Essay about Management of Leg Ulcers

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Treatment of leg ulcers
Leg ulcerations are a common manifestation of HbSS, although their prevalence varies with geographical distribution. For example, 75% of HbSS patients in Jamaica are affected whereas only 8-10% of South American patients are affected. Potential contributing factors to leg ulcerations are; obstructions due to cell sickling, venous incompetence, excessive vasoconstriction caused by malfunctioning autonomic control and bacterial infections. Furthermore, impaired endothelial function caused by decreased nitric oxide bioavailability and anaemia or chronic hypoxia are also linked. In addition, venographic studies indicate that arteriovenous shunting is the main cause of ulcerations rather than venous insufficiency.
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As mentioned earlier, iron overload can occur if patient is given repeated transfusion and therefore treatment for this is also required.

Erythrocytapheresis is now becoming a more common alternative to simple transfusion as it is an automated red cell exchange procedure which allows iron accumulation to be controlled. It removes HbS blood cells whilst replacing them with packed red cells free of HbS at the same time. Therefore, it is reducing HbS concentration without increasing total Hb post transfusion. Although more expensive than simple transfusion, it is ultimately more cost-effective with little complications.

Furthermore, the primary prevention guidelines state that if red cell transfusion is contraindicated in children, bone marrow transplantation or hydroxyurea are other possible options. (13)

Treatment of pulmonary hypertension
About one third of HbSS individuals suffer from pulmonary hypertension. Pulmonary hypertension is defined as mean pulmonary artery pressure greater than 25mm Hg at rest or greater than 30 mm Hg during physical activity with the normal value being 15mm Hg. Pulmonary hypertension occurs in about one third of HbSS adults and is likely to

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