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Red blood cell transfusions during sickle cell anemia vaso-occlusive crises: a report from the magnesium in crisis (MAGiC) study.
Transfusion 2017; 57(8):1891-1897T

Abstract

BACKGROUND

Little is known about red blood cell (RBC) transfusion practices for children hospitalized for a sickle cell vaso-occlusive pain crisis (VOC). We hypothesized that transfusion would be associated with the development of acute chest syndrome (ACS), lower hemoglobin (Hb) concentration, and lack of hydroxyurea therapy.

STUDY DESIGN AND METHODS

This is a secondary analysis of all children admitted for a sickle cell pain crisis enrolled in the Magnesium in Crisis (MAGiC) randomized trial; all had HbSS or S-β0 thalassemia. ACS development and transfusion administration were prospectively collected during the parent trial. All Hb values during the hospitalization were recorded, as was parent report of child receiving hydroxyurea. Relative risks (RRs) of transfusion were compared between groups.

RESULTS

Of 204 enrolled children, 40 (19.6%) received a transfusion. Of the 30 children who developed ACS, 22 (73.3%) received transfusions compared to 18 of 174 (10.3%) without ACS: the RR of transfusion in children with ACS was 7.1 (95% confidence interval [CI], 4.4-11.5). Among those without ACS, the lowest Hb was most strongly associated with transfusions: RR was 3.1 (95% CI 2.0 - 4.7) for each 1 g/dL decrease in lowest Hb. In a binary recursive partitioning model for those without ACS, a lowest recorded Hb level of less than 6.3 g/dL was significantly associated with transfusion during admission (p < 0.01). Hydroxyurea use was not associated with transfusions in any analysis.

CONCLUSION

ACS increased the RR of transfusion in children hospitalized for VOC sevenfold. In children without ACS, transfusion was associated with lowest Hb concentration, particularly Hb concentration of less than 6.3 g/dL.

Authors+Show Affiliations

Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri.Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.Department of Pediatrics, Northwestern University School of Medicine, Chicago, Illinois.University of Utah/Pediatric Emergency Care Applied Research Network Data Coordinating Center, Salt Lake City, Utah.University of Utah/Pediatric Emergency Care Applied Research Network Data Coordinating Center, Salt Lake City, Utah.Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.No affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, U.S. Gov't, P.H.S.
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

28500682

Citation

Hulbert, Monica L., et al. "Red Blood Cell Transfusions During Sickle Cell Anemia Vaso-occlusive Crises: a Report From the Magnesium in Crisis (MAGiC) Study." Transfusion, vol. 57, no. 8, 2017, pp. 1891-1897.
Hulbert ML, Panepinto JA, Scott JP, et al. Red blood cell transfusions during sickle cell anemia vaso-occlusive crises: a report from the magnesium in crisis (MAGiC) study. Transfusion. 2017;57(8):1891-1897.
Hulbert, M. L., Panepinto, J. A., Scott, J. P., Liem, R. I., Cook, L. J., Simmons, T., & Brousseau, D. C. (2017). Red blood cell transfusions during sickle cell anemia vaso-occlusive crises: a report from the magnesium in crisis (MAGiC) study. Transfusion, 57(8), pp. 1891-1897. doi:10.1111/trf.14155.
Hulbert ML, et al. Red Blood Cell Transfusions During Sickle Cell Anemia Vaso-occlusive Crises: a Report From the Magnesium in Crisis (MAGiC) Study. Transfusion. 2017;57(8):1891-1897. PubMed PMID: 28500682.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Red blood cell transfusions during sickle cell anemia vaso-occlusive crises: a report from the magnesium in crisis (MAGiC) study. AU - Hulbert,Monica L, AU - Panepinto,Julie A, AU - Scott,J Paul, AU - Liem,Robert I, AU - Cook,Lawrence J, AU - Simmons,Timothy, AU - Brousseau,David C, AU - ,, Y1 - 2017/05/12/ PY - 2016/10/24/received PY - 2017/02/27/revised PY - 2017/04/03/accepted PY - 2017/5/14/pubmed PY - 2017/10/11/medline PY - 2017/5/14/entrez SP - 1891 EP - 1897 JF - Transfusion JO - Transfusion VL - 57 IS - 8 N2 - BACKGROUND: Little is known about red blood cell (RBC) transfusion practices for children hospitalized for a sickle cell vaso-occlusive pain crisis (VOC). We hypothesized that transfusion would be associated with the development of acute chest syndrome (ACS), lower hemoglobin (Hb) concentration, and lack of hydroxyurea therapy. STUDY DESIGN AND METHODS: This is a secondary analysis of all children admitted for a sickle cell pain crisis enrolled in the Magnesium in Crisis (MAGiC) randomized trial; all had HbSS or S-β0 thalassemia. ACS development and transfusion administration were prospectively collected during the parent trial. All Hb values during the hospitalization were recorded, as was parent report of child receiving hydroxyurea. Relative risks (RRs) of transfusion were compared between groups. RESULTS: Of 204 enrolled children, 40 (19.6%) received a transfusion. Of the 30 children who developed ACS, 22 (73.3%) received transfusions compared to 18 of 174 (10.3%) without ACS: the RR of transfusion in children with ACS was 7.1 (95% confidence interval [CI], 4.4-11.5). Among those without ACS, the lowest Hb was most strongly associated with transfusions: RR was 3.1 (95% CI 2.0 - 4.7) for each 1 g/dL decrease in lowest Hb. In a binary recursive partitioning model for those without ACS, a lowest recorded Hb level of less than 6.3 g/dL was significantly associated with transfusion during admission (p < 0.01). Hydroxyurea use was not associated with transfusions in any analysis. CONCLUSION: ACS increased the RR of transfusion in children hospitalized for VOC sevenfold. In children without ACS, transfusion was associated with lowest Hb concentration, particularly Hb concentration of less than 6.3 g/dL. SN - 1537-2995 UR - https://www.unboundmedicine.com/medline/citation/28500682/Red_blood_cell_transfusions_during_sickle_cell_anemia_vaso_occlusive_crises:_a_report_from_the_magnesium_in_crisis__MAGiC__study_ L2 - https://doi.org/10.1111/trf.14155 DB - PRIME DP - Unbound Medicine ER -