Clinics (Sao Paulo). 2011 May; 66(5): 801-805.

Copyright © 2011 Hospital das Clínicas da FMUSP

Low bone mass density is associated with hemolysis in brazilian patients with sickle cell disease

Gabriel Baldanzi I , Fabiola Traina I , João Francisco Marques Neto III , Allan Oliveira Santos II , Celso Dario Ramos II , Sara T Olalla Saad I

Hematology and Hemotherapy Center/Instituto Nacional de Ciência e Tecnologia do Sangue, University of Campinas-UNICAMP, Campinas, SP, Brazil.

Department of Radiology, University of Campinas-UNICAMP, Campinas, SP, Brazil.

Department of Internal Medicine, University of Campinas-UNICAMP, Campinas, SP, Brazil.

E-mail: Tel.: 55 19 3289-1089

received December 20, 2010; revised January 20, 2011; accepted February 11, 2011.



To determine whether kidney disease and hemolysis are associated with bone mass density in a population of adult Brazilian patients with sickle cell disease.


Bone involvement is a frequent clinical manifestation of sickle cell disease, and it has multiple causes; however, there are few consistent clinical associations between bone involvement and sickle cell disease.


Patients over 20 years of age with sickle cell disease who were regularly followed at the Hematology and Hemotherapy Center of Campinas, Brazil, were sorted into three groups, including those with normal bone mass density, those with osteopenia, and those with osteoporosis, according to the World Health Organization criteria. The clinical data of the patients were compared using statistical analyses.


In total, 65 patients were included in this study: 12 (18.5%) with normal bone mass density, 37 (57%) with osteopenia and 16 (24.5%) with osteoporosis. Overall, 53 patients (81.5%) had bone mass densities below normal standards. Osteopenia and osteoporosis patients had increased lactate dehydrogenase levels and reticulocyte counts compared to patients with normal bone mass density (p<0.05). Osteoporosis patients also had decreased hemoglobin levels (p<0.05). Hemolysis was significantly increased in patients with osteoporosis compared with patients with osteopenia, as indicated by increased lactate dehydrogenase levels and reticulocyte counts as well as decreased hemoglobin levels. Osteoporosis patients were older, with lower glomerular filtration rates than patients with osteopenia. There was no significant difference between the groups with regard to gender, body mass index, serum creatinine levels, estimated creatinine clearance, or microalbuminuria.


A high prevalence of reduced bone mass density that was associated with hemolysis was found in this population, as indicated by the high lactate dehydrogenase levels, increased reticulocyte counts and low hemoglobin levels.

Keywords: Osteoporosis, Sickle Cell Disease, Hemolysis, Bone Mass Density, Kidney

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