Steady-state electrocardiograms and disease severity of childhood sickle cell anemia in Calabar, Nigeria

Background: Abnormal electrocardiogram (ECG) is common in children with sickle cell anemia (SCA). There are three levels of SCA severity, and the severe form is fatal. However, whether SCA severity level is associated with abnormal ECG is unknown.Aim: To determine the relationship between SCA disease severity and abnormal ECG during steady-state.Method: This cross-sectional study recruited 56 SCA patients between 4 and 17 years of age. Patients' clinical information was obtained, and a physical examination with a full blood count was performed. These data were used to classify SCA in the subjects according to their severity as mild, moderate, or severe. 12-lead electrocardiography was performed after the physical examination.Results: The median (interquartile) disease severity score was 4.0 (3.0 – 6.5), with a range of 1 – 19. Most subjects (78.6%) had mild disease, while 14.3% and 7.1% had moderate and severe disease, respectively. T-wave changes were the most prevalent (55.4%) ECG abnormality. None of the ECG abnormalities were significantly related to disease severity. However, prolonged QTc interval correlated negatively with disease severity (r=-0.272, p=0.043). Two or more ECG abnormalities per subject were observed in 53.6% of those with mild disease.Conclusion: All three disease severity levels are associated with abnormal ECG patterns, especially T-wave changes. The predominance of mild disease in the investigated locality may be why prolonged QTc interval and multiple ECG abnormalities were mainly observed in them. Routine electrocardiography may be done to identify at-risk patients for further cardiac management.