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Updated: Apr 25, 2026
A Precision Medicine Tool for Measurement and Monitoring of Hemoglobin S in Sickle Cell Disease Patients Receiving Transfusion Therapy
Improved hydroxyurea effect with the use of text messaging in children with sickle cell anemia
Jeremie H Estepp1, Bryan Winter, Margery Johnson
1Departments of Hematology, St. Jude Children's Research Hospital, Memphis, Tennessee.
Insights
Text message reminders improved adherence to hydroxyurea in children with sickle cell anemia (SCA). This intervention showed positive changes in hematologic parameters, demonstrating its effectiveness in managing this chronic condition.
Area of Science:
- Pediatric Hematology
- Chronic Disease Management
- Digital Health Interventions
Background:
- Sickle cell anemia (SCA) treatment with hydroxyurea often faces adherence challenges in pediatric patients.
- Mobile phone access is widespread among families of children with SCA, presenting an opportunity for intervention.
Purpose of the Study:
- To evaluate the impact of text message reminders (SIMON®) on hydroxyurea adherence in children with SCA.
- To assess changes in laboratory parameters and hospitalizations following the implementation of text message reminders.
Main Methods:
- Retrospective analysis of pediatric patients (<19 years) with SCA receiving hydroxyurea at maximal tolerated dosage (MTD).
- Comparison of laboratory parameters, hospitalizations, and medication possession ratios (MPR) before and after SIMON® initiation.
Main Results:
- 91% of eligible families opted for text message reminders.
- Following SIMON® implementation, improved hematologic parameters (increased MCV, Hb, HbF; decreased reticulocytes, bilirubin) suggested better adherence.
- Hospitalizations remained low, and MPRs were consistently high, with no significant changes observed.
Conclusions:
- The SIMON® system is a feasible tool for improving hematologic parameters in pediatric SCA patients on hydroxyurea.
- This technology holds potential for application in managing other chronic conditions requiring daily medication.
Background:
In children with sickle cell anemia (SCA), hydroxyurea reduces morbidity, but adherence is frequently suboptimal. Because most families of children with SCA have access to cellular telephone services, we assessed the impact of text messaged reminders as a tool to improve adherence to hydroxyurea.
Procedure:
All patients <19 years of age with HbSS or HbSβ(0) thalassemia who were treated with hydroxyurea at a maximal tolerated dosage (MTD) at St. Jude Children's Research Hospital Comprehensive Pediatric Sickle Cell Program and who received automated text message reminders (SIMON®) were retrospectively identified. Laboratory parameters, hospitalizations, and medication possession ratios (MPR) prior to and after initiation of SIMON® were compared to assess the impact of SIMON®.
Results:
Of the 97.3% of families with access to a cell phone, 91% elected to receive text message reminders. Among 55 children receiving hydroxyurea at MTD, laboratory parameters reflected waning medication compliance during the 12 months prior to SIMON®. Following initiation of SIMON®, children had higher mean corpuscular volumes, hemoglobin levels and fetal hemoglobin percentages and lower absolute reticulocyte counts and bilirubin levels, suggesting improved medication adherence. Hospitalizations were uncommon before and after SIMON®, and medication possession ratios (MPRs) were high before and after SIMON®, neither was significantly changed.
Conclusions:
SIMON® was feasible and improved hematologic parameters in children with SCA receiving hydroxyurea at a MTD. Future work will include extension of this technology to children with other chronic medical conditions who require daily use of medication.
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