Clin Pediatr | Volume 3, Issue 1 | Review Article | Open Access

Pediatric Sickle Cell Disease Osteonecrosis of the Femoral Head: A Treatment Proposal

Gildásio Daltro^1*, Nelma do Socorro Salim Ramos², Saide Maria Sarmento Trindade², Paulo Ivo Cortez de Araujo³ and Sirlene Mendes Borges⁴

¹Prof. Edgar Santos Hospital Complex, HUPES, Federal University of Bahia, Brazil ²Hemocenter Belém, Pará, Brazil ³Federal University of Rio de Janeiro, Brazil ⁴Doctoral student, Institute of Science Health, Federal University of Bahia-ISC / UFBA, Brazil

^*Correspondance to: Gildásio Daltro 

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Abstract

Background: Treatment of Osteonecrosis (ON) in children with sickle cell disease with autologous implantation of iliac crest Bone Marrow-derived Mononuclear Cells (BMMC), which contains precursor cells including Mesenchymal Stromal Cells (MSC), has been commonly treated conservatively and surgically. Methods: Thirty-six pediatric patient's sickle cell disease with osteonecrosis were recruited and assigned to BMMC injection. The radiographic stage of ON was determined according to the Harris Hip Score (HHS), and Ficat and Arlet which were assessed before and 3, 6, 12, 24, 36 and 60 months after the injection procedure. Fibroblast Colony Forming Unit (CFU-F) assay was done using BMMC isolated for the procedure. Results: We found in this work that applying BMMC injection through aspiration without decompression HHS increase in a very expressive manner (BP - 77.85 and AP - 96.33) and angle measurements show a clearly good development of tissue regeneration [Cervico-diaphyseal angle (BP - 140.5 and AP - 130.5) VCE (BP - 27 and AP - 33)] with a mean CFU-F count of 27. Conclusion: Injection of autologous BMMCs can reliably provide a good regeneration of the affected bone. This intervention is safe and effective in delaying or avoiding femoral collapse, which may if left untreated lead to premature total hip replacement.

Keywords:

Sickle cell disease; Cell therapy; Osteonecrosis; Pediatric

Citation:

Daltro G, do Socorro Salim Ramos N, Sarmento Trindade SM, Cortez de Araujo PI, Borges SM. Pediatric Sickle Cell Disease Osteonecrosis of the Femoral Head: A Treatment Proposal. Clin Pediatri. 2020;3:1022..