Indications for and complications of transfusions in patients with sickle cell disease

Abstract

Background: sickle cell disease typically has acute complications that may require transfusions. Although there is a significant prevalence of the disease in Colombia, the characterization of transfusion treatment has not been studied much.

Method: this was a descriptive, cross-sectional study at Hospital San Vicente Fundación, in Medellín, Colombia, from January 2011 to December 2023. Patients over the age of 15 with sickle cell disease and complications were included.

Results: a total of 106 patients were included, with an average age of 30.9 years, and a predominance of the SS phenotype (90.6%). The main complications were vaso-occlusive crisis (VOC) (74.5%), acute symptomatic anemia (ASA) (61.3%) and acute thoracic syndrome (ATS) (32.1%). Altogether, 85% received transfusions, mainly ordered to treat those with ASA, hepatic sequestration, splenic sequestration, multiple organ failure (MOF) and ATS. Red cell exchange was only performed in seven patients. There were two transfusion reactions, and iron overload affected 36.8% of the patients. The overall mortality was 21.7%, according to the Social Security registers.

Conclusion: the study was remarkable for the high frequency of transfusions in patients with sickle cell disease, especially due to ASA, and red cell exchange was infrequently used, even in complications like ATS, MOF and stroke. The results provide the basis for future studies to evaluate the impact of the infrequent use of erythrocyte exchange and iron overload complications, especially their relationship with the high mortality found.