World Sickle Cell Day: Should patients with the condition avoid travelling to high altitudes?

As an inherited group of blood disorders that is genetic in nature, SCD is usually transferred from parents to the child during birth i.e. both parents can be carriers of SCD. “Healthy RBCs are round in shape, which move through small blood vessels and carry oxygen to all parts of the body. In someone who has SCD, the RBC becomes sticky and hard and starts to look C-shaped, similar to that of a farm tool ‘sickle’. The sickle cells die early, which causes a constant shortage of RBC, which leads to low oxygen carriers in the body,” mentioned Dr Rahul Bhargava, director and head, haematology and bone marrow transplant, Fortis Memorial Research Institute, Gurugram.

Also, when sickle cells travel, they tend to get stuck in small blood vessels and restrict blood flow. This can cause pain in the joints, chest, and other serious problems such as stroke, acute chest syndrome, and infections.

Sickle cell trait need to be screened (Source: Getty Images/Thinkstock)

Complications

SCD can lead to a lot of complications, including stroke, acute chest syndrome, pulmonary hypertension, organ damage, blindness and leg ulcers, among others.

Diagnosis

SCD can be diagnosed with a simple blood test. Experts note that parents are advised to get the screening done before conceiving as it is transmitted from parents. “For newborns, the test is done in the hospitals as a routine screening. There is no single treatment for SCD patients and it varies from patient to patient on the basis of the symptoms. Before starting any medication, consult a haematologist who specialises in blood disorders,” Dr Bhargava said.

Issues with travelling to higher altitudes

As such, considering that lower oxygen levels are typical of high-altitude regions, and people with SCD already have impaired oxygen-carrying ability as a result of their defective red blood cells, it can worsen SCD symptoms and raise the risk of complications, said Dr Vijay Kumar Gurjar, senior consultant and HOD-internal medicine, Primus Super Speciality Hospital. “Oxygen deprivation can result in pain flare-ups, exhaustion, shortness of breath, and other health problems. So, if you’re thinking about visiting such places, use caution,” said Dr Gurjar.

Dr Amit Upadhyay, senior consultant – haemato oncology at PSRI Hospital, New Delhi, concurred and said that the lack of oxygen puts additional strain on their already compromised red blood cells, increasing the likelihood of vaso-occlusive crises. “These crises occur when sickle-shaped red blood cells block blood vessels, resulting in intense pain, organ damage, and other serious complications. The combination of oxygen deprivation and the inherent tendency of sickle cells to clump together under stress makes high-altitude travel particularly risky for individuals with SCD,” said Dr Upadhyay.

Another issue in high-altitude areas is dehydration. Low humidity is common in certain regions, which raises the possibility of dehydration. “Dehydration encourages the sickling of red blood cells, which can lead to sickle cell crises. In order to reduce the risk of problems, it is essential for people with SCD to maintain adequate levels of hydration. However, SCD patients may experience difficulties when travelling to high altitudes because of the combination of reduced oxygen levels and an elevated risk of dehydration,” said Dr Gurjar.

Another factor is physical effort. Activities that can be physically taxing, like hiking, climbing, or skiing, are frequently available in high-altitude areas. “The body is put under more stress and needs to consume more oxygen when performing vigorous tasks at high elevations. This added stress may result in consequences like pain crises, exhaustion, or even more serious occurrences like acute chest syndrome for those with SCD who already have impaired oxygen transport,” explained Dr Gurjar.

Besides, travelling to high-altitude destinations presents challenges in terms of medical care and access for individuals with SCD, said Dr Upadhyay. “High-altitude regions may have limited healthcare infrastructure and resources, making it difficult to obtain immediate medical assistance in case of a crisis. Moreover, the unfamiliarity of healthcare providers in these areas with sickle cell disease can further impede the delivery of appropriate care,” said Dr Upadhyay.

Here’s what to keep in mind when trekking to higher altitudes (Source: Pixabay)

Is the issue common to all individuals with SCD?

While it is recommended that SCD patients use caution when visiting high-altitude locations, each case should be assessed individually, urged Dr Gurjar. “It is important to consider the person’s overall health as well as the severity of the sickness. Before making such travel arrangements, patients must speak with their healthcare physician. The medical professional can examine the patient’s particular circumstances, weigh the dangers, and make tailored advice,” said Dr Gurjar.

What should be done?

Before planning any travel to high-altitude destinations, it is crucial for patients with SCD to consult with their healthcare provider, urged Dr Vikas Dua, principal director and head of paediatric haematology, and bone marrow transplant, Fortis Memorial Research Institute, Gurgaon. “The physician can assess the patient’s individual condition, evaluate their current health status, and provide personalised advice and recommendations,” said Dr Dua.

Understanding the potential risks involved and taking necessary precautions, such as adequate hydration, maintaining appropriate oxygenation, and considering the availability of medical facilities at the destination, is crucial for individuals with SCD when considering travel to high-altitude areas, added Dr Dua. “Ultimately, the well-being and safety of the patient should be the top priority, and a thorough discussion with a healthcare professional will help make an informed decision regarding travel plans,” said Dr Dua.

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