Volume 3 • Issue 4 • 1000123 J Psychol Psychother ISSN: 2161-0487 JPPT, an open access journal Research Article Open Access Ilesanmi, J Psychol Psychother 2013, 3:4 DOI: 10.4172/2161-0487.1000123 Research Article Open Access Gender Differences in Sickle Cell Crises: Implications for Genetic Counselling and Psychotherapy Oluwatoyin Olatundun Ilesanmi 1* USIP Certifcate in Confict Analysis, PN and M, Trained Genetic Counsellor Gendered Psychotherapist, Nigeria *Corresponding author: Oluwatoyin Olatundun Ilesanmi, PhD in Clinical Psychology, USIP Certificate in Conflict Analysis, PN and M, Trained Genetic Counsellor and Gendered Psychotherapist, Centre for Gender and Social Policy Studies, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria, Tel: +0234-8052236377; E-mail: toytundun@yahoo.com, toytundun@aol.com Received July 17, 2013; Accepted August 26, 2013; Published September 02, 2013 Citation: Ilesanmi OO (2013) Gender Differences in Sickle Cell Crises: Implications for Genetic Counselling and Psychotherapy. J Psychol Psychother 3: 123. doi: 10.4172/2161-0487.1000123 Copyright: © 2013 Ilesanmi OO. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Abstract Painless and painful crises are common phenomena in sickle cell crises. People with Sickle Cell Disorder (SCD) do experience both chronic and acute pain throughout life. The painful crisis is unpleasant with wide variation in intensity, quality, duration and persistence. It accounts for over 60% of hospital admissions in any given year of persons affected with SCD. Little attempt has been made to survey gender differences in frequency and intensity of pain as well as types of crises often experience by individuals suffering SCD. Thus researches focusing on gender differences in SCD crises are rear despite the fact the two men often report lower pain thresholds, higher pain ratings, and lower to lerance for pain. Men affected by SCD also experience low nitric oxide. Psychologically, women experienced high level of anxiety over pregnancy related crises. Thus, limited understanding and awareness exists among mental health practitioners on the need for genetic counseling and about the psychotherapeutic management of painful crises in persons affected by SCD. Hence, the need for this research that attempt to examine the differences in crises as well as proffer solutions for the genetic and mental health implications of these disorders. Keywords: Sickle cell disorders; Genetics; Counselling; Psychotherapy Introduction Painless and painful crises are common phenomena in sickle cell disorder which is a genetic blood disorder caused by the presence of an abnormal form of hemoglobin. It is an inherited autosomal recessive genetic disorder of hemoglobin (Hb) structure caused by point mutation at the sixth position in beta globin chain, valine substituting glutamic acid [1]. Te afected person inherits 2 mutant globin genes- one is always the sickle mutation (abnormal haemoglobin structure). Tis leads to periodic episodes of pain and damages the vital organs. Sickle red cells die afer only about 10 to 20 days, instead of the usual 120 days. Because they cannot be replaced fast enough, the blood is chronically short of red cells, thereby, causing anemia. Tere are 4 important genotypes among patients of West African origin: SS, sickle cell-hemoglobin C (SC), sickle cell-beta thalassemia (Sβ° and Sβ+). All of these disorders occur equally in males and females. Te most severe form of SCD is homozygous sickle cell anemia (Hb SS). Individuals with sickle cell trait, i.e., heterozygote’s for HbS, do not experience any adverse clinical consequences (except under acute hypoxic conditions, e.g., exposure to high altitude without time to accommodate) and have had a selective advantage against malaria. Tose with the homozygous disease face a chronic disease, with onset in childhood leading to devastating consequences. For most people, sickle cell disorder usually results in anemia, but the primary symptomatic manifestation is pain (Figure 1). Many afected persons do experience both chronic and acute pain throughout life. Te painful crises are caused by recurrent acute vaso-occlusion in the short run and chronic pain and end-organ damage in the long run; potentially afecting all organ systems with particular harm to bones, kidneys, lungs, eyes, and brain. Essentially, SCD crises usually occur whenever partially or totally deoxygenated Hgb molecules distort their normal disk shape, producing stif, sticky, sickle-shaped cells that obstruct small blood vessels and produce vaso-occlusion as well as the disruption of oxygen to body tissues. (i.e. cyclic polymerization of HbS, generation of dense, dehydrated red cells and the interaction between sickle red cells and abnormal activated vascular endothelial cells). Tus, SCD painful crises are unpleasant with wide variation in intensity, quality, duration and persistence; and accounts for over 60% of hospital admissions in any given year of persons afected with SCD. Complications include acute chest syndrome, avascular necrosis, priapism, ischemic leg ulcers, transient ischemic attacks and stroke, gallstones, renal insufciency (Figure 2). Dehydration, temperature extremes, infection, changes in altitude, stress, and physical exertion sometimes precipitate crises, but most crises occur without an identifable cause. A sickle cell crisis can be life-threatening. Te crises clinical features can afect every organ of the body. It can also occur at multiple foci, thus patients with SCD are at risk for other medical complications including, but not limited to, delayed growth and sexual maturation; acute and chronic pulmonary dysfunction; stroke; aseptic necrosis of the hip, shoulders, or both; sickle cell retinopathy; dermal ulcers; and severe chronic pain. Global and national burden of SCD SCD usually manifests early in childhood, afects millions throughout the world. It occurs more commonly in people (or their 1 Dr OluwatoyinOlatundun ILESANMI is concerned with taking care of people with the Sickle Cell Disorder, as well as creation of awareness for the Prevention and Control of Sickle Cell Disorder in Nigeria (and beyond) through Information, psycho-education and Communication, Screening and genetic counselling. Journal of Psychology & Psychotherapy J o u r n a l o f P s y c h o l o g y & P s y c h o t h e r a p y ISSN: 2161-0487