Bone marrow transplantation has recently emerged Bosutinib as a novel treatment for SCA. There had been reports suggesting a beneficial effect of bone marrow transplantation in improving target organ damage, including chronic lung, bone, and central nervous system disease. Whether bone marrow transplantation in the early stage of the disease can reverse or halt the progression of established sickle cell nephropathy is unknown and awaits clinical studies. Furthermore, experience in stem cell and kidney transplant is lacking; however, it may have potential in improving the long term outcome of kidney transplant in sickle cell patients [46, 47]. 6. Cardiovascular Challenges The perennial anaemia and recurrent vasoocclusive phenomenon prevalent in SCD patients predispose them to various cardiovascular morbidity and mortality.
Data indicate that cardiomegaly resulting from recurrent anaemia, and myocardial ischemia resulting from combined Inhibitors,Modulators,Libraries effect of anaemia, microthrombi, bone marrow embolism, and increased blood viscosity is a common presentation in SCD. These conditions predispose the patients to various myocardial dysfunctions manifesting as tachycardia, hyperactive precordium, displaced Inhibitors,Modulators,Libraries apex, systolic murmur, and occasionally premature heart beats [48, 49]. Sickle cell disease patients have also been noted to have higher blood pressure than their counterpart with normal haemoglobin (HbAA) [50]. In a study of cardiac Inhibitors,Modulators,Libraries function in 200 SCD patients using echocardiogram, patients were reported to have increased biventricular and left atrial chamber dimensions and increased interventricular septal thickness [51].
These cardiovascular complications are further Inhibitors,Modulators,Libraries heightened by the presence of kidney disease with the associated negative impact on the heart and vessels. These cardiovascular complications in SCD patients with ESRD result Inhibitors,Modulators,Libraries from fluid overload, hyperparathyroidism, electrolyte imbalance, anaemia, hypertension, malnutrition, dyslipidaemia, and atherosclerosis. Kidney transplant being a major surgical procedure further worsens cardiovascular function in SCD patients [45]. Postoperative care of these patients is greatly influenced by the stability of the cardiovascular system. These patients are at risk of fluid overload, drug toxicity, and immunologic conditions that can impact negatively on the heart and circulatory system thus perpetuating the cardiovascular morbidity.
This cardiovascular threat can be reduced by careful selection of anaesthetic agent, strict monitoring of fluid balance, haematocrit Batimastat of at least 30%, and adequate intraoperative oxygenation [45]. 6.1. Respiratory Challenges The optimum respiratory pathway is a major determinant in the choice and outcome of anaesthesia. The lung in SCD patients is a major target for acute and chronic complications; this usually worsens the hypoxia prevalent in these patients.