Measures to reduce red cell use in patients with sickle cell disease requiring red cell exchange during a blood shortage.
Measures to reduce red cell use in patients with sickle cell disease requiring red cell exchange during a blood shortage.
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DOI：
10.1182/bloodadvances.2021004395
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发表时间：
2021-06-22
期刊：
影响因子：
7.5
通讯作者：
Chou ST
中科院分区：
文献类型：
--
作者：
Uter S;An HH;Linder GE;Kadauke S;Sesok-Pizzini D;Kim HC;Friedman DF;Chou ST
红细胞交换前输血前 HbS% 值的可用性有助于计算所需的精确供体单位数量。提高红细胞交换末血细胞比容可以减少所需的红细胞单位，作为在短缺时保存血液的短期措施。 COVID-19 大流行对医疗保健服务造成了重大干扰，包括严重的血液短缺。推荐用于血红蛋白病患者的 Rh 和 K 抗原阴性红细胞单位的库存变得惊人地低，并且继续紧张。由于需要慢性红细胞交换 (RCE) 的镰状细胞病患者对红细胞单位的需求量很大，因此我们假设实施 2 项措施可以减少血液使用量。首先，通过手术开始时间获得输血前血红蛋白 S (HbS) 结果将有助于计算实现所需的 RCE 后 HbS 所需的精确红细胞体积。其次，作为一种短期保护方法，我们确定了将目标最终程序血细胞比容提高至比输血前水平高 5 个百分点（不高于 36%）没有医学禁忌的患者。目标是增强对内源性红细胞生成的抑制，从而减少维持相同目标 HbS% 所需的红细胞单位数量。这两项措施导致在 COVID-19 大流行的前 6 个月内，输给 50 名接受慢性 RCE 的患者的红细胞单位减少了 18%。尽管减少了用血量，但输血前 HbS% 目标得以维持，净铁积累量较低。这两种策略都可以帮助缓解 Rh 和 K 抗原阴性红细胞的短缺，而且更普遍的是，根据所需的精确红细胞体积输注红细胞单位可以优化患者护理和明智地使用血液资源。
Availability of pretransfusion HbS% values before red cell exchange facilitates calculation of precise donor unit numbers required. Raising the red cell exchange end hematocrit can reduce red cell units required as a short-term measure to conserve blood in a shortage. The COVID-19 pandemic has created major disruptions in health care delivery, including a severe blood shortage. The inventory of Rh and K antigen–negative red cell units recommended for patients with hemoglobinopathies became alarmingly low and continues to be strained. Because patients with sickle cell disease requiring chronic red cell exchange (RCE) incur a large demand for red cell units, we hypothesized that implementation of 2 measures could reduce blood use. First, obtaining the pretransfusion hemoglobin S (HbS) results by procedure start time would facilitate calculation of exact red cell volume needed to achieve the desired post-RCE HbS. Second, as a short-term conservation method, we identified patients for whom increasing the targeted end procedure hematocrit up to 5 percentage points higher than the pretransfusion level (no higher than 36%) was not medically contraindicated. The goal was to enhance suppression of endogenous erythropoiesis and thereby reduce the red cell unit number needed to maintain the same target HbS%. These 2 measures resulted in an 18% reduction of red cell units transfused to 50 patients undergoing chronic RCE during the first 6 months of the COVID-19 pandemic. Despite reduction of blood use, pretransfusion HbS% target goals were maintained and net iron accumulation was low. Both strategies can help alleviate a shortage of Rh and K antigen–negative red cells, and, more generally, transfusing red cell units based on precise red cell volume required can optimize patient care and judicious use of blood resources.
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