THE ASSOCIATION BETWEEN SERUM VITAMIN D LEVELS AND PAINFUL CRISES IN CHILDREN WITH SICKLE CELL ANAEMIA AT THE LAGOS UNIVERSITY TEACHING HOSPITAL, IDI- ARABA, LAGOS STATE, NIGERIA

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THE ASSOCIATION BETWEEN SERUM VITAMIN D LEVELS AND PAINFUL CRISES IN CHILDREN WITH SICKLE CELL ANAEMIA AT THE LAGOS UNIVERSITY TEACHING HOSPITAL, IDI- ARABA, LAGOS STATE, NIGERIA

Abstract

Vitamin D plays a significant role in calcium homeostasis, and bone metabolism. Vitamin D
deficiency state is known to cause acute and chronic bone pain in normal healthy individuals
among other effects. In sickle cell anaemia (SCA) similar pains are experienced during bone pain
crisis. Some studies have suggested that vitamin D may play a role in pain management of
children with SCA in painful crisis. However, data on the prevalence of vitamin D deficiency in
SCA children with painful crises are limited.
This cross-sectional study determined the prevalence of vitamin D deficiency and the association
between serum vitamin D levels and painful crises in children with SCA in Lagos University
Teaching Hospital [LUTH] , Idi-Araba Lagos.
A total of 186 children were recruited for this study. The subjects consisted of 62 children with
SCA in painful crisis, 62 SCA children in steady state and 62 apparently healthy children with
genotype AA. There were 82 (44.1%) females and 104 (55.9%) males with a male: female ratio of
1.1:1. A pre-tested interviewer-administered questionnaire was used to obtain information on the
socio-demographic parameters, the severity and frequency of painful crisis and whether or not it
required hospitalisation. The questionnaire contained information on factors affecting serum
vitamin D levels which included the number of hours spent under sunlight exposure, twenty-four
hour meal recall, the skin type, and the presence or absence of pain in limbs. The serum vitamin D
level was determined using High Performance Liquid Chromatography (HPLC). The reference
value for serum vitamin D according to the recommendation of the Global Consensus on Vitamin
D was used for analysis, where the cut-off value <12 ng/mL deficiency, 12-20 ng/mL
insufficiency, and >20 ng/ml sufficiency.
The controls with haemoglobin genotype AA had a median serum vitamin D level of 18.54 (6.22
37.78) ng/mL. This was high when compared with 15.56 (6.80-30.07) ng/mL in children with
SCA in steady state and 16 (7.80-32.07) ng/mL in children with SCA in painful crisis, though it
was not statistically significant [p=0.57] . The prevalence of vitamin D deficiency (VDD) in the
controls with genotype AA was 38.7%. This was not statistically significant [p= 0.70] when
compared with 40.3% in the SCA patients. A prevalence rate of 46.8% and 33.9% of VDD was
observed in SCA patients in steady state and SCA patients with painful crises respectively though
the difference was not statistically significant (p=0.11).
There was no significant association between serum vitamin D levels and the frequency of painful
crises in children with SCA in painful crises. (p= 0.91). Similarly, no significant association
existed between serum vitamin D levels and severity of painful crises in these children. (p= 0.46)
Furthermore, there was no statistical association between serum vitamin D levels and age,
socioeconomic class, ethnicity, dietary intake, average hours or frequency of daily outing for
sunlight exposure.
Though the prevalence of VDD was high in the study subjects, there was no association between
VDD and frequency or severity of acute painful crises in the subjects with SCA.
Due to the finding of vitamin D insufficiency across the study population, more attention should
be giving to vitamin D fortification in most local foods.

 

THE ASSOCIATION BETWEEN SERUM VITAMIN D LEVELS AND PAINFUL CRISES IN CHILDREN WITH SICKLE CELL ANAEMIA AT THE LAGOS UNIVERSITY TEACHING HOSPITAL, IDI- ARABA, LAGOS STATE, NIGERIA

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