Sheharyar Raza: Threshold-Based Transfusion in Sickle Cell Disease
Sheharyar Raza, Transfusion Medicine Specialist at Sunnybrook Health Sciences Center and Internal Medicine Physician at Unity Health Toronto, shared a post on LinkedIn about a recent article he and his colleagues co-authored, published in Blood Red Cells and Iron, adding:
“If you live with a complex chronic condition, you have likely experienced differences in care at hospitals that specialize in your disease versus those that don’t.
Our analysis in Blood Journals Portfolio RCI looked at 4000 admissions for patients with sickle cell disease across 29 hospitals in the GEMINI network.
We found that similar patients admitted to a teaching or non-teaching hospital were 2.5x more likely to get a red cell transfusion at hemoglobin less than 7.0 g/dL at non-teaching hospitals (covariate adjusted).
Nothing special happens physiologically at Hb = 7.0 g/dL.
While we do use Hb thresholds in other populations based on clinical trial data, we don’t have such studies in sickle cell disease, and sickle guidelines recommend against reflexive, threshold-based transfusion due to a higher risk of potential harm in these patients.
The figure below shows two curves comparing hospital types, with a big upswing in transfusion probability at 6.9 g/dL at some hospitals compared with others.
What does transfusion at your institution look like for patients with sickle cell disease?”
Title: Threshold-based Red Cell Transfusion for Sickle Cell Disease Patients at Teaching and Non-Teaching Hospitals
Authors: Sheharyar Raza, Malcolm Risk, Anne Loeffler, Jacob Pendergrast, Karen Fleming, Amol A. Verma, Fahad Razak, Kevin H. M. Kuo, Jeannie Callum
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