Hydroxyurea may have a number of beneficial effects in patients with sickle cell disease. It can result in an increase in hemoglobin F concentration and reduce neutrophils, monocytes and reticulocytes. Its use may be limited by the development of unacceptable myelotoxicity or by a failure to show improvement.


Indications for starting hydroxyurea therapy: both of the following:

(1) adolescent or adult

(2) one or more of the following

(2a) frequent episodes of pain

(2b) history of acute chest pain or other serious vaso-occlusive complication

(2c) severe symptomatic anemia


Indications to continue hydroxyurea therapy:

(1) with history of frequent episodes of pain: reduction in pain episodes

(2) with history of severe anemia: increase in hemoglobin

(3) increase in percent hemoglobin F and/or MCV

(4) acceptable myelotoxicity, with absolute neutrophil count >= 2,000 per µL and platelet count >= 80,000 per µL



• MCV can serve as a surrogate marker for hemoglobin F.


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