Is there a role for selective vasodilation in the management of sickle cell
disease?
GP Rodgers, MS Roy, CT Noguchi and AN Schechter
Laboratory of Chemical Biology, National Institute of Diabetes and
Digestive and Kidney Diseases, Bethesda, MD 20892.
To test the hypothesis that microvascular obstruction to blood flow at the
level of the arteriole may be significant in individuals with sickle cell
anemia, the ophthalmologic effects of orally administered nifedipine were
monitored in 11 steady-state patients. Three patients with evidence of
acute peripheral retinal arteriolar occlusion displayed a prompt
reperfusion of the involved segment. Two other patients showed fading of
retroequatorial red retinal lesions. Color vision performance was improved
in six of the nine patients tested. The majority of patients also
demonstrated a significant decrease in the amount of blanching of the
conjunctiva which reflects improved blood flow to this frequently involved
area. Such improvements were not observable in a control group of untreated
stable sickle cell subjects. These findings support the hypothesis that
inappropriate vasoconstriction or frank vasospasm may be a significant
factor in the pathogenesis of the microvascular lesions of sickle cell
disease and, further, that selective microvascular entrapment inhibition
may offer an additional strategy to the management of this disorder. We
believe a larger, placebo-controlled study with nifedipine and similar
agents is warranted.
Volume 71,
Issue 3,
pp. 597-602,
03/01/1988
Copyright © 1988 by The American Society of Hematology
