From the Guidelines
Management of sickle cell trait in a 12-year-old should focus on education, preventive measures, and awareness of potential risks, rather than medication, as recommended by the updated guidelines for athletes with heart disease 1. The child and parents should be educated about sickle cell trait, emphasizing that it's not a disease but a carrier state that rarely causes medical problems. Key preventive measures include:
- Ensuring adequate hydration, particularly during physical activity, illness, or hot weather
- Avoiding extreme exertion, especially in hot conditions or at high altitudes, with gradual acclimatization to these environments when necessary
- Taking regular breaks and hydrating well during sports participation to avoid overheating
- Informing all healthcare providers about the SCT status, and considering a medical alert bracelet Regular health maintenance is important, including annual check-ups with their pediatrician. As the child approaches adolescence, genetic counseling may be appropriate to understand inheritance patterns. Awareness of rare risks like exercise-related collapse under extreme conditions, increased UTI risk in females, and potential complications at high altitudes helps ensure appropriate preventive care, as highlighted in the guidelines for athletes with heart disease 1.
From the Research
Management of Sickle Cell Trait in 12-year-olds
- The management of sickle cell trait in 12-year-olds involves a multidisciplinary approach, including primary care physicians and specialists in various disciplines 2.
- Annual screening for proteinuria starting at age 10 years is recommended to detect kidney disease early, and limiting the use of nonsteroidal anti-inflammatory agents and the use of angiotensin-converting enzyme inhibitors may help in delaying the progression of kidney disease 3.
- Hydroxyurea, a medication that increases the production of fetal hemoglobin, is commonly used to reduce the frequency and severity of pain crises in patients with sickle cell disease, and may also improve the ability to concentrate urine 4, 5.
- Adequate hydration and adequate control of sickle cell are also important in the management of patients with sickle cell trait 3.
Prevention and Treatment of Kidney Complications
- The identification of biomarkers of early, non-invasive kidney injury can contribute to the identification of the mechanisms involved in the development of renal syndromes, facilitating the development of more effective strategies in the prevention and treatment of sickle cell disease 6.
- Angiotensin-converting enzyme inhibitors (ACEIs) may be used to reduce proteinuria in patients with sickle cell disease, but the evidence is limited and more studies are needed to determine their effectiveness 5.
- Red blood cell transfusions may also be used to prevent or reduce kidney complications in patients with sickle cell disease, but there is a lack of evidence to support their use 5.
Monitoring and Follow-up
- Regular monitoring of kidney function, including glomerular filtration rate (GFR) and serum creatinine levels, is important in patients with sickle cell trait to detect kidney disease early 3, 6.
- Patients with sickle cell trait should also be monitored for proteinuria, which can be an early sign of kidney disease, and for other complications such as anemia, fatigue, and increased infection susceptibility 4, 2.