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Adamkiewicz TV, Yee MEM, Thomas S, Tunali A, Lai KW, Omole FS, Lane PA, Yildirim I. Pneumococcal infections in children with sickle cell disease before and after pneumococcal conjugate vaccines. Blood Adv 2023; 7:6751-6761. [PMID: 37698500 PMCID: PMC10660014 DOI: 10.1182/bloodadvances.2022009643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 09/13/2023] Open
Abstract
Children with sickle cell disease (SCD) are at increased risk of invasive pneumococcal disease (IPD). Over 25 years, the Georgia Emerging Infections Program/Centers for Disease Control and Prevention Active Bacterial Core Surveillance network identified 104 IPD episodes among 3707 children with hemoglobin SS (HbSS) or HbSC aged <10 years, representing 6% of IPD in Black or African American children residing in Metropolitan Atlanta (reference population). Children with IPD and HbSS/SC were older than those with IPD in the reference population (P < .001). From 1994-1999 to 2010-2018, IPD declined by 87% in children with HbSS aged 0 to 4 years, and by 80% in those aged 5 to 9 years. However, IPD incidence rate ratios when comparing children with SCD with the reference population increased from 20.2 to 29.2 over these periods. Among children with HbSS and IPD, death declined from 14% to 3% after 2002, and meningitis declined from 16% to 8%. Penicillin resistance was more prevalent in children with SCD before 7-valent pneumococcal conjugate vaccine (PCV7) licensure. After 2010, all IPD serotypes were not included in the 13-valent PCV (PCV13). Within 3 years of vaccination, the effectiveness of the 23-valent pneumococcal polysaccharide vaccine (PPSV23) against non-PCV13 serotypes included in PPSV23 plus 15A/15C was 92% (95% confidence interval, 40.8- 99.0, P = .014; indirect-cohort effect adjusted for age and hydroxyurea). PPSV23 would cover 62% of non-PCV13 serotype IPD in children with SCD, whereas PCV15, PCV20, and PCV21/V116 (in development) could cover 16%, 51%, and 92%, respectively. Although less frequent, IPD remains a life-threatening risk in children with SCD. Effective vaccines with broader coverage could benefit these children.
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Affiliation(s)
- Thomas V. Adamkiewicz
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Marianne E. M. Yee
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Stepy Thomas
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Georgia Emerging Infections Program, Atlanta, GA
- Atlanta Veterans Administration Health System, Decatur, GA
| | - Amy Tunali
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
- Atlanta Veterans Administration Health System, Decatur, GA
| | - Kristina W. Lai
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
- University of California, Davis, CA
| | - Folashade S. Omole
- Department of Family Medicine, Morehouse School of Medicine, Atlanta, GA
| | - Peter A. Lane
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA
| | - Inci Yildirim
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT
- Yale Center for Infection and Immunity, Yale Institute of Global Health, New Haven, CT
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Astles R, Liu Z, Gillespie SE, Lai KW, Maillis A, Morris CR, Lane PA, Krishnamurti L, Bakshi N. Sex and frequency of pain episodes are associated with acute pain trajectories in adolescents with sickle cell disease. Pain Rep 2023; 8:e1084. [PMID: 37559677 PMCID: PMC10409410 DOI: 10.1097/pr9.0000000000001084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/09/2023] [Accepted: 04/29/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction/Objective Acute pain episodes are a major cause of health care utilization (HCU) in sickle cell disease (SCD), and adolescence is associated with increased pain frequency. We sought to determine whether there were differences in acute pain trajectories by sex and frequency of pain episodes among adolescents with SCD who presented to the emergency department (ED). Methods Retrospective review of electronic health records from a large, multicampus, pediatric SCD program. Results Of the 113 adolescents included, the mean age was 16.6 (SD 0.9), 41.6% (n = 47) were female, 77.9% (n = 88) had HbSS or a similarly severe genotype, and 43.4% (n = 49) had ≥3 episodes of HCU for pain, which we defined as having history of high HCU for pain. Those with a history of high HCU for pain had higher mean pain intensity scores at presentation, were more likely to receive either intravenous or intranasal opioids, and were more likely to be hospitalized. In a model considering the 3-way interaction between sex, history of high HCU for pain, and follow-up time from the initial pain intensity score, adjusted for opioid per kilogram body weight, and prescription of hydroxyurea, adolescent female patients with high HCU for pain had the slowest decline in pain intensity during treatment for acute pain in the ED. Conclusion Sex and history of high HCU for pain are associated with acute pain trajectories in adolescents with SCD presenting to the ED. These novel findings should be confirmed in future prospective studies.
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Affiliation(s)
- Rachel Astles
- Emory University School of Medicine, Atlanta, GA, USA
| | - Zihao Liu
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Scott E. Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Kristina W. Lai
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Alexander Maillis
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Claudia R. Morris
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Lakshmanan Krishnamurti
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Nitya Bakshi
- Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, GA, USA
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
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George PE, Maillis A, Zhu Y, Liu Y, Lane PA, Lam W, Lipscomb J, Ebelt S. Are children with sickle cell disease at particular risk from the harmful effects of air pollution? Evidence from a large, urban/peri-urban cohort. Pediatr Blood Cancer 2023; 70:e30453. [PMID: 37248172 PMCID: PMC10684822 DOI: 10.1002/pbc.30453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Pathophysiologic pathways of sickle cell disease (SCD) and air pollution involve inflammation, oxidative stress, and endothelial damage. It is therefore plausible that children with SCD are especially prone to air pollution's harmful effects. METHODS Patient data were collected from a single-center, urban/peri-urban cohort of children with confirmed SCD. Daily ambient concentrations of particulate matter (PM2.5 ) were collected via satellite-derived remote-sensing technology, and carbon monoxide (CO), nitrogen dioxide (NO2 ), and ozone from local monitoring stations. We used multivariable regression to quantify associations of pollutant levels and daily counts of emergency department (ED) visits, accounting for weather and time trends. For comparison, we quantified the associations of pollutant levels with daily all-patient (non-SCD) ED visits to our center. RESULTS From 2010 to 2018, there were 17,731 ED visits by 1740 children with SCD (64.8% HbSS/HbSβ0 ). Vaso-occlusive events (57.8%), respiratory illness (17.1%), and fever (16.1%) were the most common visit diagnoses. Higher 3-day (lags 0-2) rolling mean PM2.5 and CO levels were associated with daily ED visits among those with SCD (PM2.5 incident rate ratio [IRR] 1.051 [95% confidence interval: 1.010-1.094] per 9.4 μg/m3 increase; CO 1.088 [1.045-1.132] per 0.5 ppm). NO2 showed positive associations in secondary analyses; ozone levels were not associated with ED visits. The comparison, all-patient ED visit analyses showed lower IRR for all pollutants. CONCLUSIONS Our results suggest short-term air pollution levels as triggers for SCD events and that children with SCD may be more vulnerable to air pollution than those without SCD. Targeted pollution-avoidance strategies could have significant clinical benefits in this population.
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Affiliation(s)
- Paul E. George
- Emory University School of Medicine, Department of Pediatrics, Atlanta GA
- Emory University Rollins School of Public Health, Department of Health Policy and Management, Atlanta GA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta GA
| | - Alexander Maillis
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta GA
| | - Yijing Zhu
- Emory University Rollins School of Public Health, Gangarosa Department of Environmental Health, Atlanta GA
| | - Yang Liu
- Emory University Rollins School of Public Health, Gangarosa Department of Environmental Health, Atlanta GA
| | - Peter A. Lane
- Emory University School of Medicine, Department of Pediatrics, Atlanta GA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta GA
| | - Wilbur Lam
- Emory University School of Medicine, Department of Pediatrics, Atlanta GA
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta GA
| | - Joseph Lipscomb
- Emory University Rollins School of Public Health, Department of Health Policy and Management, Atlanta GA
| | - Stefanie Ebelt
- Emory University Rollins School of Public Health, Gangarosa Department of Environmental Health, Atlanta GA
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Tang AY, Zhou M, Maillis AN, Lai KW, Lane PA, Snyder AB. Trends in blood transfusion, hydroxyurea use, and iron overload among children with sickle cell disease enrolled in Medicaid, 2004-2019. Pediatr Blood Cancer 2023; 70:e30152. [PMID: 36579749 DOI: 10.1002/pbc.30152] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/07/2022] [Accepted: 11/22/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND There have been significant changes in clinical guidelines for sickle cell disease (SCD) over the past two decades, including updated indications for hydroxyurea, transfusions, and iron overload management. In practice however, there are few studies that examine SCD care utilization over time. METHODS We conducted a serial cross-sectional cohort study of pediatric SCD patients from 2004 to 2019 using Georgia Medicaid claims data. For each year, we reported receipt of any transfusion, chronic transfusion, or three or more filled hydroxyurea prescriptions. For children receiving chronic transfusion (six or more annual transfusions), we evaluated iron overload diagnosis, monitoring, and chelation use. Among children with sickle cell anemia (SCA), we examined rates of transfusions and hydroxyurea use. The Cochran-Armitage test was used to assess trend. RESULTS There were 5316 unique children 2-18 years old with SCD enrolled in Georgia Medicaid from 2004 to 2019. Children receiving any transfusion increased from 2004 to 2010, then stabilized. In SCA patients, chronic transfusions initially increased from 2004 to 2010, then stabilized from 2010 to 2019. For chronically transfused children, monitoring of iron burden and filled chelator prescriptions both increased significantly. Hydroxyurea use in SCA patients increased from 12% to 37%, with increases noted within each age group, most notably from 21% to 60% in the 13-18-year-old cohort. CONCLUSION We demonstrated changes in SCD care utilization over time, including increased hydroxyurea use, changes in transfusion rates, and increased attention to iron overload management. While trends in clinical management do follow updates in treatment guidelines, there is still delayed and suboptimal uptake of guideline recommendations in pediatric SCD patients.
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Affiliation(s)
- Amy Y Tang
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Mei Zhou
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - Alexander N Maillis
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kristina W Lai
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Peter A Lane
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Angela B Snyder
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
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Rees CA, Brousseau DC, Ahmad FA, Bennett J, Bhatt S, Bogie A, Brown KM, Casper TC, Chapman LL, Chumpitazi CE, Cohen DM, Dampier C, Ellison AM, Grasemann H, Hickey RW, Hsu LL, Lane PA, Bakshi N, Leibovich S, Patil P, Powell EC, Richards R, Sarnaik S, Weiner DL, Morris CR. Adherence to NHLBI guidelines for the emergent management of vaso-occlusive episodes in children with sickle cell disease: A multicenter perspective. Am J Hematol 2022; 97:E412-E415. [PMID: 36054566 PMCID: PMC9561082 DOI: 10.1002/ajh.26696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 01/28/2023]
Affiliation(s)
- Chris A. Rees
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - David C. Brousseau
- Children’s Research Institute of the Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Fahd A. Ahmad
- Division of Emergency Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | | | - Seema Bhatt
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Amanda Bogie
- Univesrsity of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | | | | | - Laura L. Chapman
- Alpert Medical School, Brown University, Providence, Rhode Island
| | - Corrie E. Chumpitazi
- Division of Pediatric Emergency Medicine, Baylor College of Medicine, Houston, Texas
| | | | - Carlton Dampier
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
| | | | | | - Robert W. Hickey
- Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, Pennsylvania
| | - Lewis L. Hsu
- University of Illinois at Chicago, Chicago, Illinois
| | - Peter A. Lane
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Nitya Bakshi
- Division of Pediatric Hematology/Oncology/BMT, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Sara Leibovich
- UCSF-Benioff Children’s Hospital at Oakland, Oakland, California
| | | | - Elizabeth C. Powell
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rachel Richards
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
| | | | - Debra L. Weiner
- Division of Pediatric Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Claudia R. Morris
- Division of Pediatric Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia
- Children’s Healthcare of Atlanta, Atlanta, Georgia
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Yee ME, Lai KW, Bakshi N, Grossman JK, Jaggi P, Mallis A, Wang YF, Jerris RC, Lane PA, Yildirim I. Bloodstream Infections in Children With Sickle Cell Disease: 2010-2019. Pediatrics 2022; 149:183842. [PMID: 34913059 PMCID: PMC8959248 DOI: 10.1542/peds.2021-051892] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at increased risk for bloodstream infections (BSIs), mainly because of functional asplenia. Immunizations and antibiotic prophylaxis have reduced the prevalence of invasive bacterial infections, but contemporary analysis of BSI in children with SCD is limited. METHODS We conducted a retrospective cohort study of children aged <18 years with SCD who had blood cultures collected at our institution from 2010 to 2019 to identify BSI. Probable contaminant organisms were identified and not included as BSI. We calculated the annual incidence of BSI at our institution with 95% confidence intervals (CIs) and used multivariate logistic regression to evaluate associations. RESULTS There were 2694 eligible patients with 19 902 blood cultures. Excluding repeated cultures and contaminant cultures, there were 156 BSI episodes in 144 patients. The median age at BSI was 7.5 years. The average incidence rate of BSI was 0.89 per 100 person-years (95% CI 0.45-1.32). The most common pathogens were Streptococcus pneumoniae (16.0%), Streptococcus viridans group (9.0%), Escherichia coli (9.0%), Staphylococcus aureus (7.7%), Bordetella holmesii (7.7%), Haemophilus influenzae (7.1%), and Salmonella species (6.4%). Odds of BSI were higher with sickle cell anemia genotypes (odds ratio [OR] 1.88; 95% CI 1.20-2.94) and chronic transfusions (OR 2.66; 95% CI 1.51-4.69) and lower with hydroxyurea (OR 0.57; 95% CI 0.39-0.84). CONCLUSIONS BSI remains a risk for children with SCD. Overall incidence, risk factors, and spectrum of pathogens are important considerations to guide prevention and empirical treatment of suspected infection in SCD.
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Affiliation(s)
- Marianne E. Yee
- Aflac Cancer and Blood Disorders Center,Departments of Pediatrics,Address correspondence to Marianne E. Yee, MD, MSc, Pediatric Hematology/Oncology, Emory University and Children’s Healthcare of Atlanta, 2015 Uppergate Rd, NE, Atlanta, GA 30322. E-mail:
| | | | - Nitya Bakshi
- Aflac Cancer and Blood Disorders Center,Departments of Pediatrics
| | | | | | | | - Yun F. Wang
- Pathology and Laboratory Medicine, School of Medicine,Department of Pathology and Laboratory Medicine, Grady Health System, Atlanta, Georgia
| | - Robert C. Jerris
- Department of Pathology and Laboratory Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia,Pathology and Laboratory Medicine, School of Medicine
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center,Departments of Pediatrics
| | - Inci Yildirim
- Departments of Pediatrics,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia,Center for Childhood Infections and Vaccines, Emory University and Children’s Healthcare of Atlanta, Atlanta, Georgia
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Reyes LZ, Figueroa J, Leake D, Khemani K, Kumari P, Bakshi N, Lane PA, Dampier C, Morris CR. Safety of intravenous arginine therapy in children with sickle cell disease hospitalized for vaso-occlusive pain: A randomized placebo-controlled trial in progress. Am J Hematol 2022; 97:E21-E24. [PMID: 34724240 PMCID: PMC8722015 DOI: 10.1002/ajh.26396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/25/2021] [Accepted: 10/28/2021] [Indexed: 01/03/2023]
Affiliation(s)
- Loretta Z. Reyes
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Atlanta, Georgia,
USA
| | - Janet Figueroa
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Atlanta, Georgia,
USA
| | - Deborah Leake
- Children’s Healthcare of Atlanta, Atlanta, Georgia,
USA
| | - Kirshma Khemani
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Atlanta, Georgia,
USA
| | - Polly Kumari
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Atlanta, Georgia,
USA
| | - Nitya Bakshi
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Atlanta, Georgia,
USA
| | - Peter A. Lane
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Atlanta, Georgia,
USA
| | - Carlton Dampier
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Atlanta, Georgia,
USA
| | - Claudia R. Morris
- Department of Pediatrics, Emory University School of
Medicine, Atlanta, Georgia, USA,Children’s Healthcare of Atlanta, Atlanta, Georgia,
USA
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Bakshi N, Cooley A, Ross D, Hawkins L, Sullivan M, Astles R, Sinha C, Katoch D, Peddineni M, Gee BE, Lane PA, Krishnamurti L. A pilot study of the acceptability, feasibility and safety of yoga for chronic pain in sickle cell disease. Complement Ther Med 2021; 59:102722. [PMID: 33892094 DOI: 10.1016/j.ctim.2021.102722] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/12/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES To determine the acceptability, feasibility and safety of yoga for chronic pain in sickle cell disease. DESIGN AND SETTING In Part A of this two-part study, adolescents with SCD and chronic pain (Group 1) and their parent (Group 2) completed a survey designed to capture pain characteristics, attitudes and practices related to yoga, and potential acceptability of a yoga program. In Part B, the study assessed the feasibility and safety of an instructor-led group yoga program. The study was registered on clinicaltrials.gov (NCT03694548). INTERVENTION Eight instructor-led group yoga sessions. MAIN OUTCOME MEASURES Feasibility and safety outcomes were chosen a priori, as follows: 1) Proportion of adolescent patients with SCD and chronic pain approached that consent to participate in Part A, 2) Proportion of adolescent participants enrolled in Part A that consent to participate in Part B, 3) Proportion of participants enrolled in Part B that attend at least 6 of 8 yoga sessions, 4) Proportion of participants enrolled in Part B with an ED visit or a hospitalization for pain within 24 h of completion of each yoga session, 5) Proportion of participants in Part B who complete all study assessments before, and at the end of the yoga program, 6) Adherence to submission of pain diary. RESULTS The median age of 15 patient participants in Part A was 16 (IQR 14-17), and 14 parents was 43.5 (IQR 42-51). Most participants were female. Most participant responses indicated a positive opinion of yoga. Nine adolescents (60 %) from Part A participated in Part B of the study. The median age of 9 participants in Part B was 17 (IQR 15-18), and 5 of the 9 participants were female (53.3 %). Only one participant was able to attend 3 of the 8 yoga sessions offered, and did not experience any ED visits or hospitalizations following the yoga sessions. None of the other feasibility endpoints were met in this study. CONCLUSIONS Patients with SCD and chronic pain overall have a positive opinion of yoga, but there are challenges with recruitment and retention of participants in a clinical trial of yoga, and barriers to feasibility of an in-person group yoga intervention.
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Affiliation(s)
- Nitya Bakshi
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA.
| | - Anthony Cooley
- Division of Hospital Medicine, Department of Pediatrics, Emory University, USA
| | - Diana Ross
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Lauren Hawkins
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | | | - Rachel Astles
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Cynthia Sinha
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA
| | - Deeksha Katoch
- Department of Pediatrics, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Manasa Peddineni
- NOVA Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Beatrice E Gee
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Peter A Lane
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lakshmanan Krishnamurti
- Division of Pediatric Hematology-Oncology-BMT, Department of Pediatrics, Emory University, Atlanta, GA, USA; Aflac Cancer and Blood Disorders Center of Children's Healthcare of Atlanta, Atlanta, GA, USA
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9
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Rostad CA, Maillis AN, Lai K, Bakshi N, Jerris RC, Lane PA, Yee ME, Yildirim I. The burden of respiratory syncytial virus infections among children with sickle cell disease. Pediatr Blood Cancer 2021; 68:e28759. [PMID: 33034160 PMCID: PMC8246443 DOI: 10.1002/pbc.28759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although respiratory syncytial virus (RSV) is the leading cause of pediatric lower respiratory tract infections, the burden of RSV in children with sickle cell disease (SCD) is unknown. METHODS We conducted a retrospective, nested, case-control study of children with SCD <18 years who had respiratory viral panels (RVPs) performed at Children's Healthcare of Atlanta from 2012 to 2019. We abstracted the medical records to describe the demographics, clinical features, and outcomes of children who tested positive for RSV (cases) versus children who tested negative (controls). We calculated the annual incidence of RSV and related hospitalization rates with 95% confidence intervals (CIs) and used multivariate logistic regression to evaluate associations. RESULTS We identified 3676 RVP tests performed on 2636 patients over seven respiratory seasons resulting in 219/3676 (6.0%) RSV-positive tests among 160/2636 (6.1%) patients. The average annual incidence of laboratory-confirmed RSV infection among children with SCD was 34.3 (95% CI 18.7-49.8) and 3.8 (95% CI 0.5-7.0) cases per 1000 person-years for those <5 years and 5-18 years, respectively. The RSV-related hospitalization rate for children <5 years was 20.7 (95% CI 8.5-32.8) per 1000 person-years. RSV-positive cases were significantly younger than RSV-negative patients (3.8 years vs 7.6 years, P < .001). Of RSV-positive cases, 22 (13.8%) developed acute chest syndrome and nine (5.6%) required intensive care, which was not significantly different from RSV-negative children with SCD. CONCLUSION RSV infections are common in children with SCD with higher burden in younger patients. RSV is associated with considerable morbidity, including higher rates of hospitalization compared to the general population.
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Affiliation(s)
- Christina A. Rostad
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA,Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia, USA,Corresponding Author: Christina A. Rostad, MD. Current Address: Emory Children’s Center, 2015 Uppergate Dr NE, Atlanta, Georgia, 30322, USA.
| | - Alexander N. Maillis
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Kristina Lai
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Nitya Bakshi
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA,Department of Pediatrics, Division of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Robert C. Jerris
- Department of Pathology and Laboratory Medicine, Children’s Healthcare of Atlanta, Atlanta, GA,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA,Department of Pediatrics, Division of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Marianne E. Yee
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, Georgia, USA,Department of Pediatrics, Division of Hematology and Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Inci Yildirim
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA,Center for Childhood Infections and Vaccines of Children’s Healthcare of Atlanta and Emory University, Atlanta, Georgia, USA,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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10
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Kao CM, Yee ME, Maillis A, Lai K, Bakshi N, Rostad BS, Jerris RC, Lane PA, Yildirim I. Microbiology and radiographic features of osteomyelitis in children and adolescents with sickle cell disease. Pediatr Blood Cancer 2020; 67:e28517. [PMID: 32710705 PMCID: PMC8369475 DOI: 10.1002/pbc.28517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at increased risk for bacterial infections including osteomyelitis (OM). Fever and bone pain, key presenting symptoms of OM, are common in SCD, thus complicating diagnosis. We reviewed presentation, imaging features, and microbiologic etiologies of children with SCD treated for OM. METHODS The comprehensive SCD clinical database of children and adolescents with SCD followed at a single, large tertiary pediatric center were searched to identify all diagnostic coding for potential cases of osteomyelitis in children ages 6 months to 21 years from 2010 to 2019. Medical charts were reviewed to determine OM diagnostic probability based on radiographic and microbiologic findings and the duration of prescribed antibiotic treatment for OM. RESULTS Review of 3553 patients (18 039 person-years) identified 20 episodes of probable OM in 19 children. Magnetic resonance imaging (MRI) findings to support OM were definitive in 4/19 (21%), probable in 10/19 (53%), suspected in 5/19 (26%), based on blinded radiologist review. Blood and/or operative cultures from bone and tissue debridement isolated Salmonella species in seven (35%) cases and methicillin-susceptible Staphylococcus aureus (MSSA) in two (10%). Six patients received antibiotic treatment prior to obtainment of cultures. Of culture-positive cases, MRI findings for OM were definitive or probable in six of nine (67%), suspected in three of nine (33%). CONCLUSIONS Distinction between OM and sickle-related bone infarct or vasoocclusion is difficult based on imaging findings alone. Early attainment of blood and operative cultures increases the likelihood of identifying and adequately treating OM.
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Affiliation(s)
- Carol M. Kao
- Department of Pediatrics, Division of Infectious Diseases, Emory University, Atlanta, GA
| | - Marianne E. Yee
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, GA
| | - Alexander Maillis
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Kristina Lai
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Nitya Bakshi
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, GA
| | - Bradley S. Rostad
- Department of Radiology and Imaging Services, Emory University, Atlanta, GA
| | - Robert C. Jerris
- Department of Pathology and Laboratory Medicine, Children’s Healthcare of Atlanta, Atlanta, GA.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA.,Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, GA
| | - Inci Yildirim
- Department of Pediatrics, Division of Infectious Diseases, Emory University, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health, Atlanta, GA
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11
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Kao CM, Lai K, McAteer JM, Elmontser M, Quincer EM, Yee MEM, Tippet A, Jerris RC, Lane PA, Anderson EJ, Bakshi N, Yildirim I. Influenza vaccine effectiveness and disease burden in children and adolescents with sickle cell disease: 2012-2017. Pediatr Blood Cancer 2020; 67:e28358. [PMID: 32469138 PMCID: PMC8221251 DOI: 10.1002/pbc.28358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/16/2020] [Accepted: 03/31/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Data are limited on the burden of influenza and seasonal influenza vaccine effectiveness (VE) in children with sickle cell disease (SCD). METHODS We used a prospectively collected clinical registry of SCD patients 6 months to 21 years of age to determine the influenza cases per 100 patient-years, vaccination rates, and a test-negative case-control study design to estimate influenza VE against medically attended laboratory-confirmed influenza infection. Influenza-positive cases were randomly matched to test-negative controls on age and influenza season in 1:1 ratio. We used adjusted logistic regression models to compare odds ratio (OR) of vaccination in cases to controls. We calculated VE as [100% × (1 - adjusted OR)] and computed 95% confidence intervals (CIs) around the estimate. RESULTS There were 1037 children with SCD who were tested for influenza, 307 children (29.6%) had at least one influenza infection (338 infections, incidence rate 3.7 per 100 person-years; 95% CI, 3.4-4.1) and 56.2% of those tested received annual influenza vaccine. Overall VE pooled over five seasons was 22.3% (95% CI, -7.3% to 43.7%). Adjusted VE estimates ranged from 39.7% (95% CI, -70.1% to 78.6%) in 2015/2016 to -5.9% (95% CI, -88.4% to 40.4%) in the 2016/17 seasons. Influenza VE varied by age and was highest in children 1-5 years of age (66.6%; 95% CI, 30.3-84.0). Adjusted VE against acute chest syndrome during influenza infection was 39.4% (95% CI, -113.0 to 82.8%). CONCLUSIONS Influenza VE in patients with SCD varies by season and age. Multicenter prospective studies are needed to better establish and monitor influenza VE among children with SCD.
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Affiliation(s)
- Carol M Kao
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Kristina Lai
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - John M McAteer
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Mohnd Elmontser
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Elizabeth M Quincer
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Marianne EM Yee
- Emory University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Ashley Tippet
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Robert C Jerris
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Peter A Lane
- Emory University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Evan J Anderson
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA
| | - Nitya Bakshi
- Emory University School of Medicine, Department of Pediatrics, Division of Hematology/Oncology, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Inci Yildirim
- Emory University School of Medicine, Department of Pediatrics, Division of Infectious Diseases, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health, Atlanta, GA
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12
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Yee MEM, Meyer EK, Fasano RM, Lane PA, Josephson CD, Brega AG. Health literacy and knowledge of chronic transfusion therapy in adolescents with sickle cell disease and caregivers. Pediatr Blood Cancer 2019; 66:e27733. [PMID: 30941859 DOI: 10.1002/pbc.27733] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/05/2019] [Accepted: 03/07/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Patients with sickle cell disease (SCD) may require chronic transfusion therapy (CTT) for prevention of stroke or other complications. Limited health literacy (HL) is common and is associated with poor health-related knowledge and outcomes in chronic disease. We sought to assess HL and transfusion knowledge in patients with SCD on CTT and their caregivers. METHODS A cross-sectional study of patients was conducted in outpatient hematology clinics. Forty-five pairs of adolescent patients and caregivers and 20 caregivers of pre-adolescent patients completed the Newest Vital Sign HL assessment and answered questions assessing SCD and transfusion knowledge. Community-level median income and unemployment rates were estimated from Census data. We computed the correlation of HL with knowledge and compared each to Census variables, payor status, educational attainment, and stroke. RESULTS HL was inadequate in 22 (34%) caregivers and 31 (69%) adolescents. Adequate caregiver HL was associated with higher educational attainment but not community-level socioeconomics or payor status. Mean knowledge score was lower in adolescents than in caregivers and correlated with age in adolescents (r = 0.42, P = .004). HL correlated with knowledge (r = 0.46, P < .0001). There were no significant correlations of HL or knowledge between adolescents and their caregivers. Neither HL nor knowledge was associated with prior stroke. The greatest knowledge was demonstrated for iron overload and SCD genotype, whereas knowledge gaps existed in alloimmunization, indication for CTT, and SCD curative therapy. CONCLUSIONS Enhanced educational resources in transfusion therapy, alloimmunization, and curative therapy are needed for patients with SCD and caregivers of all HL levels.
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Affiliation(s)
- Marianne E McPherson Yee
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Erin K Meyer
- Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Ross M Fasano
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Peter A Lane
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Cassandra D Josephson
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, Georgia.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, Georgia
| | - Angela G Brega
- Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
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13
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Yee M, Bakshi N, Graciaa SH, Lane PA, Jerris RC, Wang YF, Yildirim I. Incidence of invasive Haemophilus influenzae infections in children with sickle cell disease. Pediatr Blood Cancer 2019; 66:e27642. [PMID: 30724001 PMCID: PMC6472970 DOI: 10.1002/pbc.27642] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND Children with sickle cell disease (SCD) are at increased risk for invasive infection with encapsulated bacteria. Antibiotic prophylaxis and immunizations against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) have decreased the overall incidence of invasive infections and have shifted distribution of serotypes causing disease toward those not covered by immunizations. We sought to determine the current incidence of invasive H. influenzae infections in children with SCD and to describe the clinical features and management of these infections. METHODS Microbiology reports of a large pediatric tertiary care center were reviewed to identify all isolates of H. influenzae detected in sterile body fluid cultures from January 1, 2010 to December 31, 2017. Results were compared with the center's comprehensive clinical database of all children with SCD to identify all cases of children ages 0 to18 years with SCD with invasive H. influenzae disease for the same time period. RESULTS We captured 2444 patients with SCD, with 14,336 person-years. There were eight episodes of H. influenzae bacteremia in seven children with SCD (five type f, two non-typable, one type a). Most episodes (7 of 8) were in children < 5 years. The incidence rate of invasive H. influenzae in SCD was 0.58/1000 person-years for ages 0 to 18 years and 1.60/1000 person-years for children age < 5 years. There were no deaths from H. influenzae infection. CONCLUSIONS In the era of universal antibiotic prophylaxis and immunization against Hib, invasive H. influenzae disease due to nonvaccine serotypes remains a risk for children with SCD, particularly those under five years of age.
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Affiliation(s)
- Marianne Yee
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Nitya Bakshi
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Sara H. Graciaa
- Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Peter A. Lane
- Department of Pediatrics, Division of Hematology/Oncology, Emory University, Atlanta, GA.,Aflac Cancer and Blood Disorders Center, Children’s Healthcare of Atlanta, Atlanta, GA
| | - Robert C. Jerris
- Department of Pathology and Laboratory Medicine, Children’s Healthcare of Atlanta, Atlanta, GA.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Yun F. Wang
- Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA
| | - Inci Yildirim
- Department of Pediatrics, Division of Infectious Diseases, Emory University, Atlanta, GA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
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14
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Snyder AB, Zhou M, Theodore R, Quarmyne MO, Eckman J, Lane PA. Improving an Administrative Case Definition for Longitudinal Surveillance of Sickle Cell Disease. Public Health Rep 2019; 134:274-281. [PMID: 30970223 PMCID: PMC6505322 DOI: 10.1177/0033354919839072] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: Several states are building infrastructure and data collection methods for longitudinal, population-based surveillance systems for selected hemoglobinopathies. The objective of our study was to improve an administrative case definition for sickle cell disease (SCD) to aid in longitudinal surveillance. Methods: We collected data from 3 administrative data sets (2004-2008) on 1998 patients aged 0-21 in Georgia who had ≥1 encounter in which an SCD International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code was recorded, and we compared these data with data from a laboratory and medical record review. We assessed performance (sensitivity, specificity, positive predictive value [PPV], and negative predictive value [NPV]) of case definitions that differed by number and type of SCD-coded encounters; addition of SCD-associated treatments, procedures, and complications; and length of surveillance (1 vs 5 years). We identified correct diagnoses for patients who were incorrectly coded as having SCD. Results: The SCD case definition of ≥3 SCD-coded encounters in 5 years simplified and substantially improved the sensitivity (96.0% vs 85.8%) and NPV (68.2% vs 38.2%) of the original administrative case definition developed for 5-year, state-based surveillance (≥2 encounters in 5 years and ≥1 encounter for an SCD-related treatment, procedure, or complication), while maintaining a similar PPV (97.4% vs 97.4%) and specificity (76.5% vs 79.0%). Conclusions: This study supports an administrative case definition that specifies ≥3 ICD-9-CM–coded encounters to identify SCD with a high degree of accuracy in pediatric patients. This case definition can be used to help establish longitudinal SCD surveillance systems.
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Affiliation(s)
- Angela B Snyder
- 1 Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - Mei Zhou
- 1 Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - Rodney Theodore
- 1 Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - Maa-Ohui Quarmyne
- 3 Emory University School of Medicine & Sickle Cell Disease Program, Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - James Eckman
- 4 Departments of Hematology & Oncology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter A Lane
- 3 Emory University School of Medicine & Sickle Cell Disease Program, Children's Healthcare of Atlanta, Atlanta, GA, USA
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15
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Fasano RM, Branscomb J, Lane PA, Josephson CD, Snyder AB, Eckman JR. Transfusion service knowledge and immunohaematological practices related to sickle cell disease and thalassemia. Transfus Med 2019; 29:185-192. [PMID: 30740798 PMCID: PMC6767094 DOI: 10.1111/tme.12580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/09/2019] [Accepted: 01/12/2019] [Indexed: 11/29/2022]
Abstract
Objectives To assess current knowledge of National Heart, Lung and Blood Institutes (NHLBI) and Thalassemia International Federation (TIF) recommendations, blood banking practices and perceived challenges among transfusion services in the management of patients with haemoglobinopathies. Background Previous reports have demonstrated variations in transfusion practices for sickle cell disease (SCD) and thalassemia patients. Recently, NHLBI/TIF have provided transfusion recommendations for patients with haemoglobinopathies. Methods A cross‐sectional survey was conducted of transfusion services from the state of Georgia previously identified as having SCD/thalassemia populations. The survey assessed transfusion service practices in pre‐transfusion testing and blood product selection; awareness/implementation of NHLBI/TIF transfusion‐based recommendations and perceived challenges in transfusing haemoglobinopathy patients. Results Responses were received from 35 of 49 (71%) institutions. Only institutions indicating transfusing SCD or thalassemia patients (32) were included in analysis. Seventy‐one percent of non‐sickle cell treatment centres (SCTCs) and 20% of non‐thalassemia treatment centres follow NHLBI and TIF recommendations to perform a red blood cell phenotype beyond ABO/Rh(D) and provide Rh and Kell prophylactically matched units for SCD and thalassemia patients, respectively. Forty percent of institutions (33% of non‐SCTCs) employ RBC genotyping to evaluate the red cell phenotype for SCD patients. Over 77% of institutions do not utilise a reliable method to identify SCD patients prior to transfusion, such as a required question/answer field on type/screen or crossmatch orders. Conclusion Many healthcare systems' transfusion practices for haemoglobinopathy patients are discordant with NHLBI/TIF recommendations. Efforts are needed to increase awareness and implementation of current recommendations among all transfusion services seeing these patients.
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Affiliation(s)
- R M Fasano
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - J Branscomb
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - P A Lane
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics and Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C D Josephson
- Center for Transfusion and Cellular Therapies, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.,Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Department of Pediatrics and Hematology/Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
| | - A B Snyder
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia, USA
| | - J R Eckman
- Department of Hematology & Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
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16
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Tehseen S, Joiner CH, Lane PA, Yee ME. Changes in urine albumin to creatinine ratio with the initiation of hydroxyurea therapy among children and adolescents with sickle cell disease. Pediatr Blood Cancer 2017; 64. [PMID: 28612449 DOI: 10.1002/pbc.26665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 04/27/2017] [Accepted: 05/06/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Renal damage is a progressive complication of sickle cell disease (SCD) that begins in childhood and may progress to renal failure and early mortality in 12% of adults with hemoglobin SS (HbSS) SCD. Early sickle nephropathy is characterized by hyperfiltration and microalbuminuria; therefore, urine albumin to creatinine ratio (ACR) is an effective screening tool for its detection. PROCEDURE This study investigated the effect of hydroxyurea (HU) therapy on urine ACR levels among children with SCD. A retrospective review was conducted to identify all patients with HbSS or HbSβ0 thalassemia of age 7-18 years who began HU therapy in 2011-2013; a control group of patients not on HU were matched by age and baseline hemoglobin. All urine ACR measurements ≤24 months prior to and ≥24 months after HU initiation were recorded. RESULTS There were 63 eligible patients on HU and 13 (25%) with albuminuria prior to HU initiation. Among those with baseline albuminuria, the median ACR was 96 mg/g prior to HU, 39 mg/g at 1 year (P = 0.02), and 25 mg/g at 2 years (P = 0.03). Albuminuria normalized in 37.5% (6/16) after 1 year and 61% (8/13) after 2 years of HU therapy. Among those without albuminuria prior to HU, 13% (6/47) developed albuminuria during HU therapy. Sixteen percent (13/80) of control patients had albuminuria in the beginning of study period, which normalized in 15% (two of 13) of patients at 1-year follow up. CONCLUSION Introduction of HU is associated with significant decreases in urine ACR in children with SCD and albuminuria.
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Affiliation(s)
- Sarah Tehseen
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia
| | - Clinton H Joiner
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia
| | - Peter A Lane
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia
| | - Marianne E Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, Division of Pediatric Hematology/Oncology, Emory University, Atlanta, Georgia
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17
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Yee MEM, Lane PA, Archer DR, Joiner CH, Eckman JR, Guasch A. Estimation of glomerular filtration rate using serum cystatin C and creatinine in adults with sickle cell anemia. Am J Hematol 2017; 92:E598-E599. [PMID: 28670697 DOI: 10.1002/ajh.24840] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Marianne E. M. Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - David R. Archer
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - Clinton H. Joiner
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Atlanta Georgia
- Division of Hematology/Oncology; Department of Pediatrics, Emory University School of Medicine; Atlanta Georgia
| | - James R. Eckman
- Department of Hematology and Oncology; Winship Cancer Institute, Emory University School of Medicine; Atlanta Georgia
| | - Antonio Guasch
- Department of Medicine; Renal Division, Emory University School of Medicine; Atlanta Georgia
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18
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Yee ME, Lane PA, Archer DR, Joiner CH, Eckman JR, Guasch A. Losartan therapy decreases albuminuria with stable glomerular filtration and permselectivity in sickle cell anemia. Blood Cells Mol Dis 2017; 69:65-70. [PMID: 28951038 DOI: 10.1016/j.bcmd.2017.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 09/20/2017] [Indexed: 01/06/2023]
Abstract
Sickle cell nephropathy begins with hyperfiltration and microalbuminuria and may progress to renal failure. The aim of this study was to determine the effects of losartan on glomerular function and albumin excretion in sickle cell anemia (SCA). Individuals with SCA on hydroxyurea with persistent albuminuria were enrolled in a 1-year study of losartan. Glomerular filtration rate (GFR) measured by iohexol clearance, albumin excretion rate (AER), and fractional clearance of dextran were assessed at baseline, short-term (1-2month), and long-term (≥12month) intervals. Twelve subjects (6 microalbuminuria, 6 macroalbuminuria) completed short-term studies; 8 completed long-term studies. Baseline GFR was 112ml/min/1.73m2 (71-147ml/min/1.73m2). AER decreased significantly at the short-term (median decrease -134 mcg/min, p=0.0063). GFR was not significantly-different at short-term or long-term intervals. Dextran clearance improved for diameters smaller than albumin (<36Å) but not larger sizes. Losartan therapy for ≥1year in sickle nephropathy results in lower albumin excretion with stable GFR. Filtration of neutral molecules ≥36Å was not changed by losartan, suggesting that the effect of losartan is a mechanism other than alteration of glomerular filtration size-selectivity.
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Affiliation(s)
- Marianne E Yee
- Department of Pediatrics, Hematology/Oncology, Emory University, Atlanta, GA, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States.
| | - Peter A Lane
- Department of Pediatrics, Hematology/Oncology, Emory University, Atlanta, GA, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - David R Archer
- Department of Pediatrics, Hematology/Oncology, Emory University, Atlanta, GA, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Clinton H Joiner
- Department of Pediatrics, Hematology/Oncology, Emory University, Atlanta, GA, United States; Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - James R Eckman
- Emory University, Department of Medicine, Hematology/Oncology, Atlanta, GA, United States
| | - Antonio Guasch
- Department of Medicine, Renal Division, Emory University, Atlanta, GA, United States
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Quarmyne MO, Dong W, Theodore R, Anand S, Barry V, Adisa O, Buchanan ID, Bost J, Brown RC, Joiner CH, Lane PA. Hydroxyurea effectiveness in children and adolescents with sickle cell anemia: A large retrospective, population-based cohort. Am J Hematol 2017; 92:77-81. [PMID: 27761932 DOI: 10.1002/ajh.24587] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 10/14/2016] [Accepted: 10/17/2016] [Indexed: 11/11/2022]
Abstract
The clinical efficacy of hydroxyurea in patients with sickle cell anemia (SCA) has been well established. However, data about its clinical effectiveness in practice is limited. We evaluated the clinical effectiveness of hydroxyurea in a large pediatric population using a retrospective cohort, pre-post treatment study design to control for disease severity selection bias. The cohort included children with SCA (SS, Sβ0 thalassemia) who received care at Children's Healthcare of Atlanta (CHOA) and who initiated hydroxyurea in 2009-2011. Children on chronic transfusions, or children with inadequate follow up data and/or children who had taken hydroxyurea in the 3 years prior were excluded. For each patient healthcare utilization, laboratory values, and clinical outcomes for the 2-year period prior to hydroxyurea initiation were compared to those 2 years after initiation. Of 211 children with SCA who initiated hydroxyurea in 2009-2011, 134 met eligibility criteria. After initiation of hydroxyurea, rates of hospitalizations, pain encounters, and emergency department visits were reduced by 47% (<0.0001), 36% (P = 0.0001) and 43% (P < 0.0001), respectively. Average hemoglobin levels increased by 0.7 g/dl (P < 0.0001). Hydroxyurea effectiveness was similar across gender, insurance types and age, although there was a slightly greater reduction in hospitalizations in younger children. Am. J. Hematol. 92:77-81, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Maa-Ohui Quarmyne
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Wei Dong
- Connance, Inc; Waltham Massachusetts
| | - Rodney Theodore
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
| | - Sonia Anand
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
| | - Vaughn Barry
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Olufolake Adisa
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Iris D. Buchanan
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
- Department of Pediatrics, Morehouse School of Medicine; Atlanta Georgia
| | - James Bost
- Outcomes Center; Children's Healthcare of Atlanta; Atlanta Georgia
| | - Robert C. Brown
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Clinton H. Joiner
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center; Children's Healthcare of Atlanta; Atlanta Georgia
- Department of Pediatrics; Emory University School of Medicine; Atlanta Georgia
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Neunert CE, Gibson RW, Lane PA, Verma-Bhatnagar P, Barry V, Zhou M, Snyder A. Determining Adherence to Quality Indicators in Sickle Cell Anemia Using Multiple Data Sources. Am J Prev Med 2016; 51:S24-30. [PMID: 27320461 PMCID: PMC4918094 DOI: 10.1016/j.amepre.2016.02.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/22/2016] [Accepted: 02/09/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Advances in primary prophylaxis have resulted in improved outcomes for patients with sickle cell anemia (SCA; i.e., hemoglobin SS- and Sβ(0)-thalassemia). Standard prophylactic measures include a first pneumococcal polysaccharide vaccine (PPV) and transcranial Doppler ultrasound (TCD) at age 2 years. Though efficacious, evidence suggests that delivery of these interventions is suboptimal. This study reports adherence to these measures and examines concordance across various data sources, using Registry and Surveillance for Hemoglobinopathies project data. METHODS Retrospective database and SCA center chart review identified children with SCA aged 24-36 months between January 1, 2004, and December 31, 2008. PPV and TCD administration were determined through Medicaid and Children's Health Insurance Program administrative claims data, medical record review, and Georgia Registry of Immunization Transaction and Services. Analysis was conducted in 2015. RESULTS A total of 125 children met inclusion criteria. Forty-five (36.0%) children had documentation of both interventions, whereas 19 (15.2%) had no documentation of either intervention. Sixty-one (48.8%) children obtained only one intervention. Of these, more were likely to have had PPV than TCD (77.0% vs 23.0%, respectively, p<0.001). Agreement between claims data and medical record review was moderate for PPV (κ=0.55) and substantial for TCD (κ=0.74). CONCLUSIONS No single, reliable data source for tracking standard of care for children with SCA statewide was found. According to study data, prophylaxis measures were not universally implemented during the surveillance period. Further research is needed to adequately track changes over time, determine risk groups, and develop methods of evaluating important metrics.
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Affiliation(s)
- Cindy E Neunert
- Department of Pediatrics, Columbia University Medical Center and Morgan Stanley Children's Hospital, New York, New York
| | - Robert W Gibson
- Department of Emergency Medicine, Georgia Regents University, Augusta, Georgia
| | - Peter A Lane
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Pragya Verma-Bhatnagar
- Department of Pediatrics and Preventive Medicine, Quality of Life Health Services, Inc., Gadsden, Alabama
| | - Vaughn Barry
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, Georgia; Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Mei Zhou
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia
| | - Angela Snyder
- Georgia Health Policy Center, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia; Department of Public Management and Policy, Andrew Young School of Policy Studies, Georgia State University, Atlanta, Georgia.
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Nickel RS, Seashore E, Lane PA, Alazraki AL, Horan JT, Bhatia M, Haight AE. Improved Splenic Function After Hematopoietic Stem Cell Transplant for Sickle Cell Disease. Pediatr Blood Cancer 2016; 63:908-13. [PMID: 26757445 DOI: 10.1002/pbc.25904] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/15/2015] [Accepted: 12/17/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND Splenic dysfunction is a significant complication of sickle cell disease (SCD). Hematopoietic stem cell transplant (HSCT) is a proven cure for SCD; however, its long-term effect on splenic function is not well characterized. PROCEDURE We conducted a retrospective cohort study of pediatric patients who had HSCT for SCD at two transplant centers. (99m) Tc liver-spleen (LS) scans were blindly reviewed and classified as demonstrating absent, decreased, or normal splenic uptake. RESULTS Considering all engrafted nonsplenectomized Hb SS and Sβ(0) -thalassemia patients with LS scans available, at a median of 2.0 years post-HSCT (range 1.0-9.3 years) eight of 53 (15%) had normal, 40 of 53 (75%) decreased, and five of 53 (9%) absent splenic uptake. More patients had splenic uptake after HSCT: pre-HSCT 14/38 (37%) versus post-HSCT 34/38 (89%), P < 0.0001. Older age at HSCT was associated with worse splenic function post-HSCT (median age at HSCT for absent uptake 16.6 years vs. present uptake 8.0 years, P = 0.030). Extensive chronic GVHD was also more common in patients with absent splenic uptake compared to patients with present uptake (absent 40% vs. present 6%, P = 0.064). CONCLUSIONS HSCT significantly improves splenic function for most pediatric patients with SCD, but older patient age at time of HSCT and extensive chronic GVHD appear to be risk factors for poor post-HSCT splenic function.
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Affiliation(s)
- Robert Sheppard Nickel
- Division of Hematology, Children's National Health System, Washington, District of Columbia
| | - Elizabeth Seashore
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, New York, New York
| | - Peter A Lane
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Adina L Alazraki
- Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - John T Horan
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
| | - Monica Bhatia
- Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, New York, New York
| | - Ann E Haight
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, Georgia
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Nickel RS, Hendrickson JE, Fasano RM, Meyer EK, Winkler AM, Yee MM, Lane PA, Jones YA, Pashankar FD, New T, Josephson CD, Stowell SR. Impact of red blood cell alloimmunization on sickle cell disease mortality: a case series. Transfusion 2015; 56:107-14. [DOI: 10.1111/trf.13379] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/29/2015] [Accepted: 08/06/2015] [Indexed: 12/21/2022]
Affiliation(s)
- Robert Sheppard Nickel
- Center for Transfusion and Cellular Therapy, Department of Pathology; Emory University; Atlanta Georgia
- Division of Hematology; Children's National Health System; Washington DC
| | - Jeanne E. Hendrickson
- Center for Transfusion and Cellular Therapy, Department of Pathology; Emory University; Atlanta Georgia
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Emory University; Atlanta Georgia
- Department of Pediatrics; Yale University; New Haven Connecticut
- Department of Laboratory Medicine; Yale University; New Haven Connecticut
| | - Ross M. Fasano
- Center for Transfusion and Cellular Therapy, Department of Pathology; Emory University; Atlanta Georgia
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Emory University; Atlanta Georgia
| | - Erin K. Meyer
- Center for Transfusion and Cellular Therapy, Department of Pathology; Emory University; Atlanta Georgia
| | - Anne M. Winkler
- Center for Transfusion and Cellular Therapy, Department of Pathology; Emory University; Atlanta Georgia
| | - Marianne M. Yee
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Emory University; Atlanta Georgia
| | - Peter A. Lane
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Emory University; Atlanta Georgia
| | - Yuritzi A. Jones
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Emory University; Atlanta Georgia
| | | | - Tamara New
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Emory University; Atlanta Georgia
| | - Cassandra D. Josephson
- Center for Transfusion and Cellular Therapy, Department of Pathology; Emory University; Atlanta Georgia
- Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta; Emory University; Atlanta Georgia
| | - Sean R. Stowell
- Center for Transfusion and Cellular Therapy, Department of Pathology; Emory University; Atlanta Georgia
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Quang DV, Ba NX, Doyle PT, Hai DV, Lane PA, Malau-Aduli AE, Van NH, Parsons D. Effect of concentrate supplementation on nutrient digestibility and growth of Brahman crossbred cattle fed a basal diet of grass and rice straw. J Anim Sci Technol 2015; 57:35. [PMID: 26413310 PMCID: PMC4582636 DOI: 10.1186/s40781-015-0068-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 09/18/2015] [Indexed: 11/29/2022]
Abstract
Background An experiment was conducted in Vietnam to test the hypothesis that total dry matter (DM) intake and liveweight (LW) gain would increase in a curvilinear manner with increasing amounts of concentrate offered. Method There were five treatments: a basal diet of Guinea grass fed at 1 % of LW and rice straw fed ad libitum (T0), or this diet supplemented with concentrate at 0.6 (T1), 1.2 (T2), 1.8 (T3), or 2.4 % of LW (T4). The concentrate comprised locally available ingredients, namely cassava chips, rice bran, crushed rice grain, fishmeal, salt, and urea, mixed manually. Results Concentrate intake increased from T0 to T3, but there was no difference in concentrate intake between T3 and T4. Total feed intake increased in a curvilinear manner from 4.0 to 6.4 kg DM/d as the quantity of concentrate consumed increased. The substitution of concentrate for grass and rice straw increased with increasing consumption of concentrate and was as high as 0.49 kg DM reduction per kg of concentrate consumed. LW gain increased curvilinearly, with significant differences between T0 (0.092 kg/d), T1 (0.58 kg/d) and T2 (0.79 kg/d); but there were no significant differences in LW gain between T2, T3 (0.83 kg/d) and T4 (0.94 kg/d).With increasing amount of concentrate in the diet, the digestibilities of dry matter, organic matter, crude protein, and crude fat increased, but NDF digestibility decreased. Conclusion Based on these results, young Vietnamese Brahman-cross growing cattle will respond to a locally-sourced concentrate mix offered at a level of up to 1.2 % of LW.
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Affiliation(s)
- Do Van Quang
- Institute of Animal Science Southern Vietnam, Ho Chi Minh, Vietnam
| | - Nguyen Xuan Ba
- Faculty of Animal Sciences, Hue University of Agriculture and Forestry, Hue City, Vietnam
| | - Peter T Doyle
- Peter Doyle Consulting, 4 Red Bean Close, Byron Bay, NSW 2481 Australia
| | - Dau Van Hai
- Institute of Animal Science Southern Vietnam, Ho Chi Minh, Vietnam
| | - Peter A Lane
- Tasmanian Institute of Agriculture and School of Land and Food, University of Tasmania, Sandy Bay, 7001 Australia
| | - Aduli Eo Malau-Aduli
- Tasmanian Institute of Agriculture and School of Land and Food, University of Tasmania, Sandy Bay, 7001 Australia
| | - Nguyen Huu Van
- Faculty of Animal Sciences, Hue University of Agriculture and Forestry, Hue City, Vietnam
| | - David Parsons
- Tasmanian Institute of Agriculture and School of Land and Food, University of Tasmania, Sandy Bay, 7001 Australia
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Aygun B, Mortier NA, Kesler K, Lockhart A, Schultz WH, Cohen AR, Alvarez O, Rogers ZR, Kwiatkowski JL, Miller ST, Sylvestre P, Iyer R, Lane PA, Ware RE. Therapeutic phlebotomy is safe in children with sickle cell anaemia and can be effective treatment for transfusional iron overload. Br J Haematol 2015; 169:262-6. [PMID: 25612463 DOI: 10.1111/bjh.13280] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 11/04/2014] [Indexed: 11/28/2022]
Abstract
Serial phlebotomy was performed on sixty children with sickle cell anaemia, stroke and transfusional iron overload randomized to hydroxycarbamide in the Stroke With Transfusions Changing to Hydroxyurea trial. There were 927 phlebotomy procedures with only 33 adverse events, all of which were grade 2. Among 23 children completing 30 months of study treatment, the net iron balance was favourable (-8·7 mg Fe/kg) with significant decrease in ferritin, although liver iron concentration remained unchanged. Therapeutic phlebotomy was safe and well-tolerated, with net iron removal in most children who completed 30 months of protocol-directed treatment.
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Affiliation(s)
- Banu Aygun
- Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, NY, USA
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Parsons D, Van NH, Malau-Aduli AEO, Ba NX, Phung LD, Lane PA, Ngoan LD, Tedeschi LO. Evaluation of a nutrition model in predicting performance of vietnamese cattle. Asian-Australas J Anim Sci 2012; 25:1237-47. [PMID: 25049686 PMCID: PMC4092944 DOI: 10.5713/ajas.2012.12036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Revised: 06/18/2012] [Accepted: 05/03/2012] [Indexed: 11/27/2022]
Abstract
The objective of this study was to evaluate the predictions of dry matter intake (DM) and average daily gain (ADG) of Vietnamese Yellow (Vang) purebred and crossbred (Vang with Red Sindhi or Brahman) bulls fed under Vietnamese conditions using two levels of solution (1 and 2) of the large ruminant nutrition system (LRNS) model. Animal information and feed chemical characterization were obtained from five studies. The initial mean body weight (BW) of the animals was 186, with standard deviation ±33.2 kg. Animals were fed ad libitum commonly available feedstuffs, including cassava powder, corn grain, Napier grass, rice straw and bran, and minerals and vitamins, for 50 to 80 d. Adequacy of the predictions was assessed with the Model Evaluation System using the root of mean square error of prediction (RMSEP), accuracy (Cb), coefficient of determination (r2), and mean bias (MB). When all treatment means were used, both levels of solution predicted DMI similarly with low precision (r2 of 0.389 and 0.45 for level 1 and 2, respectively) and medium accuracy (Cb of 0.827 and 0.859, respectively). The LRNS clearly over-predicted the intake of one study. When this study was removed from the comparison, the precision and accuracy considerably increased for the level 1 solution. Metabolisable protein was limiting ADG for more than 68% of the treatment averages. Both levels differed regarding precision and accuracy. While level 1 solution had the least MB compared with level 2 (0.058 and 0.159 kg/d, respectively), the precision was greater for level 2 than level 1 (0.89 and 0.70, respectively). The accuracy (Cb) was similar between level 1 and level 2 (p = 0.8997; 0.977 and 0.871, respectively). The RMSEP indicated that both levels were on average under- or over-predicted by about 190 g/d, suggesting that even though the accuracy (Cb) was greater for level 1 compared to level 2, both levels are likely to wrongly predict ADG by the same amount. Our analyses indicated that the level 1 solution can predict DMI reasonably well for this type of animal, but it was not entirely clear if animals consumed at their voluntary intake and/or if the roughness of the diet decreased DMI. A deficit of ruminally-undegradable protein and/or a lack of microbial protein may have limited the performance of these animals. Based on these evaluations, the LRNS level 1 solution may be an alternative to predict animal performance when, under specific circumstances, the fractional degradation rates of the carbohydrate and protein fractions are not known.
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Affiliation(s)
- David Parsons
- Faculty of Animal Sciences, Hue University of Agriculture and Forestry, Hue City, Vietnam
| | - Nguyen Huu Van
- Faculty of Animal Sciences, Hue University of Agriculture and Forestry, Hue City, Vietnam
| | - Aduli E O Malau-Aduli
- Faculty of Animal Sciences, Hue University of Agriculture and Forestry, Hue City, Vietnam
| | - Nguyen Xuan Ba
- Faculty of Animal Sciences, Hue University of Agriculture and Forestry, Hue City, Vietnam
| | - Le Dinh Phung
- Faculty of Animal Sciences, Hue University of Agriculture and Forestry, Hue City, Vietnam
| | - Peter A Lane
- Faculty of Animal Sciences, Hue University of Agriculture and Forestry, Hue City, Vietnam
| | - Le Duc Ngoan
- Faculty of Animal Sciences, Hue University of Agriculture and Forestry, Hue City, Vietnam
| | - Luis O Tedeschi
- Department of Animal Science, Texas A&M University, College Station, TX 77843-2471, USA
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Styles L, Wager CG, Labotka RJ, Smith-Whitley K, Thompson AA, Lane PA, McMahon LEC, Miller R, Roseff SD, Iyer RV, Hsu LL, Castro OL, Ataga KI, Onyekwere O, Okam M, Bellevue R, Miller ST. Refining the value of secretory phospholipase A2 as a predictor of acute chest syndrome in sickle cell disease: results of a feasibility study (PROACTIVE). Br J Haematol 2012; 157:627-36. [PMID: 22463614 DOI: 10.1111/j.1365-2141.2012.09105.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Accepted: 01/23/2012] [Indexed: 01/28/2023]
Abstract
Acute chest syndrome (ACS) is defined as fever, respiratory symptoms and a new pulmonary infiltrate in an individual with sickle cell disease (SCD). Nearly half of ACS episodes occur in SCD patients already hospitalized, potentially permitting pre-emptive therapy in high-risk patients. Simple transfusion of red blood cells may abort ACS if given to patients hospitalized for pain who develop fever and elevated levels of secretory phospholipase A2 (sPLA2). In a feasibility study (PROACTIVE; ClinicalTrials.gov NCT00951808), patients hospitalized for pain who developed fever and elevated sPLA2 were eligible for randomization to transfusion or observation; all others were enrolled in an observational arm. Of 237 enrolled, only 10 were randomized; one of the four to receive transfusion had delayed treatment. Of 233 subjects receiving standard care, 22 developed ACS. A threshold level of sPLA2 ≥ 48 ng/ml gave optimal sensitivity (73%), specificity (71%) and accuracy (71%), but a positive predictive value of only 24%. The predictive value of sPLA2 was improved in adults and patients with chest or back pain, lower haemoglobin concentration and higher white blood cell counts, and in those receiving less than two-thirds maintenance fluids. The hurdles identified in PROACTIVE should facilitate design of a larger, definitive, phase 3 randomized controlled trial.
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Affiliation(s)
- Lori Styles
- Pediatric Sickle Cell Program, Children's Hospital & Research Center Oakland, CA, USA.
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McPherson Yee M, Jabbar SF, Osunkwo I, Clement L, Lane PA, Eckman JR, Guasch A. Chronic kidney disease and albuminuria in children with sickle cell disease. Clin J Am Soc Nephrol 2011; 6:2628-33. [PMID: 21940843 DOI: 10.2215/cjn.01600211] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Sickle cell nephropathy begins in childhood and may progress to renal failure. Albuminuria is a sensitive marker of glomerular damage that may indicate early chronic kidney disease (CKD). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The aims of this study were to determine the cross-sectional prevalence and clinical correlates of albuminuria and CKD among children with sickle cell disease (SCD). Over a 10-year period (1995 to 2005) 410 pediatric SCD patients ages 2 to 21 years were enrolled: 261 with hemoglobin SS (HbSS) or HbSβ(0) thalassemia (HbSβ(0)) and 149 with HbSC or HbSβ(+) thalassemia (HbSβ(+)). The albumin/creatinine ratio (ACR) of spot-urine specimens and serum creatinine were measured; abnormal albuminuria was defined as urinary ACR ≥ 30 mg/g. RESULTS The prevalence of abnormal albuminuria was 20.7% (23.0% in HbSS/HbSβ(0), 16.8% in HbSC/HbSβ(+)). Among HbSS/HbSβ(0), abnormal albuminuria was associated with increasing age and lower baseline hemoglobin. GFR, estimated in 189 patients using the updated Schwartz formula, correlated negatively with age (r = -0.27, P = 0.0002). CKD defined according to the Kidney Disease: Improving Global Outcomes study was present in 26.5% (50 of 189) of patients: stage 1 in 27 (14.8%) and stage 2 in 22 (11.6%). In multivariate analysis, age and HbSC/HbSβ(+) genotype were associated with CKD. CONCLUSIONS This is the first study to stage CKD in children with SCD and highlights a high prevalence of albuminuria and glomerular injury early in life. Detecting CKD in childhood could allow for earlier intervention and prevention of renal failure in adulthood.
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Affiliation(s)
- Marianne McPherson Yee
- Department of Pediatrics, Division of Hematology/Oncology, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Bell LW, Ryan MH, Ewing MA, Moore GA, Lane PA. Prospects for three Dorycnium species as forage plants in agricultural systems: a review of their agronomic characteristics. ACTA ACUST UNITED AC 2008. [DOI: 10.1071/ea07109] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Perennial legumes in the Dorycnium genus may have potential as forage plants that could reduce the seasonality of feed production and improve the sustainability of agricultural systems. However, Dorycnium species are not currently used commercially and little is known about their agronomic characteristics. This review covers the current knowledge on Dorycnium distribution, taxonomy and the agronomic performance of Dorycnium hirsutum, Dorycnium rectum and Dorycnium pentaphyllum, including adaptation, establishment, biomass production, water use, grazing management and nitrogen fixation, along with considerations for animal production. Dorycnium originate from temperate Europe and the Mediterranean basin and may be suitable for other regions with similar climatic conditions. Little data exist on the climatic and edaphic conditions to which Dorycnium species are best adapted. Current evidence suggests that D. hirsutum is widely adapted and might be suitable as a forage plant for acid soils in drier and frost-prone agricultural regions. D. hirsutum also persists well in low rainfall environments (down to 300 mm mean annual rainfall), can produce up to 21 t dry matter(DM)/ha in its first 3 years and, by utilising extra water compared with annual pastures, can reduce water leakage below the root zone, thereby slowing development of dryland salinity. The use of D. rectum would be limited to high rainfall or water-accumulating sites. D. pentaphyllum is a diverse species, yet available material appears to be less productive but has better forage quality than D. hirsutum. Currently, establishment reliability and/or forage digestibility are major limitations of the tested Dorycnium species that restrict their potential role and challenge the feasibility of their future use. Breeding may overcome or minimise these limitations and improved agronomic management might also enhance their usefulness. However, current collected genetic resources of Dorycnium are very limited and targeted collections would be needed to yield better adapted germplasm. Breeding to reduce the high levels of condensed tannins (>13% of DM) to moderate concentrations in Dorycnium might improve forage digestibility and could have positive implications for animal performance and health. Despite the poor digestibility of some Dorycnium species (<60% DM digestibility), these plants may still play a significant role as drought forage to provide feed when other forage sources are in limited supply. Further research is required to quantify the potential of Dorycnium species for commercial release and to determine how these plants should be best managed and integrated into livestock and mixed cropping systems.
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Abstract
Newborn screening fact sheets were last revised in 1996 by the American Academy of Pediatrics Committee on Genetics. This revision was prompted by advances in the field since 1996, including technologic innovations, as well as greater appreciation of ethical issues such as those surrounding informed consent. The following disorders are discussed in this revision of the newborn screening fact sheets: biotinidase deficiency, congenital adrenal hyperplasia, congenital hearing loss, congenital hypothyroidism, cystic fibrosis, galactosemia, homocystinuria, maple syrup urine disease, medium-chain acyl-coenzyme A dehydrogenase deficiency, phenylketonuria, sickle cell disease and other hemoglobinopathies, and tyrosinemia. A series of topics related to newborn screening is discussed in a companion publication to this electronic publication of the fact sheets (available at: www.pediatrics.org/cgi/content/full/118/3/1304). These topics are newborn screening as a public health system; factors contributing to the need for review of the newborn screening system; informed consent; tandem mass spectrometry; DNA analysis in newborn screening; status of newborn screening in the United States; and the effect of sample timing, preterm birth, diet, transfusion, and total parenteral nutrition on newborn screening results.
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Abstract
Newborn screening fact sheets were last revised in 1996 by the Committee on Genetics of the American Academy of Pediatrics. These fact sheets have been revised again because of advances in the field, including technologic innovations such as tandem mass spectrometry, as well as greater appreciation of ethical issues such as informed consent. The fact sheets provide information to assist pediatricians and other professionals who care for children in performing their essential role within the newborn screening public health system. The newborn screening system consists of 5 parts: (1) newborn testing; (2) follow-up of abnormal screening results to facilitate timely diagnostic testing and management; (3) diagnostic testing; (4) disease management, which requires coordination with the medical home and genetic counseling; and (5) continuous evaluation and improvement of the newborn screening system. The following disorders are reviewed in the newborn screening fact sheets (which are available at www.pediatrics.org/cgi/content/full/118/3/e934): biotinidase deficiency, congenital adrenal hyperplasia, congenital hearing loss, congenital hypothyroidism, cystic fibrosis, galactosemia,homocystinuria, maple syrup urine disease, medium-chain acyl-coenzyme A dehydrogenase deficiency, phenylketonuria, sickle cell disease and other hemoglobinopathies,and tyrosinemia.
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Hankins JS, Ware RE, Rogers ZR, Wynn LW, Lane PA, Scott JP, Wang WC. Long-term hydroxyurea therapy for infants with sickle cell anemia: the HUSOFT extension study. Blood 2005; 106:2269-75. [PMID: 16172253 PMCID: PMC1895275 DOI: 10.1182/blood-2004-12-4973] [Citation(s) in RCA: 192] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The long-term efficacy and toxicity of hydroxyurea for infants are undefined, and its role in preventing organ dysfunction is unknown. Short-term feasibility of hydroxyurea administration, toxicities, hematologic effects, and effect on spleen function in infants with sickle cell anemia (SCA) were reported (Hydroxyurea Safety and Organ Toxicity [HUSOFT] trial). These infants completing 2 years of hydroxyurea therapy (20 mg/kg/d) were offered study extension with dose escalation to 30 mg/kg/d. Patients were monitored with laboratory tests and biannual imaging studies. Hematologic indices were compared with predicted age-specific values and event rates compared with historic rates. All 21 subjects completing the original trial enrolled in the extension study: median age, 3.4 years old (range, 2.6 to 4.4 years); 12 females; 20 with Hb SS, 1 with Hb S/beta0-thalassemia. Seventeen patients completed 4 years of hydroxyurea, and 11 completed 6 years. After 4 years, hydroxyurea was associated with increased hemoglobin concentration, percentage of fetal hemoglobin (Hb F), and mean corpuscular volume (MCV) and decreased reticulocytes, white blood cells (WBCs), and platelets (P < .01). Patients experienced 7.5 acute chest syndrome (ACS) events per 100 person-years, compared with 24.5 events per 100 person-years among historic controls (P = .001). Treated patients had better spleen function than expected and improved growth rates. Infants with SCA tolerate prolonged hydroxyurea therapy with sustained hematologic benefits, fewer ACS events, improved growth, and possibly preserved organ function.
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Affiliation(s)
- Jane S Hankins
- St Jude Comprehensive Sickle Cell Center, Department of Hematology-Oncology, St Jude Children's Research Hospital, Memphis, TN 38105, USA.
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Abstract
OBJECTIVE Hydroxyurea improves hematologic values and decreases vaso-occlusive complications in adults and children with sickle cell anemia (SCA), but has not been tested in infants before the onset of chronic organ dysfunction. We conducted a collaborative pilot trial of hydroxyurea in infants with SCA to assess its (1) feasibility of administration, (2) toxicity, (3) hematologic effects, and (4) effect on spleen function. STUDY DESIGN Patients with hemoglobin (Hb) SS or Sbeta(0) thalassemia (n = 28, median age 15 months) received hydroxyurea for 2 years at 20 mg/kg/day. Hydroxyurea was temporarily discontinued for predefined toxicity. RESULTS Seven patients exited the study early: five for noncompliance or refusal to continue, one for mild stroke, and one for fatal splenic sequestration. The predominant toxicity was transient neutropenia, which was usually associated with a viral-like illness. After 2 years of treatment, mean Hb level = 8.8 g/dL and Hb F = 20.3%, both higher than predicted age-specific levels. Radionuclide splenic uptake was absent in 47% of patients at study completion, compared with predicted functional asplenia in 80% of the patients. CONCLUSIONS Hydroxyurea therapy for infants with SCA is feasible and well tolerated, has hematologic efficacy, and may delay functional asplenia. The potential for hydroxyurea to preserve organ function in SCA should be further evaluated.
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Affiliation(s)
- W C Wang
- Department of Hematology/Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105, USA
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Lane PA, Nyquist AC, O'Meara OP, Quinones RR, Thilo EH. Does information collected during the residency match process predict clinical performance? Arch Pediatr Adolesc Med 2001; 155:420-1. [PMID: 11231820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Pass KA, Lane PA, Fernhoff PM, Hinton CF, Panny SR, Parks JS, Pelias MZ, Rhead WJ, Ross SI, Wethers DL, Elsas LJ. US newborn screening system guidelines II: follow-up of children, diagnosis, management, and evaluation. Statement of the Council of Regional Networks for Genetic Services (CORN). J Pediatr 2000; 137:S1-46. [PMID: 11044838 DOI: 10.1067/mpd.2000.109437] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- K A Pass
- Council of Regional Networks for Genetic Services (CORN)
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Gore L, Lane PA, Quinones RR, Giller RH. Successful cord blood transplantation for sickle cell anemia from a sibling who is human leukocyte antigen-identical: implications for comprehensive care. J Pediatr Hematol Oncol 2000; 22:437-40. [PMID: 11037856 DOI: 10.1097/00043426-200009000-00010] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We report the successful transplantation of umbilical cord blood stem cells from a sibling who is human leukocyte antigen-matched to a child with sickle cell anemia. Conditioning was with busulfan, cyclophosphamide, and antithymocyte globulin. Time to neutrophil count >500/microL was 23 days and to platelet count >50,000/microL was 49 days. Full donor engraftment was achieved without graft-versus-host disease. This case demonstrates the potential usefulness of harvesting cord blood from full siblings of patients with sickle cell disease. Routine collection of umbilical cord blood from siblings should be considered for patients with sickle cell disease, and may increase acceptance and use of transplantation by families.
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Affiliation(s)
- L Gore
- Department of Pediatrics, University of Colorado School of Medicine, Denver, USA
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Fitzgerald LR, Dytko GM, Sarau HM, Mannan IJ, Ellis C, Lane PA, Tan KB, Murdock PR, Wilson S, Bergsma DJ, Ames RS, Foley JJ, Campbell DA, McMillan L, Evans N, Elshourbagy NA, Minehart H, Tsui P. Identification of an EDG7 variant, HOFNH30, a G-protein-coupled receptor for lysophosphatidic acid. Biochem Biophys Res Commun 2000; 273:805-10. [PMID: 10891327 DOI: 10.1006/bbrc.2000.2943] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We have identified a cDNA, designated HOFNH30, which encodes a 354 amino acid G-protein-coupled receptor (GPCR). This receptor has 96% amino acid identity to the Jurkat-T cell-derived EDG7 and could be a splice variant. RT-PCR analysis demonstrated that HOFNH30 mRNA is expressed in placenta whereas EDG7 mRNA shows highest expression in prostate. The HOFNH30 gene is localized to human chromosome 1p22. 3-1p31.1. When HOFNH30 was expressed in RBL-2H3 cells, LPA and phosphatidic acid (PA) induced a calcium mobilization response with EC(50) values of 13 nM and 3 microM, respectively. LPA also induced phosphorylation of mitogen-activated protein kinase (p42(MAPK) and p44(MAPK)) in HOFNH30-transfected but not vector-transfected RBL-2H3 cells. In the present study, we have identified a novel variant from the EDG receptor family, a GPCR for which LPA is a high-affinity endogenous ligand.
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MESH Headings
- Amino Acid Sequence
- Base Sequence
- Calcium/metabolism
- Chromosome Mapping
- Chromosomes, Human, Pair 1
- Cloning, Molecular
- Enzyme Activation
- GTP-Binding Proteins/metabolism
- Humans
- Jurkat Cells
- Lysophospholipids/metabolism
- Mitogen-Activated Protein Kinase 1/metabolism
- Mitogen-Activated Protein Kinase 3
- Mitogen-Activated Protein Kinases/metabolism
- Molecular Sequence Data
- Phosphorylation
- Receptors, Cell Surface/chemistry
- Receptors, Cell Surface/genetics
- Receptors, Cell Surface/metabolism
- Receptors, G-Protein-Coupled
- Receptors, Lysophosphatidic Acid
- Sequence Homology, Amino Acid
- Tumor Cells, Cultured
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Affiliation(s)
- L R Fitzgerald
- Department of Renal Biology, Gene Expression Sciences, SmithKline Beecham Pharmaceuticals, 709 Swedeland Road, King of Prussia, Pennsylvania 19406, USA
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Abstract
Increased adherence of sickle red blood cells (RBC) to endothelium is implicated as an initiating event of vaso-occlusion in sickle cell disease. Although much is known about the humoral influences of this interaction, there has been little investigation regarding endothelial contributions. Endothelial derived nitric oxide (NO) inhibits adhesion of platelets and leukocytes to endothelium and decreases expression of VCAM-1, an endothelial adhesion site implicated in sickle RBC/endothelial adherence. However, whether NO inhibits RBC adherence to endothelium is unexplored. We tested this hypothesis with endothelial monolayers exposed to RBC from normal (Hb AA) and sickle cell (Hb SS) volunteers in a parallel plate flow chamber. To decrease NO production, endothelial monolayers were exposed to 100 microM nitro-L-arginine (NLA), an inhibitor of nitric oxide synthase, resulting in an 87% increase in normal RBC adherence (P = 0.002). Because adherence of normal RBC to endothelium was low, the effect of DETA-NO, an NO donor, was tested after activation of endothelium with TNF-alpha increased adherence by 130% (P < 0.001). Subsequent addition of 2 mM DETA-NO produced a 75% decrease in adherence of normal RBC to endothelium (P = 0.03). At baseline, sickle RBC were significantly more adherent than normal RBC (P < 0.001) and DETA-NO decreased sickle RBC adherence by 54% (P = 0.04). Thus, NO inhibits both normal and sickle RBC adherence to endothelium. Strategies that enhance NO activity may be therapeutic in sickle cell disease.
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Affiliation(s)
- S L Space
- Department of Pediatrics, University of Colorado Health Sciences Center, Denver, Colorado.
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Abstract
OBJECTIVE To compare the health outcomes, costs, and incremental cost-effectiveness of universal neonatal screening for sickle cell disease (SCD) with screening targeted to African Americans. STUDY DESIGN A cost-effectiveness analysis was done by using a Markov simulation model that considered the costs and outcomes associated with the prevention and treatment of sepsis in those with sickle cell anemia and sickle beta(0)-thalassemia. Three strategies were compared: (1) no screening, (2) targeted screening of African Americans, and (3) universal screening for SCD. RESULTS In the base case analysis, targeted screening of African Americans compared with no screening cost $6709 per additional year of life saved, and universal screening compared with targeted screening cost $30,760 per additional year of life saved. In a sensitivity analysis, the cost per additional year of life saved with universal screening compared with targeted screening was positively correlated with the delivery rate of targeted screening and was inversely related to the proportion of African Americans in the population. CONCLUSIONS Targeted screening of African American newborns for SCD compared with no screening is always cost-effective. Universal screening compared with targeted screening always identifies more infants with disease, prevents more deaths, and is cost-effective given certain delivery rates for targeted screening and proportions of African Americans in the population.
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Affiliation(s)
- J A Panepinto
- Colorado Sickle Cell Treatment and Research Center and the Departments of Pediatrics and Preventive Medicine and Biometrics, University of Colorado School of Medicine, Denver, CO 80262, USA
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Abstract
Erythrocyte transfusion can impair detection of sickle-cell disease, galactosemia, or biotinidase deficiency with newborn screening. We report on 4 infants with SCD in whom delayed diagnosis was associated with neonatal transfusion. In 2 cases, the initial newborn screening showed no hemoglobin S. In no case was the recommended screening >/=120 days from the last transfusion obtained. Two children had significant SCD-related morbidity before diagnosis.
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Affiliation(s)
- W Reed
- Children's Hospital Oakland, Department of Hematology/Oncology, Oakland, CA 94609, USA
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Burge SK, Amodei N, Elkin B, Catala S, Andrew SR, Lane PA, Seale JP. An evaluation of two primary care interventions for alcohol abuse among Mexican-American patients. Addiction 1997; 92:1705-16. [PMID: 9581003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AIMS This study examined the effects of two primary care interventions (a physician intervention and a clinic-based psychoeducational group) on drinking patterns, psychosocial problems and blood test results (MCV, GGT, SGOT and SGPT). DESIGN Subjects were randomized into one of four treatment groups: physician intervention, psychoeducation, both interventions, or no intervention. Follow-up data were collected at 12 and 18 months. SETTING Subjects were recruited from a family practice outpatient clinic managed by a public hospital. PARTICIPANTS Included 175 Mexican-American female and male primary care patients who screened positive for alcohol abuse or dependence. These patients were not seeking help for alcohol problems. INTERVENTIONS Included a brief physician intervention and a 6-week patient psychoeducational group. MEASUREMENTS The Diagnostic Interview Schedule assessed subjects for alcohol abuse; the Addiction Severity Index measured alcohol-related problems, including psychosocial issues. FINDINGS All four treatment groups demonstrated significant improvement over time, with few differences between intervention and control groups. CONCLUSIONS Assessment can be confounded with brief interventions; future investigators should use non-assessed control groups.
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Affiliation(s)
- S K Burge
- Department of Family Practice, University of Texas Health Science Center, San Antonio 78284, USA
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41
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Lane PA, Shinar J, Yoshino K. Photoluminescence-detected magnetic-resonance study of fullerene-doped pi -conjugated polymers. Phys Rev B Condens Matter 1996; 54:9308-9313. [PMID: 9984665 DOI: 10.1103/physrevb.54.9308] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Lane PA, Wei X, Vardeny ZV. Studies of Charged Excitations in pi -Conjugated Oligomers and Polymers by Optical Modulation. Phys Rev Lett 1996; 77:1544-1547. [PMID: 10063105 DOI: 10.1103/physrevlett.77.1544] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
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Abstract
The identification of genetic mutation that causes sickle cell disease 35 years ago has not yet led to a widely applicable, specific therapy that corrects the underlying abnormality of hemoglobin. Nevertheless, recent progress in understanding the pathophysiology and natural history of sickling disorders has led directly to important prophylactic and supportive therapies that have markedly reduced morbidity and prolonged life expectancy. This is particularly true for manifestations of sickle cell disease that result from damage to the spleen, lungs, and brain. New strategies for specific therapy, including expanded use of chronic transfusions, bone marrow transplantation, and hydroxyurea, now offer hope for prevention of many or all of the hemolytic and vaso-occlusive manifestations of sickle cell disease.
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Affiliation(s)
- P A Lane
- Department of Pediatrics, University of Colorado School of Medicine, Denver, USA
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44
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Greenham NC, Shinar J, Partee J, Lane PA, Amir O, Lu F, Friend RH. Optically detected magnetic resonance study of efficient two-layer conjugated polymer light-emitting diodes. Phys Rev B Condens Matter 1996; 53:13528-13533. [PMID: 9983098 DOI: 10.1103/physrevb.53.13528] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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45
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Abstract
Nine cases of hereditary stomatocytosis (HSt) are presented which show documented thrombotic complications after splenectomy. In three cases, patients became severely ill with pulmonary hypertension and a fourth developed portal hypertension. One unsplenectomized affected adult relative had suspected but unconfirmed thrombotic pathology; the six other affected unsplenectomized adults did not. Since splenectomy is of only limited therapeutic benefit in stomatocytosis, it should not be performed without careful consideration. A tendency to iron overload, even without hypertransfusion and irrespective of splenectomy, is evident in many of these patients.
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Affiliation(s)
- G W Stewart
- Department of Medicine, University College London Medical School, UK
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46
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Lane PA, Wei X, Vardeny ZV, Partee J, Shinar J. Optically detected magnetic-resonance study of triplet-state dynamics in C70. Phys Rev B Condens Matter 1996; 53:R7580-R7583. [PMID: 9982271 DOI: 10.1103/physrevb.53.r7580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Abstract
Thalassemias occur in individuals of all ethnic backgrounds and are among the most common genetic diseases worldwide. The diagnosis of thalassemia can easily be part of primary medical practice. Here we outline a practical approach to the detection of thalassemias in three common clinical settings. The first involves any patient with a low mean corpuscular volume (MCV) with or without anemia. The second is a neonatal screening result indicating possible presence of thalassemia. Finally, evaluation for thalassemia should be considered in the context of family planning or pregnancy in patients whose ethnicity indicates origin from high risk geographic areas. We also review the various types of the thalassemia syndromes and provide an overview of general therapeutic considerations.
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Lane PA, Shinar J. Comprehensive photoluminescence-detected magnetic-resonance study of C60 and C70 glasses and films. Phys Rev B Condens Matter 1995; 51:10028-10038. [PMID: 9977678 DOI: 10.1103/physrevb.51.10028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Lane PA, O'Connell JL, Lear JL, Rogers ZR, Woods GM, Hassell KL, Wethers DL, Luckey DW, Buchanan GR. Functional asplenia in hemoglobin SC disease. Blood 1995; 85:2238-44. [PMID: 7718896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The incidence of functional asplenia in sickle-hemoglobin C (SC) disease has not been defined, and the use of prophylactic penicillin to prevent life-threatening septicemia in this disorder is controversial. The percentage of red blood cells with pits (pit count) is a reliable assay of splenic function in other disorders but has not been validated in hemoglobin SC disease. To address these issues, we conducted a prospective, multicenter study of splenic function in persons with hemoglobin SC disease. Baseline clinical data were recorded, and red blood cell pit counts were performed on 201 subjects, aged 6 months to 90 years, with hemoglobin SC; 43 subjects underwent radionuclide liver-spleen scanning. Pit counts greater than 20% were associated with functional asplenia as assessed by liver-spleen scan, whereas pit counts less than 20% were found in subjects with preserved splenic function. Pit counts greater than 20% were present in 0 of 59 subjects (0%) less than 4 years of age, in 19 of 86 subjects (22%) 4 to 12 years of age, and in 25 of 56 subjects (45%) greater than 12 years of age. Other subjects with hemoglobin SC, who had previously undergone surgical splenectomy, had higher pit counts (59.7% +/- 9.5%) than splenectomized subjects without hemoglobinopathy (38.5% +/- 8.8%) or with sickle cell anemia (20.5% +/- 1.9%; P < .001). Two subjects with hemoglobin SC disease (not splenectomized), ages 14 and 15 years, with pit counts of 40.3% and 41.7% died from pneumococcal septicemia. These data indicate that functional asplenia occurs in many patients with hemoglobin SC disease, but its development is usually delayed until after 4 years of age. The pit count is a reliable measure of splenic function in hemoglobin SC disease, but values indicative of functional asplenia (> 20% in our laboratory) are higher than in other disorders. The routine administration of prophylactic penicillin to infants and young children with hemoglobin SC disease may not be necessary.
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Affiliation(s)
- P A Lane
- Colorado Sickle Cell Treatment and Research Center, University of Colorado School of Medicine, Denver, USA
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50
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Abstract
The spleen contributes importantly to the normal and pathologic removal of blood cells from the circulation and to defense against infection with encapsulated bacteria. Surgical splenectomy provides efficacious treatment for a number of pediatric disorders but is associated with perioperative morbidity and a life-long risk of overwhelming infection. Alternatives to conventional splenectomy include laparoscopic splenectomy, partial splenectomy, partial splenic embolization, and autologous splenic transplantation. Sickle cell disease is the most common cause of functional asplenia in children. Asplenia develops during infancy in many infants with sickle cell anemia, and prophylactic penicillin markedly reduces mortality from pneumococcal infection. In contrast, recent evidence suggests that children with sickle-hemoglobin C disease do not develop functional asplenia before 3 to 4 years of age and thus may not benefit from penicillin prophylaxis. Recommendations for the treatment of asplenic patients include pneumococcal, Haemophilus influenzae type b, and meningococcal immunizations, antimicrobial prophylaxis for selected patients, and prompt evaluation and aggressive treatment of acute febrile illness.
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Affiliation(s)
- P A Lane
- Children's Hospital, Denver, Colorado, USA
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