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Article ; Online: Measures to reduce red cell use in patients with sickle cell disease requiring red cell exchange during a blood shortage.

Uter, Stacey / An, Hyun Hyung / Linder, Grace E / Kadauke, Stephan / Sesok-Pizzini, Deborah / Kim, Haewon C / Friedman, David F / Chou, Stella T

Blood advances

2021  Volume 5, Issue 12, Page(s) 2586–2592

Abstract: ... based on precise red cell volume required can optimize patient care and judicious use of blood resources. ... blood shortage. The inventory of Rh and K antigen-negative red cell units recommended for patients ... that implementation of 2 measures could reduce blood use. First, obtaining the pretransfusion hemoglobin S (HbS ...

Abstract The COVID-19 pandemic has created major disruptions in health care delivery, including a severe blood shortage. The inventory of Rh and K antigen-negative red cell units recommended for patients with hemoglobinopathies became alarmingly low and continues to be strained. Because patients with sickle cell disease requiring chronic red cell exchange (RCE) incur a large demand for red cell units, we hypothesized that implementation of 2 measures could reduce blood use. First, obtaining the pretransfusion hemoglobin S (HbS) results by procedure start time would facilitate calculation of exact red cell volume needed to achieve the desired post-RCE HbS. Second, as a short-term conservation method, we identified patients for whom increasing the targeted end procedure hematocrit up to 5 percentage points higher than the pretransfusion level (no higher than 36%) was not medically contraindicated. The goal was to enhance suppression of endogenous erythropoiesis and thereby reduce the red cell unit number needed to maintain the same target HbS%. These 2 measures resulted in an 18% reduction of red cell units transfused to 50 patients undergoing chronic RCE during the first 6 months of the COVID-19 pandemic. Despite reduction of blood use, pretransfusion HbS% target goals were maintained and net iron accumulation was low. Both strategies can help alleviate a shortage of Rh and K antigen-negative red cells, and, more generally, transfusing red cell units based on precise red cell volume required can optimize patient care and judicious use of blood resources.
MeSH term(s) Anemia, Sickle Cell/therapy ; COVID-19 ; Erythrocyte Transfusion ; Humans ; Pandemics ; SARS-CoV-2
Language English
Publishing date 2021-06-21
Publishing country United States
Document type Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID 2915908-8
ISSN 2473-9537 ; 2473-9529
ISSN (online) 2473-9537
ISSN 2473-9529
DOI 10.1182/bloodadvances.2021004395
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