Global burden of transfusion in sickle cell disease

Treating sickle cell disease in resource-limited sub-Saharan Africa: recent strategies and recommendations in addressing the gaps for the provision of evidence-based management

INTRODUCTION

The management of Sickle cell disease (SCD) in sub-Saharan Africa (SSA) suffers from the lack of universal infant and population screening, inadequate access to standard treatment and poor public health prioritization amidst unstable political systems.

AREAS COVERED

The state of evidencebased management of SCD in SSA was investigated including sustainability of international funding agencies.

EXPERT OPINION

Current efforts are fragmentary along languages lines; sometimes driven by the funder's objectives and not the national agenda. The review highlighted the role of internal and external partnerships such as SPARCO, ARISE, CONSA, as well as technology-based support for the implementation of evidence-based care for SCD. We advocate for increased funding to implement SCD comprehensive care in line with the WHO SCD Framework for Primary, Secondary, Tertiary and Specialist Comprehensive Care at state and national level. To achieve this objective, it is important that SCD, as a leading non-communicable disease in Africa, be mandated as a standing agenda for the National Council of Ministers at the African Union, WHO and other regional bodies in Africa.

Red blood cell utilization in patients with sickle cell disease: A Canadian single-center experience

BACKGROUND

Red blood cell (RBC) utilization in patients with sickle cell disease (SCD) in Canada is poorly defined. This study describes RBC utilization in an SCD cohort at a single Canadian center.

STUDY DESIGN AND METHODS

All adults with SCD who received care at the Ottawa Hospital between January 2006 and May 2019 were included, and followed until December 2021. Data on hospital encounters and RBC transfusions were obtained from hospital databases.

RESULTS

Overall, 273 patients were included (median age: 25 years; 53.8% female; median follow-up: 8.1 years). During the study period, there were 23,127 hospital encounters (median: 45 [interquartile range (IQR) 18, 100] per patient), with 165 patients (60.4% of cohort) receiving 22,538 RBC units. Most RBC units (86.5%) were transfused in the outpatient setting. Although only 2.9% of patients had O-negative blood type, O-negative RBC units accounted for 29.1% of units transfused. One hundred forty-seven patients received 2205 RBC units (9.8% of total) as simple transfusions (median: 5 [IQR 3, 13] per patient), and 88 patients received 20,333 RBC units (90.2% of total) during 2702 red cell exchange (RCE) sessions (median: 14.5 (IQR 1, 47.5) RCE per transfused patient). A median of 7 RBC units (IQR 6, 9) were transfused per RCE session, with a median of 30 days (IQR 28, 40) between sessions.

DISCUSSION

Patients with SCD at our center frequently received O-negative units, and large RBC volumes were used for RCE. These results provide a utilization baseline for future education and quality improvement initiatives to optimize RBC stewardship.

Use of automated isovolemic hemodilution red-cell exchange in patients with sickle cell disease: A Canadian single center experience

BACKGROUND

Red cell exchange (RCE) is an important treatment for sickle cell disease (SCD). It is a resource-intensive intervention requiring large volumes of red blood cells (RBC), which are frequently antigen-matched. Efforts to reduce the volume of units transfused, while maintaining treatment efficacy is an important need. This study evaluates the impact of a change to isovolemic hemodilution (IHD)-RCE on RBC utilization in SCD patients at a Canadian center.

STUDY DESIGN AND METHODS

Adult SCD patients receiving chronic automated RCE at the Ottawa Hospital were approached for study inclusion. To safely attain a meaningful reduction in transfused RBCs, RCE parameters were individualized for each patient. IHD-RCE was performed only if an estimated reduction in RBC volume of at least 200 mL was expected, with hematocrit not allowed to decrease below 20%. Data were compared in the 6-months before and after the protocol change.

RESULTS

Twenty-two adult patients met the criteria for inclusion. There was a net reduction of 107 RBC units after the transition from standard RCE to IHD-RCE (1035 vs. 928 units; -10.3%). The mean number of RBC units transfused per patient decreased by 4.8 (47.0 vs. 42.2 units; p = .01). No difference in target post-RCE hemoglobin S levels was observed.

DISCUSSION

In this study IHD-RCE reduced RBC utilization without impacting efficacy or safety, conserving 107 RBC units (an annualized savings of $95,444 CAD). No adverse events due to saline replacement were observed. Increased awareness of the benefits of IHD-RCE through knowledge translation could promote greater uptake.

Arginine supplementation improves lactate dehydrogenase levels in steady-state sickle cell patients: preliminary findings from Kinshasa, the Democratic Republic of Congo

Background

Sickle cell disease (SCD) disrupts oxygen transport due to the abnormal shape and rigidity of red blood cells, leading to hemolysis. Hemolysis, a major co-morbidity in SCD, is indicated by elevated levels of lactate dehydrogenase (LDH). Arginine depletion, which is essential for nitric oxide (NO) synthesis, contributes to various complications in SCD. L-arginine supplementation may increase NO levels and reduce oxidative stress. Research on its benefits in SCD, which is prevalent in sub-Saharan Africa, is limited. This study evaluates the effect of arginine supplementation on LDH levels in patients with steady state SCD.

Methods

In a retrospective study, we evaluated the effect of arginine supplementation on LDH levels in a cohort of 31 patients. We divided the study into three phases: pre-HU treatment, HU treatment, and combined HU and arginine supplementation.

Results

The cohort had a median age of 12 years, ranging from 2 to 43 years. Throughout all three phases of the study, lactate dehydrogenase (LDH) levels were consistently above the established normal ranges, with elevations of 216.7%, 220.3% and 176.6% above the normative values for baseline, Phase 1 (HU) and Phase 2 (HU + Arg), respectively. Specifically, LDH levels were 649.7 ± 364.2 U/L in Baseline Phase, 661.6 ± 367 U/L in Phase 1, and 529.9 ± 346.3 U/L in Phase 2. When comparing these discrete study intervals, it is noteworthy that LDH levels were significantly lower in Phase 2 compared to the previous phases (p = 0.002).

Conclusion

Preliminary findings revealed a significant lower LDH levels among sickle cell patients receiving combined arginine supplementation and hydroxyurea (HU). Although these findings are promising, their credibility and applicability require further and more extensive research.

Sickle Cell Health Awareness, Perspectives, and Experiences (SHAPE) survey: Perspectives of adolescent and adult patients, caregivers, and healthcare professionals on the burden of sickle cell disease

OBJECTIVES

Sickle cell disease (SCD) is an inherited disorder that causes lifelong complications, substantially impacting the physical and emotional well-being of patients and their caregivers. Studies investigating the effects of SCD on quality of life (QOL) are often limited to individual countries, lack SCD-specific QOL questionnaires, and exclude the caregiver experience. The SHAPE survey aimed to broaden the understanding of the global burden of SCD on patients and their caregivers and to capture the viewpoint of healthcare providers (HCPs).

METHODS

A total of 919 patients, 207 caregivers, and 219 HCPs from 10, 9, and 8 countries, respectively, answered a series of closed-ended questions about their experiences with SCD.

RESULTS

The symptoms most frequently reported by patients were fatigue/tiredness (84%) and pain/vaso-occlusive crises (71%). Patients' fatigue/tiredness had one of the greatest impacts on both patients' and caregivers' QOL. On average, patients and caregivers reported missing 7.5 days and 5.0 days per month, respectively, of school or work. HCPs reported a need for effective tools to treat fatigue/tiredness and a desire for more support to educate patients on long-term SCD-related health risks.

CONCLUSIONS

The multifaceted challenges identified using the SHAPE survey highlight the global need to improve both patient and caregiver QOL.