Pediatric Patients with Sickle Cell Disease at a Public Hospital and Early Experience with L-Glutamine Therapy

Background: Hydration and hydroxyurea (HU) can modify sickle cell disease (SCD) severity. Optimal nutrition and L-glutamine (Gln) may provide further amelioration. Procedures. EMR reviews and nutrition surveys were used to investigate pediatric SCD severity in relation to nutrition, growth, hematologic parameters, and disease-modifying agents. Results. Among 25 females and 25 males, mean age was 9.1±7 years, and mean BMI percentile was 56.4±32.6. Hemoglobinopathies were: HbSS/Sß0, 60%; HbSC, 32%; HbSß+, 8%. Annual pain crises rose with age (APC mean, 0.97±1.1 hospital visits or admissions per patient). HbF dropped to <10% in teenagers, while APC increased ≥2-fold. Proper hydration and nutrition correlated with younger ages and fewer APCs. Height and weight Z-scores were ≤ -1SD in 20% of 35 surveyed patients (12±7.8 years) with more APCs (2.5±2.5 vs. 1±1.3, p=0.03). Prealbumin was low overall. Twenty-two of 28 patients on HU reported ≥90% adherence – with higher MCVs (92±9.6 vs. 74±10 f/L, p<0.01) and HbF%, and younger ages. Most children aged ≥5 years were prescribed Gln (70% dispensed). A quarter of patients reported <50% Gln intake due to abdominal pain or taste. Gln compliance over 23 months was ≥70% in 12 patients, including 2 on chronic transfusion. Of 10 evaluable patients, 6 (8.8 ±2.2 years) had fewer APCs on Gln (mean 0.2 vs. 0.9, p=0.016), with higher prealbumin (14.1 to 15.8 mg/dL, p=0.1). Conclusions. Young, well-nourished/hydrated patients have a milder clinic course. Severe disease occurred in undernourished teenagers with suboptimal compliance. L-Glutamine should be further evaluated in pediatric SCD along with prealbumin measurements.