Consensus Protocol for Monitoring Individuals on Chronic Transfusion Therapy

Consensus Protocol for Monitoring Individuals on Chronic Transfusion Therapy

The following is a consensus protocol for the initiation and monitoring of patients on chronic transfusion therapy. It is understood that the recommended testing schedule may not be available to patients everywhere; therefore, this protocol should serve only asa helpful guide for transfusion management.

At Initiation
Obtain patient treatment history to include locations where prior transfusions were received and any adverse effects.
Notify the blood bank that the patient being initiated on chronic transfusion therapy has SCD. Ask the blood bank to contact hospitals where the patient reported receiving previous transfusion therapy to obtain transfusion information.
Obtain a RBC phenotype, type and screen, quantitative measurement of percent HbA and percent HbS, complete blood count (CBC), and reticulocyte count.
Inform the patient if he or she is alloimmunized, so that this information can be communicated as part of the patient’s self-reported medical history.

Suggested Evaluation Before Each Transfusion
CBC and reticulocyte count-This procedure is done to help guide the frequency and volume of transfusions. It is expected that, with effective chronic transfusion therapy, the patient’s bone marrow will be suppressed and the reticulocyte count should decrease, but the value may rise by the time of the next transfusion.
Quantitative measurement of percent HbA and percent HbS-This procedure is done to confirm the success of chronic transfusion therapy with achieving the target percent of HbS.
Type and screen-This is done to assess whether the patient has developed any new RBC antibodies from the prior transfusion.

Suggested Periodic Evaluations
Liver function tests annually or semiannually-Thesetests are done to follow liver function in individuals with iron overload.
Serum ferritin (SF) quarterly-This test is done to follow iron stores in individuals with iron overload;it can be helpful in evaluating compliance with chelation.
Screening for hepatitis C, hepatitis B,and HIV annually.
Evaluation for iron overload every 1-2 years by validated liver iron quantification methods such as liver biopsy, MRI R2 or MRI T2* or R2 techniques.