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Pediatrics

Research Snapshot Theater: Hematology, Pediatric I

(518) Breathing Easy: How Transfusion Types Affect Respiratory Support in Sickle Cell Acute Chest Syndrome

Monday, February 24, 2025
2:30pm – 3:30pm Eastern Time
Location: Connections Central - RST 09

    First Author(s)

  • Nancy Chung, MD

    Texas Children's Hospital, Texas, USA

    • Co-Author(s)

  • LD

    Lianna Drobatz, MD

    Pediatric Critical Care Fellow
    University of Chicago Medical Center, United States

  • IA

    Ilir Agalliu, MD, ScD

    Associate Professor of Epidemiology & Public Health and Urology
    Montefiore Medical Center, United States

  • WM

    William Mitchell, MD

    Associate Professor of Pediatrics
    The Children's Hospital at Montefiore, United States

  • KM

    Kerry Morrone, MD MS

    Assistant Professor of Pediatrics, Director of the Sickle Cell Program
    The Children's Hospital at Montefiore, United States

Introduction: Acute chest syndrome (ACS) is a leading cause of mortality in patients with sickle cell disease (SCD). Key treatments include antibiotics, respiratory support, and red blood cell transfusion. The comparative benefits of straight red blood cell transfusion (ST) versus red cell exchange (RCE) for ACS remain uncertain. The American Society of Hematology Guidelines recommends RCE for SCD patients with moderate to severe ACS, despite limited evidence. The purpose of this study is to compare how transfusion type affects weaning of respiratory support in ACS.

Methods: Single-center, retrospective cohort study including patients aged 0 to 21 years with SCD and admitted for ACS between January to December 2019. Primary outcome was the duration of oxygen support (hours) following patients receiving RCE compared to ST. Secondary outcomes included hospital length of stay (LOS), pediatric intensive care unit (PICU) LOS, total time of respiratory support, and complications associated with hemodialysis (HD) catheter placement for RCE. Descriptive statistics, chi-square tests, and t-tests compared patients receiving RCE to ST. Variables potentially associated with markers of more severe ACS including age, sex, sickle cell type, comorbid asthma and obstructive sleep apnea, and seasonality were analyzed using logistic regression models.

Results: 50 patients with SCD met inclusion criteria with 45 receiving ST and 5 receiving RCE. The median duration of respiratory support following transfusion was 42.5 hours (hrs) for the ST group, compared to 10 hrs for the RCE group (p=0.07). Median total respiratory support time was 31 hrs in the ST group and 50 hrs in the RCE group (p=0.23). The median hospital LOS was 120 hrs for the ST group and 162 hrs for the RCE group (p=0.4). PICU LOS was approximately 39 hrs longer in the RCE group (p=0.09). No complications related to HD catheter placement. Logistic regression models did not show any statistically significant associations for variables between ST and RCE.

Conclusions: Patients with ACS who underwent RCE were able to be weaned from their respiratory support faster than those who received ST. Complications associated with HD catheter placement to perform RCE were minimal. Prospective work is needed to further explore these outcomes.