Nearly one in five patients treated for sickle cell disease (SCD) in Georgia receive nonscheduled blood transfusions at multiple hospital sites over time, potentially increasing their risk for serious complications, according to a study published July 18 in Pediatric Blood & Cancer.
Georgia has one of the largest populations of patients with sickle cell disease in the nation.
Blood transfusions are part of treatment for many SCD patients, either regularly scheduled on an ongoing basis (chronic transfusion) or intermittently on an urgent basis. Repeat transfusions must be managed carefully to avoid two potential complications: a buildup of iron in the body, which can damage vital organs, and the development of antibodies to unrecognized components (antigens)in donor blood, which can trigger severe reaction upon repeated exposure.
A usual care doctor overseeing chronic transfusion typically has access to the patient’s history to avoid or manage these complications. Providers of emergent transfusions, particularly at different hospitals separated by months or years, may not. Additionally, providers who see SCD patients only rarely may not be aware of the critical importance of seeking out this information.
Using data from the Sickle Cell Data Collection Program, the REdHHoTT project, led by the Georgia Health Policy Center, characterized the use of intermittent transfusions for SCD patients in emergency departments and inpatient hospitals. The study found that
- 3,073 of 8,529 sickle cell patients seen in Georgia hospitals from 2007 through 2016 had two or more intermittent transfusions during that period and
- Over half of these patients received intermittent transfusions at multiple hospitals.
“Given the lack of a statewide system to share patient transfusion histories across hospitals, receiving transfusions at multiple hospitals can increased the risk of transfusion complication,” says Jane Branscomb, the project lead for REdHHoTT. “While a handful of Georgia hospitals provide high volumes of intermittent transfusion for sickle cell patients, many average less than one such transfusion per year. With limited experience, provider knowledge and practice may not be current with the latest evidence-based practice recommendations.”
The REdHHoTT project is working in two priority areas to enhance intermittent transfusion safety — assessing the feasibility of implementing a statewide transfusion registry or other data-sharing system to give providers immediate access to accurate patient transfusion data and expanding patient and provider education to enhance health decisions and self-advocacy.