Examining the utility of RBC transfusions in uncomplicated vaso-occlusive episodes Free

Vaso-occlusive episodes (VOE) are the leading cause of in-patient admissions in sickle cell disease (SCD). While RBC transfusions are indicated for severe acute chest syndrome (ACS), the utility of RBC transfusions in uncomplicated VOEs is unclear. Despite this, RBC transfusions are often administered when hemoglobin levels fall below baseline. This study evaluates whether simple transfusions impact pain, opioid use, and measures of diseases severity in patients hospitalized for VOE.

We conducted a retrospective cohort study involving adults 21 years and older, hospitalized for VOE at one of three Montefiore hospitals between January 2020 and January 2024. Patients that presented with ACS or developed ACS during their hospitalization were excluded. The primary endpoint was change in pain scores at rest at 24 hours before and after transfusion. Secondary outcomes included opioid usage 24 hours before and after transfusion, total opioid usage throughout hospitalization, incidence of new-onset acute chest syndrome (ACS), rates of ICU admission, in-hospital mortality, and length of hospital stay. Opioid exposure was standardized to oral morphine milliequivalents (MME). For patients that received more than one RBC transfusion, data are presented for the first transfusion.

Among 430 patients admitted for uncomplicated VOE, 95 (22%) received RBC transfusions for uncomplicated VOE. Transfusions occurred at a median of 48 hours after ED arrival, raising mean hemoglobin from 6.0 (SD 0.8) to 7.4 g/dL (SD 1.1) with a mean of 1.3 (SD 0.5) units transfused. Patients who received transfusions experienced a mean reduction in pain scores at 24 hours after transfusion of 2.5 units (SD 3.2) on a 0-10 scale, however there was no difference in opioid use in the 24 hours before and after transfusion (median decrease =7.5 MME, IQR: 40 MME decrease to 38 MME increase). Between the transfusion and non-transfusion groups, there were no significant differences in total opioid use throughout hospitalization (p=0.16), rates of ICU admission (p=0.17), or mortality (p=0.64). Transfused patients had longer LOS (p<0.01).

In uncomplicated VOE, RBC transfusions are associated with a reduction in pain scores and longer lengths of stay but not with opioid use, ICU admissions, or mortality.