Effect of Long Term Supplement with Omega-3 Fatty Acids on Some Coagulation Parameters and Blood Counts in Patients with Sickle Cell Disease

Abstract

Chronic prothrombotic state is thought to be one of the factors that contribute to the episodic vaso-occlusive crisis that characterizes sickle cell disease (SCD).The fish oil derived omega-3 fatty acids, like eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA), claim a plethora of health benefits which affect coagulation and blood count cascade. The present study aimed to assess the effect of long term supplementation with omega -3 fatty acids on the coagulation parameters and blood counts in patients with homozygous sickle cell disease. This case-control study included 156 participants, divided into homozygous sickle cell disease patients (HbSS) with omega-3 supplemented omega-3 for two years (n=44); non-supplemented group (n=52);homozygous sickle cell disease (HbSS) patients treated with hydroxyurea (n=8)and healthy controls(HbAA) (n=52). Patients and controls were matched for age, gender, ethnicity and socioeconomic background. Coagulation parameters and blood counts were assessed using automated analyzers. Data were analyzed using SPSS version 19 with P. value <0.05 considered significant. The age of the study participants ranged from 4-20 years old. Omega-3 supplemented group had significant differences compared with non-supplemented in plasma PT (17.2±1.8 versus 31.3±11.1 sec, p<0.001), plasma APTT (38.3±4.2 versus 57.0±11.3sec, p< 0.001), INR (1.2±0.14 versus 2.3±0.9, p<0.001) and PLTs count (489.5±121.1versus 533.6±98.7×10³/µL, p=0.031). However, there was no significant difference between omega-3 treated patients compared with healthy controls in these parameters. The hydroxyurea treated group and non-supplemented group had significantly lower levels of plasma PT (18.5±1.8 versus 31.3±11.1 sec, p< 0.001), plasma APTT (42.8±2.7 versus 57.0±11.3 sec, p< 0.001), INR (1.3±0.12 versus 2.3±0.9, p<0.001) and PLTs count (414.5±109.9 versus 533.6±98.7×10³/µL, p=0.002). Nevertheless, there were no significant differences between the hydroxyurea treated patients compared with healthy controls in the same parameters. Omega-3 supplemented group and non-supplemented group had insignificant comparable levels of complete blood counts. However, a significant decrease was found when omega-3 supplemented group compared with healthy controls in Hb (7.56±1.62 versus 12.60±1.09 g/l, p< 0.001), HCT (22.9±4.7 versus 38.0±3.5 %, p< 0.001), RBCs count (2.8±0.7 versus 4.6±0.5×106/µL, p< 0.001) and increase in WBCs count (12.4±4.3 versus 6.3±1.3×10³/µL, p< 0.001). Moreover, there was no significant difference between the two groups for mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC). The healthy control subjects had a lower level of plasma D-dimer concentration than the n-3 fatty acid treated, HU-treated and un-treated patients, (p<0.001). The n-3 fatty acid treated group compared with the HU treated (Median =1.14 (Inter Quartile Range =0.74) µg/mL versus Median= 2.33 (IQR=3.17) µg/mL, (p<0.001)) and untreated (Median =1.14 (IQR=0.74) µg/mL versus Median= 1.75(IQR=1.16) µg/mL, (p<0.001)). Omega-3 treated patients had a lower plasma D-dimer level. Patients treated with HU had a higher levels of plasma D-dimer compared to HbSS untreated (p=0.002). No significant differences foundin protein- C and protein S plasma levels between HbSS omega-3 fatty acids-treated and HbSS HU-treated patients. The bulk of evidence demonstrates that (PT,PTT,INR and PLT) are reduced in omega-3 treated and hydroxyurea treated patients compared with untreated HSS patients. Furthermore, the haematological parameters (Hb, HCT, RBC) do not vary significantly but still reduced in omega-3 treated, hydroxyurea treated and untreated HSS patients compared with healthy controls. Additionally, D-dimer is significantly reduced in omega-3 treated compared with untreated HSS patients but still increased compared with healthy controls.