Fatigue & Sleep Disturbances
Feeling tired is a common symptom in sickle cell disease and is often due to an underlying anemia, or a shortage of red blood cells (RBCs). Sickled RBCs have a lifespan of 17 days compared to a normal RBC lifespan of 120 days and there is a need to constantly replace RBCs. This takes a large amount of energy and it is common in individuals with sickle cell to have chronic anemia, a red blood cell count will be less than normal over your life. You may also feel that you get tired quicker than usual, especially during intense activity such as exercise or sports.
There are some situations that may cause a more severe anemia. “Stressful situations” such as infection and trauma are common examples. Sometimes the spleen, which helps to clean the blood, will collect too many RBCs in a condition called splenic sequestration. This causes severe anemia, cool or clammy skin, rapid pulse, and rapid breathing. This is a life-threatening episode that occurs more often in infants and young children and requires immediate attention by a medical professional.
The heart in individuals with sickle cell operates at a higher rate than the rest of the population due to the chronic anemia that is present. This can lead to heart disease as you get older.
- Signs of heart disease include shortness of breath, discomfort with day-to-day activity, chest pain, chest pressure
Sometimes the body may also temporarily stop producing new RBCs in a condition called aplastic crisis. This also requires immediate attention by a medical professional.
- Treatment & Prevention: You can reduce the chances of developing anemia by supplementing your diet with folic acid, a vitamin important in RBC production. Hydroxyurea is a medication that you can take to reduce the number of sickle RBCs and reduce the need for constant RBC production by the bone marrow. Some individuals can also receive blood transfusions if their blood counts are extremely low. These individuals should also have their iron levels monitored as it is possible to have an iron overload with multiple blood transfusions.
Many individuals with sickle cell will have damage to the kidney due to the blood vessel blockages, and this can cause damage to the filtration systems of the kidney. In childhood the kidneys will work harder to make up for the damage and there may be some protein lost in the urine. Through early adulthood, there will be a slow reduction in the filtration abilities of the kidney as the kidney is no longer able to repair damage. This is referred to as chronic kidney disease and should be evaluated by a kidney specialist who may recommend blood pressure control medications, dialysis, or kidney transplant.
- Signs: Tiredness, weight loss, swelling in the feet and legs, shortness of breath
- You can help slow kidney damage by avoiding medications that harm the kidneys. Nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen and ketorolac can damage the kidneys if taken long term. Specific antibiotics and medications used for imaging studies can also damage the kidneys. You should discuss your kidney health with your doctor before taking these medications
- Using hydroxyurea has been shown to decrease the risk for blocked arteries in individuals with sickle cell and improve kidney function. Because this drug is removed from the body by the kidneys, changes in the health of your kidneys may call for a change in the dose of hydroxyurea. The timing and dose may also change if you are receiving dialysis, your kidney specialist will be able to determine the best treatment plan for you.
- Having trouble falling or staying asleep is common in individuals with sickle cell. This is thought to be due to changes in the airway such as narrowing or issues with air exchange in the lungs.
- Poor sleep can have many consequences beyond affecting ability to get through the day including high blood pressure and an increased risk for clots, heart and brain disease.
- Treatment/Prevention: If you wake up still feeling tired or have been told that you snore, gasp or choke when sleeping you should get evaluated with a sleep study. They may prescribe you a machine to help you get enough air while you are sleeping.