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A Precision Medicine Tool for Measurement and Monitoring of Hemoglobin S in Sickle Cell Disease Patients Receiving Transfusion Therapy

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Bleeding in patients with sickle cell disease: a population-based study.

Nisha Hariharan¹, Ann Brunson², Anjlee Mahajan²

¹Department of Internal Medicine and.

|February 29, 2020

Summary

Bleeding is common in sickle cell disease (SCD), with over 40% experiencing an event by age 60. Gastrointestinal bleeding is frequent, and bleeding significantly increases mortality risk in SCD patients.

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Area of Science:

Hematology
Vascular Biology
Epidemiology

Background:

Bleeding complications, including stroke and hematuria, are recognized in sickle cell disease (SCD).
The precise incidence and risk factors for bleeding events in SCD patients remain incompletely characterized.
Understanding bleeding patterns is crucial for managing SCD complications and improving patient outcomes.

Purpose of the Study:

To determine the cumulative incidence of bleeding events in a large cohort of patients with SCD.
To identify risk factors associated with bleeding in SCD.
To evaluate the impact of bleeding on mortality in individuals with SCD.

Main Methods:

A retrospective, population-based study utilizing California emergency department and hospitalization databases.
Inclusion of 6423 patients diagnosed with SCD between 1991 and 2014.
Analysis of specific bleeding events (intracranial hemorrhage, GI bleeding, hematuria, etc.) and application of Cox proportional hazards regression models for risk factor and mortality assessment.

Main Results:

The cumulative incidence of any first bleeding event reached 21% by age 40 and 41% by age 60.
Gastrointestinal bleeding constituted the majority of events (41.6%), with a predilection for the upper GI tract.
Increased hospitalization frequency, prior venous thromboembolism, osteonecrosis of the femoral head, and ischemic stroke were associated with higher bleeding risk.
Bleeding events were linked to a twofold increased risk of death in SCD patients.

Conclusions:

Patients with sickle cell disease exhibit a high cumulative incidence of bleeding events, particularly gastrointestinal bleeding.
Factors such as frequent hospitalizations and specific SCD-related complications elevate bleeding risk.
Bleeding is an independent risk factor for increased mortality in the SCD population, underscoring the need for proactive management and further etiological investigation.