Homocysteine level in diagnosis of sickle cell anemia vaso-occlusive crisis and efficacy of magnesium in treatment

Objective: In our study, we aimed to investigate the effect of magnesium (Mg+2) on crisis pain levels and the diagnostic value of homocysteine in the treatment of painful crisis by evaluating adult sickle cell anemia patients who applied to the emergency department with painful crisis in the light of clinical and laboratory findings. Material and Method: A total of 62 patients were evaluated in our study, which included patients over the age of 18 with sickle cell anemia who applied to the Emergency Department of Çukurova University Medical Faculty Hospital between March 2020 and February 2022 with vaso-occlusive painful crisis. The patients were divided into two groups as moderate and severe according to their VAS pain levels at the time of admission. The visual pain scale (VAS) scores of the patients at admission, after conventional treatment, and after Mg+2 treatment were recorded and compared. Results: Thirty-two (51.6%) of the 62 patients included in our study were women. When the patients were separated according to their gender, it was observed that there was no significant relationship between age, pain severity, hospitalization rates and recurrent admission rates (p>0.05). While the homocysteine levels of male patients were 17±11.4 µmol/L, the mean homocysteine levels of female patients were found to be 11.7±5.7 µmol/L, and there was a statistically significant increase in males (p=0.033). When the patients are evaluated according to whether they have COVID-19 or not; There was no statistically significant difference between the two groups in terms of age, gender, VAS score, ECG findings, hospitalization status and the number of repeated admissions (p>0.05). Homocysteine levels of patients who had COVID-19 were found to be significantly higher than those who did not (p=0.041). When the patients were divided into two groups as moderate and severe according to their VAS scores, there was no statistically significant difference in terms of age, erythrocyte replacement status, ECG finding, the factor triggering the painful crisis, hospitalization, the number of repeated admissions, and homocysteine levels (p>0.05). Although homocysteine levels were higher in the group with moderate pain, the difference was not statistically significant. It was determined that patients who presented with both moderate and severe pain after magnesium treatment had a significant benefit in terms of pain levels (p=0.001). The VAS scores determined at each stage of the patients who were decided to be hospitalized after their treatment in the emergency department were found to be significantly higher than the patients who were discharged (p=0.001). Conclusion: Homocysteine levels were observed to be significantly higher in men with sickle cell disease and those who had COVID-19, who presented to the emergency department with vaso-occlusive crisis. As a result of our study, it was shown that Mg+2 therapy is an effective treatment in the vaso-occlusive crisis of patients with sickle cell anemia. We think that magnesium can be added to the analgesic treatment for supportive treatment to reduce the pain levels of the patients. In addition, we recommend that homocysteine level be studied in patients with sickle cell anemia in terms of diagnosis, since it can be helpful in men. A high pain scale score and its failure to regress with treatment are significant in terms of ward hospitalization indication. According to VAS, the absence of regression in the patient's pain with treatment is an indication for ward hospitalization in these patients. Key Words: Sickle cell anemia, Vaso-occlusive crisis, Homocysteine, Magnesium