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Red blood cell transfusion therapy for sickle cell patients with frequent painful events
Author(s) -
Hilliard Lee M.,
Kulkarni Varsha,
Sen Bisakha,
Caldwell Cathy,
BemrichStolz Christina,
Howard Thomas H.,
Brandow Amanda,
Waite Emily,
Lebensburger Jeffrey D.
Publication year - 2018
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.27423
Subject(s) - medicine , transfusion therapy , emergency department , sickle cell anemia , opioid , chronic pain , blood transfusion , medical prescription , dosing , retrospective cohort study , disease , emergency medicine , pediatrics , physical therapy , receptor , psychiatry , pharmacology
Background Recurrent pain events or chronic pain are among the most common complications of sickle cell disease. Despite attempts to maximize adherence to and dosing of hydroxyurea, some patients continue to suffer from pain. Our institution developed a program to initiate chronic red blood cell transfusions for one year in patients clinically deemed to have high healthcare utilization from sickle cell pain, despite being prescribed hydroxyurea. Procedure An institutional review board approved retrospective study to evaluate the health outcomes associated with a one‐year red blood cell transfusion protocol in sickle cell patients experiencing recurrent pain events as compared with the health outcomes for these patients in the one year prior to receiving transfusion therapy. We performed a matched‐pair analysis using a Wilcoxon signed rank to determine the impact of transfusion therapy on clinic visits, emergency department visits, hospital admissions, hospitalization days, and opioid prescriptions filled. Results One year of transfusion therapy significantly reduced the number of total emergency department visits for pain (6 vs 2.5 pain visits/year, P = 0.005), mean hospitalizations for pain (3.4 vs 0.9 pain admissions/year), and mean hospital days per year for pain crisis (23.5 vs 4.5, P = 0.0001), as compared with the one year prior to transfusion therapy. We identified no significant difference in opioid prescriptions filled during the year of transfusion therapy. Conclusion Patients with frequent pain episodes may benefit from one year of transfusion therapy.