CLINICAL IMPLICATIONS OF SICKLE-CELL TRAIT AND GLUCOSE-6-PHOSPHATE-DEHYDROGENASE DEFICIENCY IN HOSPITALIZED BLACK-MALE PATIENTS

To determine whether sickle-cell trait and glucose-6-phosphate dehydrogenase deficiency influence the course and fatality rates of certain diseases requiring hospitalization, especially those associated with thrombotic phenomena, we conducted a Cooperative study of 65,154 consecutively admitted, black male patients in 13 Veterans Administration hospitals. The overall frequency of sickle-cell trait was 7.8 per cent and of glucose-6-phosphate dehydrogenase deficiency 11.2 per cent. Both conditions were present in 0.9 per cent of those examined. There were regional, but no age-dependent, differences in the frequency of sickle-cell trait. Sickle-cell trait had no effect on average age at hospitalization or death, overall mortality, length of hospitalization on medical and surgical wards and frequency of any diagnosis, except essential hematuria and pulmonary embolism. Although statistically significant (P<0.001), the differences for the latter were small (1.5 per cent of all patients with normal hemoglobin and 2.2 per cent of patients with sickle-cell trait). Glucose-6-phosphate dehydrogenase deficiency had no adverse effect. (N Engl J Med 300:1001–1005, 1979) THE possibility that sickle-cell trait could be an aggravating factor in diseases associated with tissue hypoxia, acidosis and thrombotic phenomena has been repeatedly suggested in many anecdotal reports, recently reviewed by Sears.1 Although it would be highly desirable to clarify this problem by a long-term prospective study of a large number of healthy subjects with sickle-cell trait, it is not likely that such a study could succeed because of the intrinsic difficulties of such a survey, which would require many years of observation. We considered it likely that analysis of relevant data on hospitalized veterans and follow-up study would provide. © 1979, Massachusetts Medical Society. All rights reserved.