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Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
05:23

Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload

Published on: March 14, 2017

Computerized physician order entry improves compliance with a manual exchange transfusion protocol in the pediatric

Michael C McCrory1, John J Strouse, Clifford M Takemoto

  • 1*Departments of Anesthesiology and Pediatrics, Pediatric Critical Care, Baptist Hospital, School of Medicine, Wake Forest University, Winston-Salem, NC †Department of Pediatrics, Pediatric Hematology, Johns Hopkins University School of Medicine, Baltimore, MD ‡Departments of Pediatrics and Anesthesiology, Cardiovascular Anesthesiology and Critical Care, Texas Children's Hospital/Baylor College of Medicine, Houston, TX.

Journal of Pediatric Hematology/Oncology
|April 27, 2013
PubMed

Insights

Computerized physician order entry (CPOE) improved red blood cell exchange transfusions for children with sickle cell disease. This protocol enhanced compliance and reduced sickle hemoglobin levels, optimizing patient care.

Area of Science:

  • Pediatric Hematology
  • Clinical Informatics
  • Transfusion Medicine

Background:

  • Sickle cell disease (SCD) affects children, often requiring red blood cell (RBC) exchange transfusions.
  • Manual RBC exchange transfusions aim to reduce sickle hemoglobin and maintain adequate hemoglobin levels.
  • Protocol adherence is crucial for effective and safe transfusion outcomes.

Purpose of the Study:

  • To evaluate the impact of a computerized physician order entry (CPOE) protocol on manual RBC exchange transfusions.
  • To assess changes in protocol compliance, sickle hemoglobin reduction, and hemoglobin levels post-CPOE implementation.

Main Methods:

  • Retrospective study comparing manual RBC exchange transfusions before (2001-2008) and after (2008-2009) CPOE implementation.
  • Analysis of protocol violations, percentage reduction in sickle hemoglobin, and peak/post-exchange hemoglobin levels.
  • Study included critically ill children with sickle cell disease.

Main Results:

  • CPOE implementation significantly improved protocol compliance (20 violations pre-CPOE vs. 3 post-CPOE, P=0.02).
  • Greater reduction in sickle hemoglobin was observed post-CPOE (55% vs. 70%, P=0.04).
  • Hemoglobin levels after prolonged exchange were higher pre-CPOE (11.5 g/dL vs. 10.5 g/dL, P=0.006), indicating better maintenance post-CPOE.

Conclusions:

  • Computerized physician order entry (CPOE) protocols enhance manual RBC exchange transfusions in pediatric sickle cell disease.
  • CPOE use is associated with improved adherence to transfusion protocols.
  • The protocol leads to better reduction of sickle hemoglobin and improved hemoglobin level management during exchange transfusions.
Abstract

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