Prolonged tonsillar hypertrophy may be an indicator of disease-induced immunosuppression in sickle cell patients

Mehmet Rami Helvaci1, Celaletdin Camci1, Alper Sevinc1, Eulis Khoerun Nisa2, Tugce Ersahin3, Aynur Atabay3, Ramazan Davran4, Abdulrazak Abyad5, Lesley Pocock6

1 Specialist of Internal Medicine, MD, Turkey
2 Manager of Writing and Statistics, Indonesia
3 Assistant of Emergency Medicine, MD, Turkey
4 Specialist of Radiology, MD, Turkey
5 Middle-East Academy for Medicine of Aging, MD, Lebanon
6 medi-WORLD International, Australia

Corresponding author:
Prof Dr Mehmet Rami Helvaci, MD
07400, ALANYA, TurkeyPhone: 00-90-506-4708759
Email: mramihelvaci@hotmail.com

Received: January 2024; Accepted: February 2024; Published: March 2024
Citation: Helvaci MR et al. Prolonged tonsillar hypertrophy may be an indicator of disease-induced immunosuppression in sickle cell patients Middle East Journal of Nursing 2023; 18(1): 13-28 DOI: 10.5742/MEJN2023.9378041

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ABSTRACT

Background: The hardened red blood cells-induced capillary endothelial damage initiates at birth, and terminates with multiorgan failures even at childhood in sickle cell diseases (SCDs).

Methods: All patients with the SCDs were taken into the study.

Results: The study included 334 cases (164 females). There were 27 patients (8.0%) with tonsilectomy and 307 patients without (91.9%). The mean age, female ratio, and smoking were similar in both groups (p>0.05 for all). Although the white blood cells and platelets counts of peripheric blood were higher in patients without tonsilectomy, the mean hematocrit value was lower in them, but the differences were nonsignificant probably due to the small sample size of the tonsilectomy group (p>0.05 for all). Similarly, although the painful crises per year, digital clubbing, leg ulcers, pulmonary hypertension, chronic obstructive pulmonary disease, rheumatic heart disease, avascular necrosis of bone, cirrhosis, stroke, and mortality were all higher in patients without tonsilectomy, the differences were nonsignificant probably due to the same reason again (p>0.05 for all).

Conclusion: There may be an inverse relationship between prevalence of tonsilectomy and severity of SCDs, and the tonsils may act as chronic inflammatory foci accelerating the chronic endothelial damage all over the body in such patients. On the other hand, such a high prevalence of tonsilectomy may show the fact that the prolonged tonsillar hypertrophy may be an indicator of disease-induced immunosuppression in sickle cell patients.

Key words: Sickle cell diseases, immunosuppression, tonsillar hypertrophy, tonsilectomy, hardened red blood cells, arterial endothelial damage, sudden deaths