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Elevated plasma homocysteine is a risk factor for vascular disease and may be associated with increased risk of vascular complications in SCD patients. In the present study, microvascular characteristics were assessed in the bulbar conjunctiva of 18 paediatric and 18 adult SCD patients, using the non\u2010invasive technique of computer\u2010assisted intravital microscopy. A vasculopathy severity index (SI) was computed to quantify the degree of microvasculopathy in each patient. Plasma homocysteine and several of its determinants [serum folate and vitamin B12, plasma pyridoxal\u20105'\u2010phosphate (vitamin B6 status) and creatinine (kidney function)] were measured. Age was strongly correlated with microvasculopathy in the SCD patients, with the SI increasing about 0\u00b71 unit per one\u2010year increase in age (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00\u00b7001). After adjusting for age, gender, B\u2010vitamin status and creatinine, homocysteine concentration was directly correlated with severity index (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00\u00b705). Age and homocysteine concentration were independent predictors of microvasculopathy in SCD patients. It remains to be determined whether lowering homocysteine concentrations using appropriate B\u2010vitamin supplements (folate and vitamins B12 and B6) \u2012 particularly if started early in life \u2012 could ameliorate microvasculopathy and its associated complications in SCD patients.<\/jats:p>","DOI":"10.1111\/bjh.16618","type":"journal-article","created":{"date-parts":[[2020,4,20]],"date-time":"2020-04-20T06:41:15Z","timestamp":1587364875000},"page":"450-457","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Homocysteine is associated with severity of microvasculopathy in sickle cell disease patients"],"prefix":"10.1111","volume":"190","author":[{"given":"Sandra L.","family":"Samarron","sequence":"first","affiliation":[{"name":"Department of Medical Pathology and Laboratory Medicine University of California Davis CA 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