Interval decline in hemoglobin A is associated with annual clinical event rate in sickle cell anemia patients receiving maintenance apheresis RBC exchange.

Autor: Kamyszek RW; Duke University School of Medicine, Durham, North Carolina., Raval JS; Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina., Srinivasan AJ; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Ansari AK; Duke University School of Medicine, Durham, North Carolina., Evans BA; Duke University School of Medicine, Durham, North Carolina., Rollins-Raval MA; Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina., Poisson JL; Department of Pathology, Duke University Medical Center, Durham, North Carolina., Shah NR; Department of Medicine, Duke University Medical Center, Durham, North Carolina., Welsby IJ; Department of Anesthesiology, Duke University Medical Center, Durham, North Carolina.
Jazyk: angličtina
Zdroj: Transfusion [Transfusion] 2019 Aug; Vol. 59 (8), pp. 2622-2628. Date of Electronic Publication: 2019 Jun 03.
DOI: 10.1111/trf.15386
Abstrakt: Background: Apheresis red blood cell (RBC) exchange (RCE) is a standard intervention for patients with sickle cell anemia (SCA) who have had previous thromboembolic stroke or intractable chronic pain. Replacing sickling cells with those containing hemoglobin A (HbA) minimizes microvascular pathophysiology that produces clinical crises. Limited data exist regarding the interval changes in HbA between transfusions. We sought to describe the HbA decrement between RCE procedures and its relationship to clinical status.
Study Design and Methods: SCA patients (all hemoglobin SS disease) treated with maintenance RCE (n = 21) over a 15-month period at two neighboring institutions were retrospectively reviewed. Time-normalized daily HbA decrement was calculated to reflect loss of transfused RBCs, and annual events of either emergency department or hospital admissions for SCA complications were noted. Associations between HbA decrement and laboratory measures were calculated using mixed linear regression models and unpaired t test was used to compare HbA decrement between high and low event rate groups.
Results: A total of 31 events were recorded, and mean HbA decrement per day was 0.77 ± 0.16%. The mean interval between RCEs was 36 ± 12 days. Patients with more annual events exhibited a significantly greater daily HbA decrement (p = 0.007). No significant association between RBC unit age and HbA decrement or annual event rate was observed.
Conclusions: Patients exhibiting greater daily HbA decrement were more likely to have multiple emergency department visits or admissions for sickling crises. Modulating HbA decrement may merit study as an intermediate metric for interventions to improve outcomes in hemoglobin SS disease.
(© 2019 AABB.)
Databáze: MEDLINE
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