Case Report
We present a 34-month-old female with sickle cell anemia (SCA HbSS) who
was diagnosed at 15 months of age. She was one of the first set of
patients to use HU in the Pediatric Hematology Unit of the University of
Abuja Teaching Hospital from January 2017 . The unit offers
comprehensive care to patients with SCD, that includes structured health
education in addition to prophylaxis for malaria and pneumococcal
infections. She had all childhood immunizations according to the
National Program on Immunization, including pneumococcal and
meningococcal vaccines. Following parental consent, she was started on
HU at a daily dose of 15 mg/kg (187mg daily) for frequent, recurrent
severe bone pain crises. HU was compounded by the hospital pharmacy,
using vitamin C syrup and was renewable fortnightly. Within the first
year, there was a dose escalation to 20mg/kg with good hematologic
response. Her parents were satisfied with the therapy and reported
reduction in acute painful episodes and improved general wellbeing of
the patient.
At 13 months of HU therapy, her parents called the managing team to
report accidental ingestion of an overdose of HU. She was said to have
ingested the entire contents of the medication in the container. The
child was stable at presentation to the emergency room eighteen hours
after drug ingestion. She had ingested about 105mg per kilogram body
weight of HU, which was equivalent to 5 times her regular daily dose.
Because she presented late, vomiting was not induced, and activated
charcoal was not administered. HU serum levels could not be determined.
At presentation, she had mild myelosuppression as her total white blood
cell and absolute neutrophil counts dropped but values were back to
pre-overdose levels about 21 days later. Hemoglobin concentration
remained fairly constant after overdose while there was a steady
increase in mean corpuscular volume. Apart from a transient rise in
serum creatinine 18 hours post ingestion, the transaminases and
creatinine were down to pre-ingestion levels within 3 weeks of HU
overdose. Patient is currently doing well. Hematologic indices one year
post overdose, remain stable but serum creatinine and alanine
transaminase show mild increase (Table 1). Patient is still being
followed up.