Blood transfusion usage among adults with sickle cell disease - a single institution experience over ten years

Molecular Haematology, Division of Gene and Cell Based Therapy, King's College London School of Medicine, Denmark Hill, London, UK.
British Journal of Haematology (Impact Factor: 4.71). 03/2011; 152(6):766-70. DOI: 10.1111/j.1365-2141.2010.08451.x
Source: PubMed


Transfusion of red blood cells is a major therapeutic option in sickle cell disease (SCD). There is strong evidence for its efficacy, particularly in primary and secondary stroke prevention in children, however, its use in other areas remains controversial. This study assessed the patterns of transfusion in the adult cohort attending King's College Hospital over a 10-year period, from 2000 to 2009. Total blood usage has increased significantly (P = 0·006) during this time, with 78% of the blood received by only 6% of the patients. The increase is explained by increased automated red cell exchange and increased usage for planned and acute transfusions for sickle-related complications.

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Available from: Alex Mijovic, Oct 06, 2014
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    • "Blood transfusion is increasingly used in the prevention and treatment of many of the complications of sickle cell disease (SCD) (Drasar et al, 2011). The benefits of transfusion must be weighed against its risks, including iron overload, infections and haemolytic transfusion reactions. "
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    ABSTRACT: Delayed haemolytic transfusion reactions (DHTR) are potentially life-threatening complications in patients with sickle cell disease (SCD). Between 1 August 2008 and 31 December 2013, 220 of 637 adult patients in our centre had at least one red blood cell (RBC) transfusion in 2158 separate transfusion episodes. Twenty-three DHTR events occurred in 17 patients (13 female) including 15 HbSS, one HbSC and one HbSβ(0) thalassaemia, equating to a DHTR rate of 7·7% of patients transfused. Mean interval from RBC transfusion to DHTR event was 10·1 ± 5·4 d, and typical presenting features were fever, pain and haemoglobinuria. Twenty of the 23 (87·0%) DHTR episodes occurred following transfusion in the acute setting. Notably, 11/23 (47·8%) of DHTRs were not diagnosed at the time of the event, most were misdiagnosed as a vaso-occlusive crisis. 16/23 DHTRs had 'relative reticulocytopenia', which was more common in older patients. Seven of 23 episodes resulted in alloantibody formation, and three caused autoantibody formation. DHTRs are a severe but uncommon complication of RBC transfusion in SCD and remain poorly recognized, possibly because they mimic an acute painful crisis. Most of the DHTRs are triggered by RBC transfusion in the acute setting when patients are in an inflammatory state. © 2015 John Wiley & Sons Ltd.
    British Journal of Haematology 03/2015; 169(5). DOI:10.1111/bjh.13339 · 4.71 Impact Factor
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    • "Blood transfusion is increasingly used in the management of SCD. Indeed, a recent audit of patients at King's College Hospital (London, UK) showed expanding indications , and a large number of patients presenting with clinically significant iron overload after a period of sporadic blood transfusions (Drasar et al, 2011). With repeated blood transfusion, iron deposits in target organs causing oxidative damage and fibrosis (Andrews, 2000). "
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    ABSTRACT: Spin density projection-assisted R2-magnetic resonance imaging (R2-MRI; FerriScan(®)) scans from 40 chelation-naïve sickle cell patients were used to assess renal iron load by measuring renal R2 (R-R2). Clinical data were collected retrospectively for the 2-year period preceding the scan. R-R2 showed no significant correlation with transfusional iron load (assessed by liver iron concentration), but correlated significantly with serum bilirubin (R = 0·61, P < 0·0001) and lactate dehydrogenase (R = 0·58, P < 0·0001). Mean (±standard deviation) R-R2 was higher (P = 0·02) in patients with renal hyperfiltration (29·8 ± 10·3/s) than those without (23·11 ± 6·6/s). Five patients had significantly lower signal intensity in the renal cortex, as compared to the medulla. These patients had a significantly higher (P < 0·0001) mean R-R2 than those showing no cortico-medullary difference. We postulate that the increased R-R2 is associated with haemolysis rather than transfusional iron load in sickle cell disease.
    British Journal of Haematology 03/2012; 157(5):599-605. DOI:10.1111/j.1365-2141.2012.09093.x · 4.71 Impact Factor
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    • "Blood transfusion therapy usage in sickle cell disease (SCD) is increasing (Drasar et al, 2011) and with this comes the potential for morbidity and mortality associated with the consequent iron overload. Whilst patients treated with regular blood transfusions have their iron indices monitored regularly and are under regular clinical review, patients receiving sporadic blood transfusions can accrue a substantial iron load relatively unnoticed. "
    British Journal of Haematology 02/2012; 157(5):645-7. DOI:10.1111/j.1365-2141.2012.09060.x · 4.71 Impact Factor
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