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.