Researchers produced and evaluated a novel therapeutic algorithm for patients with sickle cell disease (SCD) and severe COVID-19 and found it useful for identifying factors to be considered when prescribing a treatment regime, as published in the American Journal of Hematology.

Patients with SCD are at risk of developing painful vaso-occlusive events and ischemia-related morbidity. The COVID-19 infection represents a significant mortality risk for patients with SCD. Acute chest syndrome (ACS) was identified in about 30% of patients with SCD hospitalized for COVID-19.

Treatment strategies for patients with SCD with severe COVID-19 include supplemental oxygen, corticosteroids, tocilizumab, and anticoagulants. “Selection of the appropriate therapies may have a critical impact on patient outcome, due to the complex relationship between the drugs’ mechanism of action and SCD pathophysiology,” De Luna and colleagues wrote.

Read more about SCD therapies

The research team hence proposed a treatment algorithm with the aim of minimizing the worsening of the patients’ clinical condition. They proposed 3 main items:

  • A blood exchange transfusion using a protocol matched for Rh/Kell blood groups should be performed prior to commencing corticosteroid therapy.
  • If transfusions are not recommended, tocilizumab should be administered as an alternative to corticosteroids. 
  • Prophylactic anticoagulants should be administered during the duration of the hospitalization and after discharge.

The researchers then put their treatment algorithm to the test. Eleven patients with SCD and severe COVID-19 were treated with this algorithm between March 13, 2020, and January 17, 2022. Through this study, the research team was better able to identify important factors to take into consideration when treating patients with SCD and severe COVID-19.

“In conclusion, severity of COVID-19 infection, ACS diagnosis and history of transfusion reactions must be taken into account when considering the use of corticosteroids for the management of severe COVID-19 pneumonia in SCD patients,” De Luna and colleagues wrote.

Reference

De Luna G, Habibi A, Odièvre MH, et al. Blood exchange transfusion with dexamethasone and tocilizumab for management of hospitalized patients with sickle cell disease and severe COVID-19: preliminary evaluation of a novel algorithmAm J Hematol. Published online April 6, 2022. doi:10.1002/ajh.26563