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Gül M, Luca B, Dimitropoulos K, Capogrosso P, Milenkovic U, Cocci A, Veeratterapillay R, Hatzichristodoulou G, Modgil V, Russo GI, Tharakan T, Kalkanli A, Omar MI, Bettocchi C, Carvalho J, Corona G, Jones TH, Kadioglu A, Martinez-Salamanca JI, Serefoglu EC, Verze P, Minhas S, Salonia A. What is the effectiveness of surgical and non-surgical therapies in the treatment of ischemic priapism in patients with sickle cell disease? A systematic review by the EAU Sexual and Reproductive Health Guidelines Panel. Int J Impot Res 2024; 36:20-35. [PMID: 35941221 DOI: 10.1038/s41443-022-00590-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/09/2022]
Abstract
Sickle cell disease (SCD) is an inherited hemoglobin disorder characterized by the occlusion of small blood vessels by sickle-shaped red blood cells. SCD is associated with a number of complications, including ischemic priapism. While SCD accounts for at least one-third of all priapism cases, no definitive treatment strategy has been established to specifically treat patients with SC priapism. The aim of this systematic review was to assess the efficacy and safety of contemporary treatment modalities for acute and stuttering ischemic priapism associated with SCD. The primary outcome measures were defined as resolution of acute priapism (detumescence) and complete response of stuttering priapism, while the primary harm outcome was as sexual dysfunction. The protocol for the review has been registered (PROSPERO Nr: CRD42020182001), and a systematic search of Medline, Embase, and Cochrane controlled trials databases was performed. Three trials with 41 observational studies met the criteria for inclusion in this review. None of the trials assessed detumescence, as a primary outcome. All of the trials reported a complete response of stuttering priapism; however, the certainty of the evidence was low. It is clear that assessing the effectiveness of specific interventions for priapism in SCD, well-designed, adequately-powered, multicenter trials are strongly required.
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Affiliation(s)
- M Gül
- Department of Urology, Selcuk University School of Medicine, Urology, Konya, Turkey
| | - B Luca
- Urological Research Institute, IRCCS Ospedale San Raffaele, Experimental Oncology/Unit of Urology, Milan, Italy
| | | | - P Capogrosso
- ASST-Sette Laghi, Circolo & Fondazione Macchi Hospital, University of Insurbria, Varese, Italy
| | - U Milenkovic
- University of Leuven, Laboratory for Experimental Urology, Leuven, Belgium
| | - A Cocci
- Careggi Hospital, University of Florence, Urology, Florence, Italy
| | - R Veeratterapillay
- Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Urology, Newcastle, UK
| | - G Hatzichristodoulou
- Julius-Maximilians-University of Würzburg, Urology and Pediatric Urology, Würzburg, Germany
| | - V Modgil
- Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester Andrology Centre, Manchester, UK
| | - G I Russo
- Vittorio Emanuele II, University of Catania, Urology, Catania, Italy
| | - T Tharakan
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, Urology, London, UK
| | - A Kalkanli
- Taksim Education and Research Hospital, Department of Urology, Istanbul, Turkey
| | - M I Omar
- University of Aberdeen, Academic Urology Unit, Aberdeen, UK
| | - C Bettocchi
- University of Foggia, Department of Urology, Foggia, Italy
| | - J Carvalho
- Lusófona University of Humanities and Technologies, School of Psychology and Life Sciences, Lisbon, Portugal
| | - G Corona
- Azienda Usl Bologna Maggiore-Bellaria Hospital, Endocrinology Unit, Bologna, Italy
| | - T H Jones
- University of Sheffield Medical School, Oncology and Metabolism, Sheffield, UK
| | - A Kadioglu
- Istanbul University, Urology, Istanbul, Turkey
| | | | | | - P Verze
- University of Naples Federico II, Urology, Naples, Italy
| | - S Minhas
- Imperial Healthcare NHS Trust, Charing Cross Hospital, Urology, London, UK
| | - A Salonia
- URI-Urological Research Institute, Experimental Oncology/Unit of Urology, Milan, Italy.
- University Vita-salute San Raffaele, Milan, Italy.
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2
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Hequet O, Fort R, Driss F. Red blood cell exchange in an emergency in sickle cell disease. Transfus Apher Sci 2020; 59:102996. [PMID: 33189570 DOI: 10.1016/j.transci.2020.102996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Red blood cell exchange (RBCEx) has become a standard therapy to remove abnormal red blood cells (RBCs) in patients with sickle cell disease (SCD). In the last few decades, numerous RBCEx procedures have been performed chronically during regular programs, while numerous procedures have also been performed in an emergency for several indications, this therapeutic option being very efficient in vital and emergency situations. In both groups of indications, large amounts of sickle RBCs have to be removed, which requires great precision and the setting of specific hematological targets. The aim of this review is to discuss the aims, clinical and biological targets, and the requirements and precautions when performing RBCEx in an emergency. Moreover, we analyze how improvement of the techniques as well as the clinical and biological targets has led to optimization of the procedures in emergency settings. We also consider the outstanding issues that require additional investigation.
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Affiliation(s)
- O Hequet
- Apheresis Unit, Etablissement Français du Sang Auvergne Rhône-Alpes, Centre Hospitalier Lyon Sud, Pierre Bénite, France.
| | - R Fort
- Department of Internal Medicine, CHU Edouard Herriot, Lyon, France; Laboratoire LIBM EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard, Lyon, France; Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France
| | - F Driss
- Biological Hematological Unit, Centre Hospitalier universitaire Bicêtre, le Kremlin-Bicêtre, France
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Fort R. Recommendations for the use of red blood cell exchange in sickle cell disease. Transfus Apher Sci 2019; 58:128-131. [PMID: 30879904 DOI: 10.1016/j.transci.2019.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Sickle cell disease (SCD) is a genetic disorder characterised by a single mutation of the beta globin gene, causing the production of an abnormal haemoglobin called sickle haemoglobin (HbS). In its deoxygenated form, HbS polymerises, causing major rheological disorders, which presents clinically as periodic vaso-occlusive crises, chronic haemolysis and chronic vascular dysfunction. Patients often resort to a background treatment, and transfusion remains the cornerstone in the management of the disease, significantly reducing morbidity and mortality. The aim of red blood cell exchange (RBCX) is to improve tissue oxygenation by increasing haemoglobin levels while lowering HbS levels. RBCX can be performed by manual or automated exchange, and each technique has its own set of advantages and disadvantages. This article will outline the transfusion indications for the main complications of SCD, as well as the most appropriate strategy to use.
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Affiliation(s)
- Romain Fort
- Department of Internal Medicine, CHU Edouard Herriot, Lyon, France; Laboratoire LIBM EA7424, Equipe "Biologie Vasculaire et du Globule Rouge", Université Claude Bernard, Lyon, France; Laboratoire d'Excellence du Globule Rouge (LABEX GR-Ex), PRES Sorbonne, Paris, France.
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Rees DC, Robinson S, Howard J. How I manage red cell transfusions in patients with sickle cell disease. Br J Haematol 2018; 180:607-617. [DOI: 10.1111/bjh.15115] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- David C. Rees
- Department of Haematological Medicine; King's College Hospital; King's College London; London UK
| | - Susan Robinson
- Department of Haematology; Guy's and St Thomas’ Hospital; London UK
| | - Jo Howard
- Department of Haematology; Guy's and St Thomas’ Hospital; London UK
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Davis BA, Allard S, Qureshi A, Porter JB, Pancham S, Win N, Cho G, Ryan K. Guidelines on red cell transfusion in sickle cell disease Part II: indications for transfusion. Br J Haematol 2016; 176:192-209. [DOI: 10.1111/bjh.14383] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Shubha Allard
- Barts Health NHS Trust & NHS Blood and Transplant; London UK
| | - Amrana Qureshi
- Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - John B. Porter
- University College London Hospitals NHS Foundation Trust; London UK
| | - Shivan Pancham
- Sandwell and West Birmingham Hospitals NHS Trust; Birmingham UK
| | - Nay Win
- NHS Blood and Transplant; London UK
| | | | - Kate Ryan
- Central Manchester University Hospitals NHS Foundation Trust; Manchester UK
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Kim HC. Red cell exchange: special focus on sickle cell disease. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2014; 2014:450-456. [PMID: 25696893 DOI: 10.1182/asheducation-2014.1.450] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The primary function of red blood cells (RBCs) is to deliver oxygen from the lungs to tissues. Tissue hypoxia occurs when the oxygen-carrying capacity of RBCs is compromised due primarily to 3 causes: (1) a reduction in circulating RBC mass, (2) an increase in circulating RBC mass, or (3) abnormal hemoglobin (Hb) that either does not sufficiently release oxygen to tissues (high-oxygen-affinity hemoglobin) or occludes the microvasculature due to deformed RBCs (sickled RBCs). To improve oxygenation in patients with reduced or increased RBC mass, RBC administration (simple transfusion) or RBC removal (RBC depletion) is performed, respectively. However, for patients with abnormal Hb, RBCs containing abnormal Hb are removed and replaced by healthy volunteer donor RBCs by red cell exchange (RCE). RCE can be performed by manual exchange or by automated exchange using a blood cell separator (erythrocytapheresis). In this review, indications for RCE in sickle cell disease using the evidence-based American Society for Apheresis categories(1) are presented and the rationale for RCE in each disorder are discussed. Simple transfusion versus RCE and manual RCE versus automated RCE are compared. Finally, this review briefly presents some of the challenges of performing erythrocytapheresis in small children and discusses various choices for central venous access during RCE.(2.)
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Affiliation(s)
- Haewon C Kim
- Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Madu AJ, Ubesie A, Ocheni S, Chinawa J, Madu KA, Ibegbulam OG, Nonyelu C, Eze A. Priapism in homozygous sickle cell patients: important clinical and laboratory associations. Med Princ Pract 2014; 23:259-63. [PMID: 24685837 PMCID: PMC5586878 DOI: 10.1159/000360608] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/13/2014] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between the occurrence of priapism and important steady-state clinical and laboratory parameters in homozygous sickle cell disease (SCD). SUBJECTS AND METHODS Steady-state clinical and laboratory data were obtained from the medical records of 126 male patients seen in the clinic over a 7-year period. Estimated prevalence rates, correlation coefficients and independent t tests were calculated to assess the relationship between priapism and several important clinical and laboratory indices. Patient data on age, haemoglobin concentrations, the frequency of crises per annum, leucocyte counts, platelet counts, serum bilirubin and aspartate transaminase were evaluated. RESULTS The prevalence of priapism was determined to be 21.4%, and 22.2% of those affected had erectile dysfunction. There was a significant positive correlation between priapism and older age (p = 0.049) and lower leucocyte counts (p = 0.008). There was no significant relationship with other clinical or laboratory indices. CONCLUSION About 1 in 4 of all homozygous older SCD patients had priapism, and an approximately similar ratio developed erectile dysfunction; they also had lower steady-state leucocyte counts. Other clinical and laboratory indicators of disease severity in SCD did not positively correlate with the occurrence of priapism, and this may imply an alternative pathogenetic mechanism.
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Affiliation(s)
- Anazoeze Jude Madu
- Department of Haematology and Immunology, University of Nigeria Enugu Campus, Enugu, Nigeria
- *Dr. Anazoeze J. Madu, Department of Haematology and Immunology, University of Nigeria Enugu Campus (UNEC), PMB 01129, Enugu 400001 (Nigeria), E-Mail
| | - Agozie Ubesie
- Department of Pediatrics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Sunday Ocheni
- Department of Haematology and Immunology, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Josephat Chinawa
- Department of Pediatrics, College of Medicine, University of Nigeria Enugu Campus, Enugu, Nigeria
| | | | | | - Charles Nonyelu
- Department of Haematology and Immunology, University of Nigeria Enugu Campus, Enugu, Nigeria
| | - Alozie Eze
- Department of Haematology and Immunology, University of Nigeria Enugu Campus, Enugu, Nigeria
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9
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Abstract
Priapism due to sickle cell disease is a common but less well characterized complication of the disorder. It represents a "medical emergency" with the key determinant of outcome being the duration of penile ischaemia and time to detumescence of <4 h associated with a successful treatment outcome. Management can be outpatient-based and consists of pre-emptive strategies for early stuttering attacks based on prior health education of the association between the 2 disorders, non pharmacological management, outpatient penile aspiration and irrigation with or without instillation of alpha and beta adrenergic agonists for acute episodes and secondary prophylaxis to prevent the high rates of recurrences. The evidence to recommend medical prophylaxis is sparse but based on a consensus of experts and small phase 2 or III clinical trials. A clearer understanding of the molecular mechanism(s) involving normal and dysregulated erectile physiology, scavenger haemolysis and nitric oxide pathway paves way for the use of phosphodiesterase type 5 inhibitors in medical prophylaxis of stuttering attacks. These agents will need to be studied in multi-centre randomized phase III trials before they become standard of care. A multidisciplinary team approach is required to enhance "sexual wellness" and prevent erectile dysfunction in this sexually vulnerable group.
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Affiliation(s)
- Ade Olujohungbe
- Department of Hematology, CancerCare Manitoba, Winnipeg, MB, Canada.
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Azık FM, Atay A, Kürekçi AE, Ay H, Kibar Y, Ozcan O. Treatment of Priapism with Automated Red Cell Exchange and Hyperbaric Oxygen in an 11-year-old Patient with Sickle Cell Disease. Turk J Haematol 2012; 29:270-3. [PMID: 24744672 PMCID: PMC3986753 DOI: 10.5505/tjh.2012.78553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 03/05/2011] [Indexed: 12/03/2022] Open
Abstract
Priapism affects up to 50% of all males with sickle cell disease, and there is no standard treatment. Delayed and unsuccessful treatment leads to corporal fibrosis and impotence. It is therefore necessary to determine the best treatment methods for this complication in order to offer effective interventions to all affected patients. Herein we report an 11-year-old patient with sickle cell disease that presented with priapism 72 h after onset, and was successfully treated with automated red cell exchange and hyperbaric oxygen following unsuccessful surgical and conventional interventions.
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Affiliation(s)
- Fatih Mehmet Azık
- Gülhane Military Medical Academy, Department of Pediatric Hematology, Ankara, Turkey
| | - Avni Atay
- Gülhane Military Medical Academy, Department of Pediatric Hematology, Ankara, Turkey
| | - Ahmet Emin Kürekçi
- Gülhane Military Medical Academy, Department of Pediatric Hematology, Ankara, Turkey
| | - Hakan Ay
- Gülhane Military Medical Academy, Department of Underwater and Hyperbaric Medicine, Ankara, Turkey
| | - Yusuf Kibar
- Gülhane Military Medical Academy, Department of Urology, Ankara, Turkey
| | - Okan Ozcan
- Gülhane Military Medical Academy, Department of Pediatric Hematology, Ankara, Turkey
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11
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Boga C, Kozanoglu I, Yeral M, Bakar C. Assessment of corrected QT interval in sickle-cell disease patients who undergo erythroapheresis. Transfus Med 2008; 17:466-72. [PMID: 18067651 DOI: 10.1111/j.1365-3148.2007.00801.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Extension of the QT interval is characterized by syncope and cardiac arrest and often occurs in association with medical therapies and procedures. Whether erythroapheresis (EPH) could influence the QT interval duration in patients with sickle cell disease (SCD) is not known. We aimed to investigate the effects of EPH on the heart rate-corrected QT (QTc) interval. The study included 25 patients with SCD who underwent 34 EPH procedures. Two independent observers measured QTc interval duration from electrocardiograms performed continuously for 3 min at three different points during the EPH procedures (prior to EPH, after completion of 50% EPH and 15 min after EPH). Multiple regression analysis was used to determine if the ionized plasma calcium, the level of plasma magnesium, citrate infusion rate and painful crisis significantly contributed to the QTc interval. There was a non-significant trend (P = 0.184) towards increased QTc in sickle cell patients during EPH compared with pre-EPH values. QTc prolongation (>440 ms) occurred in 72% of the procedures. Fifty percent QTc values returned to baseline after the procedure. The independent variables were not significantly associated with QTc interval. Exchange procedures can induce QTc prolongation in patients with SCD.
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Affiliation(s)
- C Boga
- Department of Hematology, Baskent University Faculty of Medicine, Ankara, Turkey.
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12
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Poullin P, Lefèvre P. [Therapeutic erythrocytapheresis: technical aspects and clinical applications]. Rev Med Interne 2007; 29:290-6. [PMID: 18280010 DOI: 10.1016/j.revmed.2007.10.406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 06/21/2007] [Accepted: 10/13/2007] [Indexed: 11/28/2022]
Abstract
PURPOSE Therapeutic erythrocytapheresis is a selective red cell-depletion aphaeresis technique. CURRENT KNOWLEDGE AND KEY POINT Using a discontinuous or continuous flow blood cell separator, the technique safely allows quickly and automatically collecting a large volume of red cells. The main obstacle of implementation is a poor peripheral venous access. The procedure is well-tolerated. Polycythemia vera, hereditary hemochromatosis, complicated sickle-cell-disease and retinal venous occlusion are the main clinical applications. PROSPECT AND PROJECT Therapeutic erythrocytapheresis is a more modern and more effective method than the classic patient-bleeding. It has to be preferred in the early treatment of patients with polycythemia vera and hereditary hemochromatosis.
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Affiliation(s)
- P Poullin
- Service d'hémaphérèse et d'autotransfusion, hôpital de la Conception, 13385 Marseille cedex 05, France.
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13
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Boga C, Ozdogu H, Kozanoglu I, Sozer O, Sezgin N, Kizilkilic E, Bakar C. Platelet P-selectin expression in patients with sickle cell disease who undergo apheresis. Ther Apher Dial 2007; 11:255-61. [PMID: 17661830 DOI: 10.1111/j.1744-9987.2007.00475.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Activated platelets have been identified in patients with sickle cell disease. However, the association of platelet P-selectin expression and automated red cell exchange procedures in these patients is not well known. We hypothesized that altered whole platelet P-selectin expression is associated with automated red cell exchange. Flow cytometric quantification of platelet P-selectin expression was carried out in 23 patients with sickle cell disease before and after automated red cell exchange. P-selectin expression was quantified as a binding index for platelet P-selectin (the percentage of positive platelets multiplied by the mean fluorescence of positive platelets). The patients were divided into two groups: individuals with painful vaso-occlusive crises (four women and five men; group 1) and those in a steady state (six women and eight men; group 2). The 33 exchange procedures were evaluated prospectively and used acid-citrate-dextrose A solution (whole blood to anticoagulant ratio = 14:1). Platelet P-selectin expression did not significantly change after automated red cell exchange. Clinical factors such as the volume of replacement fluid and the citrate infusion rate did not correlate with postapheresis platelet P-selectin expression. In addition, the association of platelet P-selectin expression and automated red cell exchange was independent of other laboratory factors (hematocrit level, hemoglobin S level, platelet count, and nitric oxide level). Finally, the difference between the study groups regarding platelet P-selectin expression before and after apheresis was insignificant. In conclusion, automated red cell exchange procedures do not induce platelet P-selectin expression in patients with sickle cell disease in the steady state or in vaso-occlusive crisis.
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Affiliation(s)
- Can Boga
- Department of Hematology, University of Baskent, Ankara, Turkey.
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Kozanoglu I, Boga C, Ozdogu H, Sezgin N, Kizilkilic E, Kural M. Automated red cell exchange procedures in patients with sickle cell disease. Transfus Apher Sci 2007; 36:305-12. [PMID: 17584530 DOI: 10.1016/j.transci.2007.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 03/20/2007] [Indexed: 11/26/2022]
Abstract
In automated red cell exchange, about 60% of the patient's red blood cells are exchanged via apheresis for those of the donor. We report the outcome of 83 patients with sickle cell anemia (48 women and 35 men; age range, 17-49 years) who underwent a total of 196 apheresis procedures between December 2003 and October 2006 at our institution. We found that automated red cell exchange involving a reduced citrate infusion rate may provide benefit in the prevention or treatment of vaso-occlusive complications in patients with sickle cell disease and may be associated with protean effects on biochemical dynamics.
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Affiliation(s)
- Ilknur Kozanoglu
- Department of Physiology, Baskent University, Faculty of Medicine, 06490-Ankara, Turkey
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Abstract
Sickle cell disease (SCD) is the most commonly inherited hemoglobinopathy in the United States. Blood transfusion is a critical part of the multidisciplinary approach necessary in the management of SCD; however, blood transfusions are not without complications. The successful use of transfusion as a treatment strategy in SCD requires the critical review and knowledge of transfusion methods, generally accepted indications, clinical situations in which transfusion generally is not considered, the selection of blood products, and strategies to prevent transfusion-related complications.
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Affiliation(s)
- Sam O Wanko
- Duke University Medical Center, DUMC Box 3841, Durham, NC 27710, USA
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16
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Nolan VG, Baldwin C, Ma Q, Wyszynski DF, Amirault Y, Farrell JJ, Bisbee A, Embury SH, Farrer LA, Steinberg MH. Association of single nucleotide polymorphisms in klotho with priapism in sickle cell anaemia. Br J Haematol 2005; 128:266-72. [PMID: 15638863 DOI: 10.1111/j.1365-2141.2004.05295.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The complications of sickle cell disease are probably determined by genes whose products modify the pathophysiology initiated by the sickle haemoglobin mutation. Priapism, one vaso-occlusive manifestation of sickle cell disease, affects more than 30% of males with the disease. We examined the possible association of single nucleotide polymorphisms (SNPs) in 44 candidate genes of different functional classes for an association with the occurrence of priapism. One hundred and forty-eight patients with sickle cell anaemia and incident or a confirmed history of priapism were studied, along with 529 controls that had not developed priapism. Polymorphisms in the KLOTHO gene (KL; 13q12) showed an association with priapism by genotypic [reference SNP cluster identifier number (rs)2249358; odds ratio (OR) = 2.6 (1.4-5.5); rs211239; OR = 1.7 (1.2-2.6)] and haplotype analyses [rs211234 and rs211239; OR = 2.3 (1.5-3.4)]. These findings may have broader implications in sickle cell disease, as KL encodes a membrane protein that regulates many vascular functions, including vascular endothelial growth factor expression and endothelial nitric oxide release.
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Affiliation(s)
- Vikki G Nolan
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Saad STO, Lajolo C, Gilli S, Marques Júnior JFC, Lima CS, Costa FF, Arruda VR. Follow-up of sickle cell disease patients with priapism treated by hydroxyurea. Am J Hematol 2004; 77:45-9. [PMID: 15307105 DOI: 10.1002/ajh.20142] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hydroxyurea is one of the most successfully used therapies for sickle cell disease. Results of many clinical trials point to hydroxyurea administration for patients with frequent painful crises and acute chest syndrome. Priapism is one of the complications that could be prevented by hydroxyurea, but there are few reports demonstrating the results. Since November 1993, hydroxyurea has been used in our clinic for preventing priapism in patients with stuttering or major attacks who are still capable of achieving intercourse on demand. Five patients were enrolled in the study, and 4 cases benefited by this treatment. After the initial treatment for the acute attack, all five patients developed stuttering priapism. Hydroxyurea was then introduced at the initial dose of 10 mg/kg, and as the hydroxyurea dosage increased, the number or length of priapism episodes decreased. One to two months after the maximal dose (20-35 mg/kg) was introduced, the episodes disappeared. In two patients, we were forced to administer over 30 mg hydroxyurea/kg to abort the episodes, and, in another patient, 25 mg/kg was necessary. All patients present normal sexual activity. Hydroxyurea was discontinued in two patients, but stuttering priapism reappeared. Hydroxyurea was then re-introduced, and priapism disappeared. One patient, using 20 mg hydroxyurea/kg, had a 6-year remission of priapism after hydroxyurea administration; however, he experienced stuttering priapism, 1 month before a major attack, that progressed to impotence. During that month, he did not seek medical attention. In conclusion, the data here presented suggests that hydroxyurea may prevent priapism attacks in sickle cell disease, probably at higher doses than usually prescribed for painful crisis prevention.
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Affiliation(s)
- Sara T O Saad
- Hematology and Hemotherapy Center of the State University of Campinas, Campinas, São Paulo, Brazil.
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Amrolia PJ, Almeida A, Halsey C, Roberts IAG, Davies SC. Therapeutic challenges in childhood sickle cell disease. Part 1: current and future treatment options. Br J Haematol 2003; 120:725-36. [PMID: 12614202 DOI: 10.1046/j.1365-2141.2003.04143.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Persis J Amrolia
- Department of Bone Marrow Transplantation, Great Ormond Street Hospital for Sick Children, London, UK.
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Danielson CFM. The role of red blood cell exchange transfusion in the treatment and prevention of complications of sickle cell disease. THERAPEUTIC APHERESIS : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR APHERESIS AND THE JAPANESE SOCIETY FOR APHERESIS 2002; 6:24-31. [PMID: 11886573 DOI: 10.1046/j.1526-0968.2002.00396.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Patients with sickle cell disease have abnormal red blood cells (RBCs). This can cause chronic hemolytic anemia and vaso-occlusion leading to tissue hypoxemia and organ dysfunction. RBC exchange transfusion can, without increasing the whole-blood viscosity, quickly replace abnormal erythrocytes with normal and raise the hematocrit resulting in improved delivery of oxygen to hypoxic tissues. Unfortunately, transfusion can also be associated with complications. This paper reviews the role of transfusion, both simple and exchange, in the treatment and prevention of sickle-related complications. The benefits of exchange versus simple transfusion and transfusion versus alternative therapies are discussed.
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