Preliminary exploration of secondhand smoke exposure in youth with Sickle Cell Disease: biochemical verification, pulmonary functioning, and health care utilization

A 21-Year-Old Woman with Sickle Cell Disease and Vaso-Occlusive Pain Associated with Using an Electronic Nicotine Dispensing System (E-Cigarette or Vape) - a Case Report

BACKGROUND Sickle cell disease is an inherited blood disorder that leads to multisystem complications. The heterogeneous course of sickle cell disease is due to both genetic modifiers and environmental factors. Cigarette smoking is a strong risk factor for sickle cell complications and even secondhand exposure to tobacco smoke can be detrimental for individuals with sickle cell disease. However, no prior reports have associated e-cigarettes and sickle cell vaso-occlusive pain. CASE REPORT A 21 year old woman presented with sickle cell disease SS complicated by frequent pain, multiple acute chest syndrome episodes, sickle cell nephropathy, and avascular necrosis of the left hip, plus mild intermittent asthma. She developed pain in the ribs and back after her first use of e-cigarettes. After 4 days of home pain management, she came to the Emergency Department. She was mildly hypoxic and received supplemental oxygen. Chest radiograph did not show airspace consolidation, and the sites of pain were consistent with her prior pain episodes, so the diagnosis was sickle cell vaso-occlusive pain. Her hemoglobin was more than 2 g/dL below baseline and she received a red blood cell transfusion on hospital day 2. Overall, this was among her more severe pain episodes. CONCLUSIONS The rising popularity of e-cigarettes, also known as vapes or Electronic Nicotine Delivery Systems (ENDS), is partly due to the misconception that they are safer than traditional cigarettes. Although firm conclusions will depend on studies designed to provide rigorous evidence, this case suggests that the acute adverse effects of ENDS might trigger complications of sickle cell disease, especially with asthma as a comorbidity.

Risk factors associated with increased emergency department utilization in patients with sickle cell disease: a systematic literature review

Sickle cell disease (SCD), a genetic disorder affecting up to 100,000 patients in the USA, impacts multiple organ systems. The emergency department (ED) is frequently utilized by patients with SCD who have severe pain from vaso-occlusive crises. The goal of this systematic literature review is to identify predictors for ED use among patients with SCD in the USA, as high ED reliance is not ideal because of the potential for discontinuity of care as well as higher costs. PubMed and Embase were searched for articles containing the keywords "sickle cell disease" AND ("emergency" OR "acute care") AND ("utilization" OR "health care") published between 2000 and 26 September 2019. A total of 26 publications were identified meeting the following inclusion criteria: report of ED or acute care clinic use; report of health care utilization for SCD; and report of ED visits independent of hospital admission, ED revisits, inpatient care visits, and SCD care unit visits. Articles unavailable in English or those focused on populations outside the USA were excluded. Of the 26 articles included, 4 were prospective and the remainder were retrospective. Qualitative analysis of the articles revealed a higher rate of ED utilization among adults than children, patients with public insurance than private insurance, and patients with more comorbidities, complications, or pain. Age and pain levels were both commonly cited as predictors of ED utilization. Additional prospective and interventional studies are needed to further define predictors of ED utilization and to uncover treatments that decrease ED visits.