Imperial College London

Dr Frédéric B. Piel

Faculty of MedicineSchool of Public Health

Senior Lecturer



+44 (0)20 7594 3346f.piel




Praed StreetSt Mary's Campus






BibTex format

author = {Tewari, S and Brousse, V and Piel, FB and Menzel, S and Rees, DC},
doi = {10.3324/haematol.2014.120030},
journal = {Haematologica},
pages = {1108--1116},
title = {Environmental determinants of severity in sickle cell disease},
url = {},
volume = {100},
year = {2016}

RIS format (EndNote, RefMan)

AB - Sickle cell disease causes acute and chronic illness, and median life expectancy is reduced by at least 30 years in all countries, with greater reductions in low-income countries. There is a wide spectrum of severity, with some patients having no symptoms and others suffering frequent, life-changing complications. Much of this variability is unexplained, despite increasingly sophisticated genetic studies. Environmental factors, including climate, air quality, socio-economics, exercise and infection, are likely to be important, as demonstrated by the stark differences in outcomes between patients in Africa and USA/Europe. The effects of weather vary with geography, although most studies show that exposure to cold or wind increases hospital attendance with acute pain. Most of the different air pollutants are closely intercorrelated, and increasing overall levels seem to correlate with increased hospital attendance, although higher concentrations of atmospheric carbon monoxide may offer some benefit for patients with sickle cell disease. Exercise causes some adverse physiological changes, although this may be off-set by improvements in cardiovascular health. Most sickle cell disease patients live in low-income countries and socioeconomic factors are undoubtedly important, but little studied beyond documenting that sickle cell disease is associated with decreases in some measures of social status. Infections cause many of the differences in outcomes seen across the world, but again these effects are relatively poorly understood. All the above factors are likely to account for much of the pathology and variability of sickle cell disease, and large prospective studies are needed to understand these effects better.
AU - Tewari,S
AU - Brousse,V
AU - Piel,FB
AU - Menzel,S
AU - Rees,DC
DO - 10.3324/haematol.2014.120030
EP - 1116
PY - 2016///
SN - 0390-6078
SP - 1108
TI - Environmental determinants of severity in sickle cell disease
T2 - Haematologica
UR -
UR -
VL - 100
ER -