Covid-19 and sickle cell disease do not mix

Text by: Caroline Paré Follow | Ophélie Lahccen

The presence of other pathologies increases the risk of complications in a patient with the new coronavirus. Sickle cell disease, a very common genetic disorder that affects the hemoglobin in red blood cells, is one of them. Interview.

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What additional risks does Covid-19 pose to patients affected by sickle cell disease on the African continent? How to take care of them? Elements of response with Professor Léon Tshilolo . Pediatrician, hematologist, he heads the Training and Health Support Center within the Mère-Enfant Monkole hospital center in Kinshasa. Member of the French Academy of Medicine, he is also the president of the sickle cell anemia study network in Central Africa.

Wednesday, April 22, he was the guest of the broadcast health priority , on RFI.

RFI: Is being sickle cell an increased risk when faced with Covid-19?

Prof Léon Tshilolo: The Covid-19 is not only of interest to virologists, pulmonologists or infectious disease  specialists. Recently, we learned that this disease also affects the small red blood cell and therefore subjects who have an inherited disease, sickle cell anemia.

Sickle cell subjects are particularly vulnerable to Covid-19 for very simple reasons: they have weakened immunity and low hemoglobin levels. In addition, they know very well that when they have a fever, it can be a factor that will trigger other complications of sickle cell anemia, such as the pain attack. We therefore started a strong awareness campaign for this vulnerable population to Covid-19.

What advice to give to these sickle cell patients to protect themselves now?

We must respect the measures that the authorities have advised the population. You really have to follow the containment and distancing measures. In addition, another precaution must be adopted: wearing a mask. It is one of the ways to protect yourself and your environment. Wearing a mask is really essential, among other things, for sickle cell anemia. You must continue to follow the usual measures that you have been advised for sickle cell anemia: stay well hydrated, continue to take your penicillin (especially for children). For those who are on treatment, you must continue to take his medicine called hydroxyurea, because it is a medicine that will allow you to not have the complications that you know, even during a Covid-19 infection.

They must also continue to take a vitamin called folic acid. This vitamin contributes to the production of red blood cells. As it is a viral disease, Vitamin C is indicated. It is also advisable to have a balanced diet, rich in vitamin B3. It is a vitamin that helps improve the immunological defense of patients during Covid-19 infection.

In which foods is vitamin B3 found ?

Poultry, meat, fatty fish ... This vitamin is particularly abundant in certain foods of animal origin. It is also found in peanuts, brewer's yeast, canned tuna or even cereals.

Are there any contraindications to the use of chloroquine for sickle cell patients ?

Certain sickle cell subjects also carry other anomalies such as G6PD deficiency. This means that they have an enzyme which is lacking and which means that when they take certain drugs, red blood cells are easily hemolyzed. Among these drugs, which they are advised to avoid, are antimalarials such as primaquine but also chloroquine. This molecule has long been used in antimalarial treatment, in several African countries. We arrested him because of the resistance. Sickle cell patients with G6PD deficiency, if they have coronavirus, can take chloroquine, but with special medical supervision. It can cause hemolysis (Editor's note: destruction of red blood cells) but this is rare. After 48 hours, it will be necessary to check whether the patient has not hemolyzed. He can see it for himself, if his urine is darker and his eyes turn yellow.

You are a member of the Academy of Medicine, as a foreign correspondent… As such, how are the exchanges, the sharing of experiences between you and the French specialists?

The French Academy of Medicine organizes newsletters on the Covid-19 almost every week with specific angles. A special session on the Covid-19 and Africa is planned within the Academy. With other French researchers, we are studying the impact of Covid-19 on sickle cell subjects. We are recording all cases of sickle cell subjects with Covid-19. Covid-19 is a hyper inflammatory disease that is linked to a tornado of cytokines. Sickle cell subjects have a chronic inflammatory state, with many cytokines, similar to those released during Covid-19. This already opens up research perspectives.

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