Regional consensus opinion for the management of Beta thalassemia major in the Arabian Gulf area

Incidence of acute transfusion reactions and associated factors among adult blood-transfused patients at Jimma University Medical Center, southwest Ethiopia: A cross-sectional study

Acute transfusion reaction is mainly related to the infusion of blood or blood products resulting at any time within a day of the intervention. It ranges from a non-specific febrile episode to a life-threatening intravascular hemolysis. The severity of the reaction and the degree of morbidity are usually related to the degree of ABO incompatibility and the volume of blood transfused. Therefore, this study aimed to determine the incidence of acute transfusion reactions and its associated factors in Jimma University Medical Center, southwest Ethiopia. Institution-based cross-sectional study was conducted from 1 October to December 30, 2020. A total of 384 transfused patients were followed in this study. Socio-demographic and clinical data were collected through a structured questionnaire. Baseline measurement and 24-hour periodic vital signs monitoring were conducted after each transfusion. Four milliliters of venous blood were drawn after transfusion intervention from each distrusted patient for complete blood count, blood group phenotype, direct antihuman globulin test (DAT), and crossmatching. Data were entered into Epi data version 3.1 and analyzed using Statistical Package for Social Science software (SPSS) version 20. Descriptive statistics, and bivariable and multivariable logistic regression were employed to test the association between independent and dependent variables. A P value ≤ .05 was considered to indicate statistical significance. Acute transfusion reactions were diagnosed in 5.7% of patients, with most of these reactions were febrile nonhemolytic reactions (63.6%) followed by allergic (36.4%) reactions with mild clinical manifestations (27.3%). Transfusion history, transfused blood that was kept for more than 13 days, abortion history, and number of transfused units (≥3 units of blood/blood component) have 3.3, 3.85, 4.2, and 3.9 times greater odds, respectively, besides their significant association with the incidence of acute transfusion reactions. Patients with a history of previous transfusion, abortion, multi-unit transfusion, and patients transfused with blood stored for ≥14 days should be closely monitored. Starting a hemovigilance system of monitoring, collecting, and evaluating data on adverse effects of blood transfusion locally and nationally will decrease the occurrence of acute transfusion reactions.

Correlation of Transfusion Dependence and Its Associated Sequelae to Hematological and Biochemical Parameters in Patients With Sickle Cell Disease and Beta Thalassemia Major in Khobar: A Retrospective Study

Sickle cell disease (SCD) and beta thalassemia major (βTM) are multisystemic, genetically inherited diseases. They are caused by mutations of hemoglobin, which ultimately cause abnormal functioning of the red blood cells. The morbidity and mortality rates of these diseases are significant, as they may result in severe complications, some of which are quite fatal; hence, early diagnosis and treatment are crucial. The purpose of this study is to collect patients' data in terms of their manifestations and overall clinical picture and correlate them to the laboratory parameters with emphasis on their transfusion dependence and its sequelae in King Fahd Hospital of the University (KFHU), Al-Khobar, Saudi Arabia. After obtaining ethical approval from the institutional review board and in collaboration with the blood bank, patients' data were retrospectively collected from the hospital's database and categorized into two disease groups. Accordingly, data related to the biological and demographic information, clinical picture pattern, laboratory investigations, and therapeutic measures, with emphasis on blood transfusion as a treatment option, were gathered and analyzed. Eventually, the aforementioned data aspects were assessed for the probability of correlations, which were proven to be present to some level as an answer to our cohort study's question. Such findings, which will be depicted later in this study, might represent a ground for having a more comprehensive and extensive approach in terms of the general evaluation of patients with SCD and βTM based on the established level of correlation. During the course of conducting our research, we encountered some limitations, including the sample size and scarce data available during the process of data collection.

Healthcare resource utilization and direct costs of transfusion-dependent thalassemia patients in Dubai, United Arab Emirates: a retrospective cost-of-illness study

BACKGROUND

Patients with transfusion-dependent thalassemia (TDT) require lifelong blood transfusions and iron chelation therapy. Thus, patients afflicted with TDT often have to undergo blood transfusion and iron chelation therapy, which causes a major economic burden on them. However, this topic has not been reported in Dubai, United Arab Emirates (UAE). Hence, this study aimed to evaluate healthcare resource utilization and associated direct costs related to patients with TDT in Dubai, UAE.

METHODS

For this study, a retrospective prevalence-based cost-of-illness analysis based on the UAE healthcare system and patient perspectives was conducted among patients with TDT treated at the Dubai Thalassemia Center in 2019. Information regarding healthcare resource utilization and direct medical costs was collected from the billing system connected to the electronic medical record system. Patients and their families were interviewed for direct non-medical cost estimations.

RESULTS

A total of 255 patients with TDT were included in the study. The mean annual direct medical cost was estimated at AED 131,156 (USD 35,713) (95% CI: 124,735 - 137,578). The main driver of the medical cost for the participants as iron chelation therapy AED 78,372 (95% CI: 72,671 - 84,074) (59.8%), followed by blood transfusions, which accounted for AED 34,223 (95% CI: 32,854 - 35,593) 26.1% of the total direct medical costs. The mean annual direct non-medical costs was AED 2,223 (USD 605) (95% CI: 1,946 - 2,500). Age (p < 0.001), severe serum ferritin levels (p = 0.016), the presence of complications (p < 0.001), and the type of iron chelation therapy (p < 0.001) were significant predictors of higher direct medical costs incurred by the participants.

CONCLUSION

Transfusion-dependent thalassemia poses a substantial economic burden on the healthcare system, patients, and their families. Our results show that the highest medical cost proportion was due to iron chelation therapy. In this regard, efforts must be made to improve the patients' acceptance and satisfaction with their iron chelation therapy to increase their compliance and improve the effectiveness of treatment, which could play an essential role in controlling the economic burden of this disease. Moreover, greater support is essential for families that suffer catastrophic out-of-pocket expenses.

Blood Demand and Challenges for Patients With Beta-Thalassemia Major in Eastern Saudi Arabia

Background

β-thalassemia major is a hereditary disorder of hemoglobin (Hb) that results in defective Hb synthesis, leading to severe chronic anemia. The mainstay of its treatment is lifelong regular packed red cell transfusions associated with iron-chelating therapy. Globally, there is a gap between blood donation and the actual needs of the patients who depend on transfusion. Patients with β-thalassemia major are no exception and have limited access to regular and safe blood transfusions. This study aimed to assess the gap between the demand and supply of blood for transfusion-dependent patients with β-thalassemia major treated at the Hereditary Blood Diseases Center, Al Ahsa, Eastern Saudi Arabia.

Methodology

This was a retrospective, cross-sectional study conducted at the Hereditary Blood Disease Center, Al Ahsa, Saudi Arabia, including patient data from January 2017 to December 2019. We used Excel 365 from Microsoft Office 2016, version 1706.

Results

A total of 158 patients were on chronic transfusion. Of the total patients, 65% were adults, while the remaining 35% comprised the pediatric population. The total number of units requested and received during the three-year period was 14,509 and 9,530, respectively, indicating a gap of 4,979 (34%) units. The age of most of the units received was more than 14 days: 36% of those in 2017, 49.9% in 2018, and 61.5% in 2019. Rare blood groups and alloimmunization accounted for <8% of the patients. Prestorage filtration was the policy for all units.

Conclusions

There was a gap between the demand and supply of blood for patients with β-thalassemia major treated at our center. We suggest raising awareness regarding the high demands for fresh red blood cell components in patients with thalassemia major, encouraging voluntary blood donations, enhancing national blood-banking policies, and reducing the fragmentation of blood services to reduce the gap between demand and supply.

Proportion of Acute Transfusion Reaction and Associated Factors Among Adult Transfused Patients at Felege Hiwot Compressive Referral Hospital, Bahir Dar, Northwest Ethiopia: A Cross-Sectional Study

Introduction

Acute transfusion reactions are adverse events occurring within 24 hrs of transfusion and cause simple-to-severe complications. They may vary with the blood component transfused and recipient factors. In Ethiopia, there is a limited evidence about the incidence and associated factors of transfusion reactions.

Objective

To determine the proportion of acute transfusion reactions and associated factors among adult transfused patients.

Methods

A total of 384 study participants were included in the study. Structured questionnaires were used for socio-demographic and past medical history data collection. Vital signs were measured as a baseline for every study participants and monitored and followed for 24 hrs. Laboratory tests like complete blood count, direct anti-human globulin test and urine hemoglobin were done as a baseline for suspected patients. Cross-match, blood grouping, and blood culture for patients and donors sample were also done for suspected patients. Descriptive statistics, bivariable and multivariable binary logistic regression were analyzed using SPSS version 20. P-value of <0.05 in the multivariable model was considered as statistically significant.

Results

Acute transfusion reactions were observed in 5.2% of patients. Of total cases of acute transfusion reaction, the majority developed allergic reactions (65%) and febrile non-hemolytic transfusion reaction (30%). It was significantly associated with transfusion history (AOR=3.4; 95% CI: 1.2–9.7), abortion history (AOR=5.0; 95% CI: 1.5–16.4), longer blood storage time (AOR=5.1; 95% CI: 1.7–15.2) and receiving three or more unit of blood (AOR= 4.1; 95% CI: 1.5–11.2).

Conclusion

Acute transfusion reactions were observed in 5.2% of patients (allergic reactions (65%), febrile non-hemolytic transfusion reaction (30%) and alloimmunization (5%)). Patients with a history of transfusion, abortion, transfused with blood stored ≥14 days and multi-transfused patients should be closely monitored.

Clinical and hematological features among β-thalassemia major patients in Jazan region: A hospital-based study

Context:

Beta-thalassemia is a prevalent hereditary blood disorder in Saudi Arabia. Various clinical manifestations and hematological abnormalities are common among these patients.

Aims:

To evaluate the clinical manifestations and hematological parameters of β-thalassemia patients in Jazan, Saudi Arabia.

Settings and Design:

This is a cross-sectional study conducted in Jazan region, Saudi Arabia.

Methods and Materials:

We included 36 β-Thalassemia major patients who admitted to PMNH during the period from February 1, 2016 to December 31, 2017. Clinical features were obtained via physical examination. The hematological parameters were obtained from the patients' medical records.

Statistical Analysis Used:

Descriptive and inferential statistics were conducted using SPSS. Continuous data was evaluated using independent sample t-test and Chi-square was used to evaluate categorical variables. P < 0.05 indicated statistical significance.

Results:

Mean age was 18.56 ± 6.89 years. Males were 23 (63.9%). About 41.4% of patients were underweight. Exposing of the upper teeth was the most prominent feature (n = 19, 59.4%). The majority of patients were splenectomized (62.1%). About two-thirds have moderate anemia. More than half of the patients (58.8%) had high WBCs counts and 35.3% had a high platelet count, especially among those who underwent splenectomy. Approximately, two-thirds had a ferritin level higher than 2500 ng/ml. O⁺ blood group was the most frequent blood group among the patients (n = 15, 46.9%).

Conclusions:

Deteriorated clinical and hematological parameters in our study justify the need for more efforts for regular evaluation and follow-up of the βTM patients and reevaluation of the management protocols to be improved or modified.

Computational Analysis of Protein Structure Changes as a Result of Nondeletion Insertion Mutations in Human β-Globin Gene Suggests Possible Cause of β-Thalassemia

Beta-thalassemia is described as a group of hereditary blood disorders characterized by abnormalities in the synthesis of beta chains of hemoglobin. These anomalies result in different phenotypes ranging from moderate to severe clinical symptoms to no symptoms at all. Most of the defects in hemoglobin arise directly from the mutations in the structural β-globin gene (HBB). Recent advances in computational tools have allowed the study of the relationship between the genotype and phenotype in many diseases including β-thalassemia. Due to high prevalence of β-thalassemia, these analyses have helped to understand the molecular basis of the disease in a better way. In this direction, a relational database, named HbVar, was developed in 2001 by a collective academic effort to provide quality and up-to-date information on the genomic variations leading to hemoglobinopathies and thalassemia. The database recorded details about each variant including the altered sequence, hematological defects, its pathology, and its occurrence along with references. In the present study, an attempt was made to investigate nondeletion mutations in the HBB picked up from HbVar and their effects using the in silico approach. Our study investigated 12 nucleotides insertion mutations in six different altered sequences. These 12 extra nucleotides led to the formation of a loop in the protein structure and did not alter its function. It appears that these mutations act as ‘silent' mutations. However, further in vitro studies are required to reach definitive conclusions.

The Effect of a Training Program Based on the PRECEDE-PROCEED Model on Lifestyle of Adolescents with Beta-Thalassemia: A Randomized Controlled Clinical Trial

Background: Lifestyle is a key issue in the concept of health promotion. Lifestyle includes all activities that encourage optimum physical, spiritual, and mental functions. The aim of this study was to determine the effect of a training program based on PRECEDE-PROCEED Model on lifestyle of adolescents with beta thalassemia. Materials and Methods: In this clinical trial study, 64 adolescents (age 16-20) who referred to the Thalassemia Center of Ahvaz (2015) were selected and randomly divided into two groups: experimental and control group. The components of the PRECEDE-PROCEED Model were used for planning, implementation and evaluation of the program. Changes in predisposing, reinforcing, enabling factors and lifestyle were immediately and a month after the intervention were assessed by a questionnaire based on PRECEDE-PROCEED Model and the Health-Promoting Lifestyle Profile. Results: The intervention had significantly positive effect on predisposing, enabling and reinforcing factors immediately and a month after the intervention (P < 0.05). Repeated measures analysis of variance showed a significant positive increase in the six dimensions of lifestyle score in the experimental group from baseline to one-month follow-up (P < 0.05). Conclusion: This study showed that the theory-based training program in adolescents suffered from beta thalassemia disease could improve the adolescent's awareness and attitude of healthy lifestyle.

Sotatercept, a novel transforming growth factor β ligand trap, improves anemia in β-thalassemia: a phase II, open-label, dose-finding study

β-thalassemia, a hereditary blood disorder caused by defective synthesis of hemoglobin β globin chains, leads to ineffective erythropoiesis and chronic anemia that may require blood transfusions. Sotatercept (ACE-011) acts as a ligand trap to inhibit negative regulators of late-stage erythropoiesis in the transforming growth factor β superfamily, correcting ineffective erythropoiesis. In this phase II, open-label, dose-finding study, 16 patients with transfusion-dependent β -thalassemia and 30 patients with non-transfusion-dependent β-thalassemia were enrolled at seven centers in four countries between November 2012 and November 2014. Patients were treated with sotatercept at doses of 0.1, 0.3, 0.5, 0.75, or 1.0 mg/kg to determine a safe and effective dose. Doses were administered by subcutaneous injection every 3 weeks. Patients were treated for ≤22 months. Response was assessed as a ≥20% reduction in transfusion burden sustained for 24 weeks in transfusion-dependent β-thalassemia patients, and an increase in hemoglobin level of ≥1.0 g/dL sustained for 12 weeks in non-transfusion-dependent β-thalassemia patients. Sotatercept was well tolerated. After a median treatment duration of 14.4 months (range 0.6-35.9), no severe life-threatening adverse events were observed. Thirteen percent of patients reported serious but manageable adverse events. The active dose of sotatercept was ≥0.3 mg/kg for patients with non-transfusion-dependent β-thalassemia and ≥0.5 mg/kg for those with transfusion-dependent β-thalassemia. Of 30 non-transfusion-dependent β-thalassemia patients treated with ≥0.1 mg/kg sotatercept, 18 (60%) achieved a mean hemoglobin increase ≥1.0 g/dL, and 11 (37%) an increase ≥1.5 g/dL, sustained for ≥12 weeks. Four (100%) transfusion-dependent β-thalassemia patients treated with 1.0 mg/kg sotatercept achieved a transfusion-burden reduction of ≥20%. Sotatercept was effective and well tolerated in patients with β-thalassemia. Most patients with non-transfusion-dependent β-thalassemia treated with higher doses achieved sustained increases in hemoglobin level. Transfusion-dependent β-thalassemia patients treated with higher doses of sotatercept achieved notable reductions in transfusion requirements. This trial was registered at ClinicalTrials.gov with the number NCT01571635.

Reducing the iron burden and improving survival in transfusion-dependent thalassemia patients: current perspectives

Hypertransfusion regimens for thalassemic patients revolutionized the management of severe thalassemia; transforming a disease which previously led to early infant death into a chronic condition. The devastating effect of the accrued iron from chronic blood transfusions necessitates a more finely tuned approach to limit the complications of the disease, as well as its treatment. A comprehensive approach including carefully tailored transfusion protocol, continuous monitoring and assessment of total body iron levels, and iron chelation are currently the mainstay in treating iron overload. There are also indications for ancillary treatments, such as splenectomy and fetal hemoglobin induction. The main cause of death in iron overload continues to be related to cardiac complications. However, since the widespread use of iron chelation started in the 1970s, there has been a general improvement in survival in these patients.

Single Breath-Hold Physiotherapy Technique: Effective tool for T2* magnetic resonance imaging in young patients with thalassaemia major

Magnetic resonance imaging using T2* (MRI T2*) is a highly sensitive and non-invasive technique for the detection of tissue iron load. Although the single breath-hold multi-echo T2* technique has been available at the Sultan Qaboos University Hospital (SQUH), Muscat, Oman, since 2006, it could not be performed on younger patients due to their inability to hold their breath after expiration. This study was carried out between May 2007 and May 2015 and assessed 50 SQUH thalassaemic patients aged 7-17 years old. Seven of these patients underwent baseline and one-year follow-up MRI T2* scans before receiving physiotherapy training. Subsequently, all patients were trained by a physiotherapist to hold their breath for approximately 15-20 seconds at the end of expiration before undergoing baseline and one-year follow-up MRI T2* scans. Failure rates for the pre- and post-training groups were 6.0% and 42.8%, respectively. These results indicate that the training of thalassaemic patients in breath-hold techniques is beneficial and increases rates of compliance for MRI T2* scans.