Implementation of national blood conservation recommendations at an adult sickle cell center.

Authors

• Jennifer M Jones
• Ariel D Swett
• Elizabeth P Crowe
• Courtney Lawrence
• Evan M Bloch
• Sophie M Lanzkron

Publication/Presentation Date

9-1-2022

Abstract

BACKGROUND: Due to the national blood supply crisis caused by the COVID-19 pandemic, the American Society of Hematology proposed guidance to decrease blood utilization for sickle cell patients on chronic transfusion therapy (CTT). Little evidence exists to support the efficacy and safety of these blood conservation strategies.

STUDY DESIGN AND METHODS: Through retrospective analysis, we sought to describe outcomes following implementation of these recommendations in 58 adult sickle cell patients on chronic exchange transfusions. The strategies employed included: relaxing the goal fraction of cells remaining (FCR) to 30%-50%, utilizing depletion exchanges in select patients, and transitioning select patients to monthly simple transfusions. We compared hemoglobin S%, hemoglobin values, and other laboratory parameters, acute care visits, and red blood cell usage during the first year of the COVID-19 pandemic to the year prior using Wilcoxon signed rank test.

RESULTS: Of 53 patients who remained on chronic exchanges during the pandemic, use of depletion exchange increased (15%-23%) and FCR increased (34.9 [SD 4.7] vs. 37.6 [SD 4.5], p <  .05). These changes resulted in 854 units conserved without clinically significant changes to pre-exchange laboratory parameters, including hemoglobin S%, or number of acute care presentations. In contrast, five patients who transitioned to predominantly simple transfusions, experienced difficulty maintaining hemoglobin S% less than 30 and worsening anemia.

DISCUSSION: Our data suggest that in a blood shortage crisis, optimizing the exchange procedure itself may be the safest means of conserving blood in a population of adult patients with sickle cell disease.

Volume

62

Issue

9

First Page

1763

Last Page

1771

ISSN

1537-2995

Published In/Presented At

Jones, J. M., Swett, A. D., Crowe, E. P., Lawrence, C., Bloch, E. M., & Lanzkron, S. M. (2022). Implementation of national blood conservation recommendations at an adult sickle cell center. Transfusion, 62(9), 1763–1771. https://doi.org/10.1111/trf.17007

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

35837727

Department(s)

Administration and Leadership

Document Type

Article