Evidence-based guidelines to healthcare professionals for decision-making about transfusion assistance for patients with sickle cell disease (SCD) and the management of any transfusion-related complications were provided in a study published in Cureus.

The early detection and treatment of hemolytic transfusion reactions in patients with SCD can ensure poor clinical outcomes are avoided. “Red cell transfusions, red cell antigen matching optimization, and iron chelation can also help reduce negative consequences,” the authors said. 

But perhaps most importantly, the most effective therapeutic strategy for patients with SCD who rely on blood transfusions for survival is the prevention of transfusion-related acute lung injury. “Several recent studies have shown that immunotherapy or immunological targets can effectively prevent these complications,” they wrote.

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The team led by Alena Yarema, DO, from St. Bernards Medical Center in Jonesboro, Arkansas conducted a systematic review of the literature to provide a comprehensive understanding of SCD and its complications, treatment protocols, risk factors, transfusion-related acute lung injury complications, and the management of these complications, as well as potential future treatments.

After defining transfusion-related acute lung injury in SCD, the authors provide management options for the condition. These include supportive care modalities such as oxygen supplementation, mechanical ventilation, albumin treatment, and the use of erythropoietin and iron.

They also describe preventative options including blood antibody testing of donors, the use of enhanced and standardized blood and plasma selection protocols, rapid reporting to blood banks, and prophylaxis with rituximab.

Finally, the researchers touch on potential future treatments such as anti-CD40L monoclonal antibodies and immunotherapy, including IL-10 therapy that could counter transfusion-related acute lung injury more effectively than existing ones.

Reference

Arzoun H, Srinivasan M, Adam M, Thomas SS, Lee B, Yarema A. A systematic review on the management of transfusion-related acute lung injury in transfusion-dependent sickle cell disease. Cureus. 2022;14(2):e22101. doi:10.7759/cureus.22101