Folic acid has long been prescribed as a supplement for SCD, despite a lack of evidence supporting its effectiveness. Folate, also known as vitamin B9, is a water-soluble vitamin involved in the production of red blood cells. It is believed that adequate intake of folic acid can alleviate anemia symptoms caused by the rapid breakdown of red blood cells in SCD patients. However, recent data analysis indicates that while supplementation with folic acid increases folate levels, it does not significantly impact hemoglobin concentration, anemia symptoms, pain crises, rate of infections, or hospitalizations.[1]
Iron deficiency is common in individuals with SCD, but there are conflicting opinions regarding supplementation with iron. On one hand, low iron levels may reduce painful crises by decreasing hemoglobin concentration in sickled red blood cells.[2] On the other hand, iron deficiency can have a detrimental impact on both physical and mental growth, making adequate levels important. Until further studies are conducted, people with SCD should consult their doctor before starting any iron supplements.
Zinc sulfate may also be a promising supplement for SCD. Studies show that it may reduce the frequency of pain crises if taken for a year, and it may reduce the number of infections after just three months of use. However, these findings are based on a small group of trials, and more studies should be conducted to verify its efficacy and safety.[3]
Additionally, research is exploring the use of L-arginine as an adjunct therapy to reduce vaso-occlusion and associated pain crises. L-arginine is required to produce nitric oxide (NO), a vasodilator. Studies show that children who received L-arginine in addition to parenteral opioids experienced a 54% reduction in total opioid use throughout the study.[4]