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Donna Morelli: Hydroxyurea Safe and Effective for Pediatric Sickle Cell in Africa

Donna Morelli/LinkedIn

Oct 12, 2026, 17:53

Donna Morelli: Hydroxyurea Safe and Effective for Pediatric Sickle Cell in Africa

Donna Morelli, Data Analyst / Adult Cardiac and Thoracic Surgery at Boston Medical Center Corporation, shared a post on LinkedIn:

“Children living with sickle cell can be treated safely using hydroxyurea. New research shows the efficacy and safety of hydroxyurea treatment for sickle cell anemia, in four low-income sites in Africa, with no increase in clinically diagnosed infections.

Imperial College London. 08 Oct. 2026

Excerpt: Hydroxyurea is a drug taken once daily by mouth that reduces the complications of sickle cell anemia by encouraging the body to produce more fetal hemoglobin, the form of hemoglobin normally made by babies in the womb, that stops red blood cells from sickling.

Note: Hydroxyurea is a recommended treatment in high-income countries, doctors have been cautious in low-income settings, because it reduces the number of infection-fighting neutrophils, and could lead to an increased risk of infections where access to clinical services is low.

The study, part of the National Institutes of Health (NIH)-funded Realizing Effectiveness Across Continents with Hydroxyurea, (REACH) trial, showed there was no increase in the incidence or severity of infections, including malaria, in children receiving hydroxyurea treatment.

Sickle cell anemia is the most common and severe inherited blood disease in humans. Approximately 80 percent of cases occurring in sub-Saharan Africa. Around 550,000 children are born with sickle cell anemia yearly. This results in complications such as pain, vulnerability to infections and chronic ill health.

Bacterial and viral infections are a common complication of sickle cell anemia, including life-threatening infections. In theory, treatment by hydroxyurea could worsen infections including malaria because it dampens the immune system; however, this has not been studied in detail previously.

The study, published in The Lancet Hematology (enc), was carried out at four sites in Africa: Angola, DR Congo, Kenya and Uganda. It involved treatment of 606 children and young adults living with sickle cell anemia. Recruitment of children aged one to ten took place between 2014 and 2016. Patients have been followed up every two to three months since then.

The children participating in the multicenter trial began hydroxyurea treatment for six months at a fixed dose, then escalated to the maximum dose tolerated.

During the trial, most infections were reported retrospectively, usually through clinical history rather than through real time testing for infection. The incidence of malarial and non-malarial infections decreased as the dose of hydroxyurea increased. The researchers found the risk of infection dropped by 51 percent for malaria and 38 percent for non-malarial infections.

REACH has been running for more than 10 years and has shown hydroxyurea therapy is both safe and highly effective in reducing most sickle-related complications. Through extended analysis, the latest research shows hydroxyurea treatment does not increase the risk of serious infections in low-income settings in Africa.

Additional information and link to the published study enclosed.”

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