Introduction

Red blood cell (RBC) transfusion is frequently used in sickle cell disease (SCD) patients to help prevent and treat various acute and long-term medical issues. Since curative therapies are not a viable option for the majority of SCD patients, disease-modifying medications that can slow the progression of the disease and blood transfusion are the main focus of the current management of SCD. Although red blood cell transfusions have the potential to save lives, we are concerned about the severe side effects of transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) in this patient population. In individuals with SCD, TRALI and TACO are frequently misdiagnosed, mainly because the symptoms resemble those of acute chest syndrome. We aim to describe the outcome and prevalence of complications in hospitalized SCD patients receiving blood transfusions.

Methodology

Our study was comprehensive, utilizing the National Inpatient Sample data from 2016 to 2021 to perform a retrospective analysis. We identified and analyzed patients hospitalized with a diagnosis of sickle cell disease and those who received blood product transfusions. The primary outcome was in-hospital mortality, and secondary outcomes included length of stay (LOS), the total cost of hospitalization, and the prevalence of TRALI and TACO.

Results

There were 94,400 admissions for sickle cell disease. Among these, 19,960 patients received blood transfusions during hospitalization. The mean age in the transfusion group was 34 ± 16 years, with 57% female. TRALI was reported in only 0.13% of patients, while TACO occurred in 1.8% of patients. The odds of mortality for sickle cell patients without transfusion [aOR 1.04; 95% CI 1.03-1.05; p=0.001] and the odds of mortality in the transfusion group were similar [aOR 1.04; 95% CI 1.02-1.05; p=0.001]. The mean LOS was 4 ± 3 days for the non-transfusion group and 6 ± 3 days for the transfusion group. The total cost of hospitalization was $52,500 for the non-transfusion group versus $75,213 for the transfusion group.Conclusion

Our study on patients admitted with sickle cell disease who received blood transfusions has significant implications for patient care. We found that mortality did not differ significantly between transfused and non-transfused patients. However, patients who received transfusions had a prolonged length of stay and higher total hospitalization costs. Moreover, the prevalence of TRALI and TACO was low in transfused patients. These findings emphasize the importance of careful consideration when deciding on blood transfusions for sickle cell disease patients, urging healthcare professionals to reassess their practices and strive to provide the best care possible.

Disclosures

No relevant conflicts of interest to declare.

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2024
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