Comparison of Two Methods of Transfusion Therapy for Stroke Prevention in Sickle Cell

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Comparison of Two Methods of Transfusion Therapy for Stroke Prevention in Sickle Cell

Journal Title: Journal of Blood Disorders & Transfusion - Year 2018, Vol 9, Issue 3

Abstract

Aim: Chronic blood transfusions are essential to the care of sickle cell patients at high risk for morbidity andmortality due to stroke. In our comprehensive sickle cell centre, we support chronic transfusion with rapid manualpartial exchange transfusions (RMPET) using a single access central line port. We do not have a comprehensiveadult sickle cell program at our hospital, but upon transition of patients to an adult transfusion clinic they would beprovided simple transfusion (ST) instead of exchange. Since we have a smaller sickle cell population and do nothave erythrocytapheresis capabilities, we investigated whether switching our patients to simple transfusion would befeasible without compromising their haemoglobin S quantification parameters or ferritin levels.Objective: To study our patients on chronic transfusion support and compare the different modalities to betterunderstand the effects from switching from RMPET to ST.Method: We used a prospective observational cohort design to determine which method of transfusion was bestfor lowering haemoglobin S quantification. A crossover design was used so that each patient acted as its owncontrol. Nine subjects between the ages of 4 years to 23 years were included in the study of 10 chronicallytransfused patients. Eight of nine subjects had Sickle cell SS hemoglobinopathy and one had S Beta°Thalassemia.We additionally surveyed patient preference for each transfusion modality and nursing time to perform thetransfusion.Results:A Wilcoxon signed-rank test determined that there was not a statistically significant median difference inHb S at the end of the transfusion, both methods achieving Hb S<30%. There was also no statistically significantmedian difference in Ferritin levels. Conclusion: Our centre has opted to change our transfusion practice to straighttransfusion and not RMPET which is more time consuming. Patients were more satisfied with the straight transfusionmethod. Nursing staff was appreciative of the shorter transfusion times. Our results may assist other smallerprograms choose to use straight transfusion rather than rapid manual partial exchange for their chronicallytransfused patients.

Authors and Affiliations

Jennifer Keates-Baleeiro, Avery Mixon, Manoo Bhakta, Meghann McManus

Keywords

Chronic transfusion therapy. Sickle cell disease. Stroke prevention.

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EP ID EP582788
DOI 10.4172/2155-9864.1000405
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