Narbey et al reported an algorithm for transfusing a patient with sickle cell disease. This can help to guide patient management. The authors are from multiple institutions in France.
Patient selection: sickle cell disease
Goal: prescription of an occasional transfusion
Parameters for a predictive score:
(1) history of significant antibodies
(2) history of non-significant antibodies and/or anti-Rh and/or anti-K
(3) number of previous transfused units
(4) history of delayed hemolytic transfusion reaction (DHTR)
Parameter
Finding
Poitns
history of significant antibody
no
0
yes
6
history of nonsignificant antibodies or anti-Rh/K
no
0
yes
5
number of previous transfusions
< 12
8
>= 12
0
history of DHTR
no
0
yes
5
where:
• The patient with no history of transfusion has a high rate of DHTR. A patient who has received multiple units is at a lower risk for DHTR (page 1346, column 1).
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score 24
Status
Score < 8
Score >= 8
no previous immunization
match for Rh and K
match for Rh and K; extended crossmatch
only anti-Rh and/or anti-K
match for Rh and K
match for Rh and K; extended crossmatch
significant antibodies
match for Rh and K; match for antibody specificity; if possible perform an extended crossmatch
match for Rh and K; extended match; rituximab therapy
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