|
Abstract
Background: After excess
weight, smoking may be the
second most common cause of
vasculitis all over the body.
Methods:
All patients with sickle
cell diseases (SCD) were included.
Results:
We studied 222 males and 212
females with similar ages
(30.8 vs 30.3 years, p>0.05,
respectively). Smoking (23.8%
vs 6.1%, p<0.001), alcohol
(4.9% vs 0.4%, p<0.001),
transfused red blood cells
(RBC) in their lives (48.1
vs 28.5 units, p=0.000), disseminated
teeth losses (5.4% vs 1.4%,
p<0.001), ileus (7.2% vs
1.4%, p<0.001), chronic
obstructive pulmonary disease
(COPD) (25.2% vs 7.0%, p<0.001),
cirrhosis (8.1% vs 1.8%, p<0.001),
leg ulcers (19.8% vs 7.0%,
p<0.001), clubbing (14.8%
vs 6.6%, p<0.001), coronary
heart disease (18.0% vs 13.2%,
p<0.05), chronic renal
disease (9.9% vs 6.1%, p<0.05),
and stroke (12.1% vs 7.5%,
p<0.05) were all higher
in males.
Conclusion:
The hardened RBC-induced capillary
endothelial damage initiates
at birth, and terminates with
leg ulcers-like atherosclerotic
endpoints even at childhood
in the SCD. Similarly, smoking
causes a systemic inflammation
on vascular endothelium terminating
with an accelerated atherosclerosis-induced
end-organ insufficiencies
in whole body. Its atherosclerotic
effect is the most obvious
in COPD and Buerger’s
disease, probably due to the
higher concentrations of toxic
substances in lungs and pooling
of blood in extremities. Since
the already developed vascular
stenoses are irreversible
in Buerger’s disease,
low-dose aspirin plus low-dose
warfarin may be the best treatment
regimen to protect fingers
and toes from infarctions
at the moment. The regimen
may even increase the leg
performance by preventing
recurrent ischemiaes in microcirculation
of the legs.
Key
words: Sickle cell diseases,
capillary endothelial inflammation,
leg ulcers, Buerger’s
disease, smoking, low-dose
aspirin, low-dose warfarin
|
