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Martino S, Turki RC, Zouiti F, Fort R, Pakdaman S, Forté S, Menouche D, Calvet D, Rupp T, Pirenne F, Bartolucci P. Near-Infrared Spectroscopy Demonstrates the Benefit of Erythracytapheresis in Sickle Cell Disease Adult Patients with Cerebral Vasculopathy. J Clin Med 2023; 12:jcm12041256. [PMID: 36835792 PMCID: PMC9966188 DOI: 10.3390/jcm12041256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Cerebral vasculopathy can induce chronic cerebral hypoperfusion leading to stroke in patients with sickle cell disease (SCD) and is treated by blood exchange transfusion (BET). However, no prospective clinical study has demonstrated the benefit of BET in adults with SCD and cerebral vasculopathy. Near Infrared Spectroscopy (NIRS) is a recent non-invasive method complementary to Magnetic Resonance Imaging (MRI). We evaluated cerebral perfusion using NIRS during erythracytapheresis in patients with SCD with and without steno-occlusive arterial disease. METHODS We conducted a monocentric, prospective study in 16 adults with SCD undergoing erythracytapheresis in 2014. Among them, 10 had cerebral steno-occlusive arterial disease. NIRS measured the relative amounts of oxyhemoglobin (OxyHb), deoxyhemoglobin (DeoxyHb) and total hemoglobin (Total Hb) in brain tissue and in muscle. RESULTS In cerebral hemispheres associated with steno-occlusive arterial disease, we observed a significant increase of OxyHb and Total Hb during BET, without modification of DeoxyHb. CONCLUSION Using NIRS during BET showed that BET improves cerebral perfusion in adult patients with SCD with cerebral vasculopathy.
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Affiliation(s)
- Suella Martino
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Creteil, France
| | - Rym Chouk Turki
- Etablissement Français du Sang, Île-de-France Mondor, 94000 Creteil, France
| | - Fouzia Zouiti
- Etablissement Français du Sang, Île-de-France Mondor, 94000 Creteil, France
| | - Romain Fort
- Department of Internal Medicine, Edouard Herriot University Hospital, 69003 Lyon, France
| | - Sadaf Pakdaman
- Etablissement Français du Sang, Île-de-France Mondor, 94000 Creteil, France
| | - Stéphanie Forté
- Division of Hematology and Oncology, Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC H2X 3E4, Canada
| | - Dehbia Menouche
- Department of Apheresis, Henri Mondor University Hospital, UPEC, APHP, 94000 Creteil, France
| | - David Calvet
- Department of Neurology, Sainte-Anne Hospital, 75014 Paris, France
| | - Thomas Rupp
- Interuniversity Laboratory of Human Movement Biology, University Savoie Mont Blanc, 73000 Chambery, France
| | - France Pirenne
- Etablissement Français du Sang, Île-de-France Mondor, 94000 Creteil, France
- Laboratoire D’Excellence, GRex, Institut Mondor, INSERM U955 Equipe 2, 94000 Creteil, France
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Creteil, France
- Laboratoire D’Excellence, GRex, Institut Mondor, INSERM U955 Equipe 2, 94000 Creteil, France
- Correspondence:
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Forté S, De Luna G, Abdulrehman J, Fadiga N, Pestrin O, Pham Hung d’Alexandry d’Orengiani AL, Aneke JC, Guillet H, Budhram D, Habibi A, Ward R, Bartolucci P, Kuo KHM. Thromboprophylaxis Reduced Venous Thromboembolism in Sickle Cell Patients with Central Venous Access Devices: A Retrospective Cohort Study. J Clin Med 2022; 11:jcm11051193. [PMID: 35268283 PMCID: PMC8910838 DOI: 10.3390/jcm11051193] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 12/16/2022] Open
Abstract
Sickle cell disease (SCD) induces a chronic prothrombotic state. Central venous access devices (CVADs) are commonly used for chronic transfusions and iron chelation in this population. CVADs are an additional venous thromboembolism (VTE) risk factor. The role of thromboprophylaxis in this setting is uncertain. The objectives are: (1) to determine whether thromboprophylaxis reduces VTE risk in SCD patients with CVAD and (2) to explore characteristics associated with VTE risk. We identified adults with SCD and CVAD intended for chronic use (≥3 months) at two comprehensive SCD centers. Thromboprophylaxis presence; type; intensity; and patient-, catheter-, and treatment-related VTE risk factors were recorded. Among 949 patients, 49 had a CVAD (25 without and 24 with VTE prophylaxis). Thromboprophylaxis type and intensity varied widely. Patients without thromboprophylaxis had higher VTE rates (rate ratio (RR) = 4.0 (95% confidence interval: 1.2−12.6), p = 0.02). Hydroxyurea was associated with lower VTE rates (RR = 20.5 (6.4−65.3), p < 0.001). PICC lines and Vortex and Xcela Power implantable devices were associated with higher rates compared with Port-a-Cath (RR = 5.8 (1.3−25.9), p = 0.02, and RR = 58.2 (15.0−225.0), p < 0.001, respectively). Thromboprophylaxis, hydroxyurea, and CVAD subtype were independently associated with VTE. The potentially protective role of thromboprophylaxis and hydroxyurea for VTE prevention in patients with SCD and CVAD merits further exploration.
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Affiliation(s)
- Stéphanie Forté
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Gonzalo De Luna
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Créteil, France; (G.D.L.); (A.-L.P.H.d.d.); (H.G.); (A.H.); (P.B.)
| | - Jameel Abdulrehman
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Nafanta Fadiga
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Olivia Pestrin
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Anne-Laure Pham Hung d’Alexandry d’Orengiani
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Créteil, France; (G.D.L.); (A.-L.P.H.d.d.); (H.G.); (A.H.); (P.B.)
| | - John Chinawaeze Aneke
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Henri Guillet
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Créteil, France; (G.D.L.); (A.-L.P.H.d.d.); (H.G.); (A.H.); (P.B.)
| | - Dalton Budhram
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Anoosha Habibi
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Créteil, France; (G.D.L.); (A.-L.P.H.d.d.); (H.G.); (A.H.); (P.B.)
| | - Richard Ward
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
| | - Pablo Bartolucci
- Sickle Cell Referral Center, Department of Internal Medicine, Henri Mondor University Hospital, UPEC, APHP, 94000 Créteil, France; (G.D.L.); (A.-L.P.H.d.d.); (H.G.); (A.H.); (P.B.)
- Laboratoire D’Excellence, GRex, Institut Mondor, INSERM U955 Equipe 2, 94000 Créteil, France
| | - Kevin H. M. Kuo
- Division of Medical Oncology and Hematology, University Health Network, Toronto, ON M5G 2C4, Canada; (S.F.); (J.A.); (N.F.); (O.P.); (J.C.A.); (D.B.); (R.W.)
- Correspondence:
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Ilonze C, Anderson M, Stubblefield A, Journeycake J, Sinha AA. Use of infusion ports in patients with sickle cell disease: Indications and complications. Pediatr Blood Cancer 2022; 69:e29445. [PMID: 34786823 DOI: 10.1002/pbc.29445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/27/2021] [Accepted: 10/15/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Peripheral venous access in patients with sickle cell disease (SCD) can become difficult over time due to frequent access and scarring. Infusion ports provide reliable central venous access. Deep venous thrombosis (DVT) and infections are complications associated with SCD and infusion ports. METHODS We performed a 17.5-year single-institution retrospective chart review (January 2000 to July 2018) with literature review regarding use of infusion ports in patients with SCD. RESULTS We identified 32 patients with infusion ports placed for a total of 63 devices (48 for chronic transfusion [CT] and 15 for poor venous access [PVA], not on CT) for a total of 99,272 catheter days. The mean age at first insertion was 8 years (range 1-20 years). Complications included malfunction, infection, thrombosis, difficult access, and pain over infusion port site. The rate of infection was 0.2 per 1000 catheter days. Thrombosis was identified in three devices (5%) in three patients (9%), with a rate of 0.03 per 1000 catheter days. There was no difference in complications by site in either the left or right subclavian vein (p = 1). The rate of premature removal was 0.36 per 1000 catheter days, which was higher among patients with infusion ports solely for PVA (0.87 per 1000 catheter days) compared with those placed for CT (0.29 per 1000 catheter days). CONCLUSION Infusion ports in patients with SCD was associated with low rates of thrombosis, infection, and malfunction, and may be considered as an alternative to frequent intravenous access, especially in patients requiring CT.
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Affiliation(s)
- Chibuzo Ilonze
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael Anderson
- Department of Epidemiology & Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Alex Stubblefield
- Department of Epidemiology & Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Economics, Michigan State University, East Lansing, Michigan, USA
| | - Janna Journeycake
- Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Arpan A Sinha
- Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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