2020
- Sickle Cell children need more than 7,000 IU of vitamin D daily – May 2015
- Overview Sickle Cell and Vitamin D
- Sickle cell Vitamin D deficiency corrected with 160 K IU loading dose – July 2014
- Bone density does not decrease with lower vitamin D levels in blacks as it does in whites – April 2014
- Vitamin D different relationship between whites and blacks for bone and plaque – June 2012
- Sickle cell and low vitamin D – 3 presentations Dec 2012
- Forearm fracture 3.5X more often in black children with low levels of vitamin D – Sept 2012
- Sickle Cell Anemia: 64 percent had less than 10ng of vitamin D – April 2012
- Black seniors near equator: increased vitamin D decreases bone density – Sept 2011
- 14000 IU vitamin D (50000 twice a week) often stops Sickle Cell pain
- Blacks may not need as much Vitamin D (for their bones)
- Low vitamin D before orthopedic surgery – dark skin 5X more likely – Oct 2010
- Arthritis 2X as severe in African-Americans - April 2010
See also web
- Iron Overload in Sickle Cell Disease 2010 full text online
Transfusions result in Iron Overload