The following is a summary of “An innovative intervention for the prevention of vaso-occlusive episodes in sickle cell disease,” published in the May 2023 issue of Hematology by Jeon, et al.
Sickle cell disease (SCD) is a genetic condition characterized by a mutation in the beta-globin gene, producing abnormal hemoglobin S (HgbS). This leads to complications, including anemia and recurrent vaso-occlusive episodes (VOEs), often necessitating chronic blood transfusions. Treatment options for SCD include hydroxyurea, voxelotor, L-glutamine, and crizanlizumab. Prophylactic measures like simple and exchange transfusions were commonly used to prevent VOEs, as they help reduce the level of sickled red blood cells (RBCs) and minimize the need for emergency department (ED)/urgent care (UC) visits or hospitalizations. When VOEs occur, treatment involves intravenous (IV) hydration and pain management. Studies have shown that sickle cell infusion centers (SCIC) are crucial in reducing hospital admissions for VOEs, with IV hydration and pain medications being vital components of their management approach. Based on these findings, researchers hypothesized that implementing a structured infusion protocol in the outpatient setting could effectively decrease the incidence of VOEs.
The study presented the cases of two patients with SCD who participated in a trial of scheduled outpatient intravenous (IV) hydration and opioids as an alternative approach to prevent VOEs. The goal was to reduce the frequency of VOEs in these patients. The trial aimed to evaluate the efficacy of this intervention in the context of the blood product shortage and patients’ preferences.
The outcomes of the trial differed for the two patients. One patient experienced a reduction in the frequency of VOEs following the implementation of scheduled outpatient sessions for IV hydration and opioids. On the other hand, the other patient had mixed results due to noncompliance with the scheduled outpatient sessions.
The findings suggested that implementing outpatient sickle cell infusion centers (SCICs) with a structured infusion protocol may be an effective intervention for preventing VOEs in patients with SCD. However, further patient-centered research and quality improvement initiatives are needed to understand better the factors influencing outpatient SCICs’ efficacy in reducing the incidence of VOEs. The findings highlighted the importance of tailoring interventions to meet the specific needs and preferences of patients with SCD, particularly in the context of blood product shortages and individual treatment preferences.
Source: tandfonline.com/doi/full/10.1080/16078454.2023.2215575