{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T15:45:52Z","timestamp":1781883952427,"version":"3.54.5"},"reference-count":32,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T00:00:00Z","timestamp":1657843200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Transfusion"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Due to the national blood supply crisis caused by the COVID\u201019 pandemic, the American Society of Hematology proposed guidance to decrease blood utilization for sickle cell patients on chronic transfusion therapy (CTT). Little evidence exists to support the efficacy and safety of these blood conservation strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design and Methods<\/jats:title><jats:p>Through retrospective analysis, we sought to describe outcomes following implementation of these recommendations in 58 adult sickle cell patients on chronic exchange transfusions. The strategies employed included: relaxing the goal fraction of cells remaining (FCR) to 30%\u201350%, utilizing depletion exchanges in select patients, and transitioning select patients to monthly simple transfusions. We compared hemoglobin S%, hemoglobin values, and other laboratory parameters, acute care visits, and red blood cell usage during the first year of the COVID\u201019 pandemic to the year prior using Wilcoxon signed rank test.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 53 patients who remained on chronic exchanges during the pandemic, use of depletion exchange increased (15%\u201323%) and FCR increased (34.9 [SD 4.7] vs. 37.6 [SD 4.5], <jats:italic>p<\/jats:italic>\u00a0&lt;\u2009.05). These changes resulted in 854\u2009units conserved without clinically significant changes to pre\u2010exchange laboratory parameters, including hemoglobin S%, or number of acute care presentations. In contrast, five patients who transitioned to predominantly simple transfusions, experienced difficulty maintaining hemoglobin S% less than 30 and worsening anemia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Our data suggest that in a blood shortage crisis, optimizing the exchange procedure itself may be the safest means of conserving blood in a population of adult patients with sickle cell disease.<\/jats:p><\/jats:sec>","DOI":"10.1111\/trf.17007","type":"journal-article","created":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T07:19:23Z","timestamp":1657869563000},"page":"1763-1771","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Implementation of national blood conservation recommendations at an adult sickle cell center"],"prefix":"10.1111","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7246-4486","authenticated-orcid":false,"given":"Jennifer M.","family":"Jones","sequence":"first","affiliation":[{"name":"Department of Hematology Johns Hopkins Hospital  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ariel D.","family":"Swett","sequence":"additional","affiliation":[{"name":"Department of Hematology Johns Hopkins Hospital  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1910-2800","authenticated-orcid":false,"given":"Elizabeth P.","family":"Crowe","sequence":"additional","affiliation":[{"name":"Division of Transfusion Medicine, Department of Pathology Johns Hopkins Hospital  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Courtney","family":"Lawrence","sequence":"additional","affiliation":[{"name":"Division of Transfusion Medicine, Department of Pathology Johns Hopkins Hospital  Baltimore Maryland USA"},{"name":"Division of Pediatric Hematology, Department of Pediatrics Johns Hopkins Hospital  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8181-9517","authenticated-orcid":false,"given":"Evan M.","family":"Bloch","sequence":"additional","affiliation":[{"name":"Division of Transfusion Medicine, Department of Pathology Johns Hopkins Hospital  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie M.","family":"Lanzkron","sequence":"additional","affiliation":[{"name":"Department of Hematology Johns Hopkins Hospital  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,7,15]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"American Red Cross.American Red Cross faces severe blood shortage as coronavirus outbreak threatens availability of nation's supply. Available from:https:\/\/www.redcross.org\/about-us\/news-and-events\/press-release\/2020\/american-red-cross-faces-severe-blood-shortage-as-coronavirus-outbreak-threatens-availability-of-nations-supply.html."},{"key":"e_1_2_8_3_1","unstructured":"American Red Cross.Nation confronts severe blood shortage: Blood donations urgently needed. Available from:https:\/\/www.redcross.org\/about-us\/news-and-events\/press-release\/2021\/nation-confronts-severe-blood-shortage-blood-donations-urgently-needed.html."},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-3026(20)30186-1"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.16278"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019001143"},{"key":"e_1_2_8_7_1","unstructured":"Amercian Society of Hematology.COVID\u201019 and sickle cell disease. Available from:https:\/\/www.hematology.org:443\/covid-19\/covid-19-and-sickle-cell-disease."},{"key":"e_1_2_8_8_1","unstructured":"Sickle Cell Disease Association of America Inc.NEW\u2010Sickle Cell Disease and COVID\u201019: Provider Advisory.2020. Available from:https:\/\/www.sicklecelldisease.org\/2020\/03\/18\/sickle-cell-disease-and-covid-19-provider-directory\/."},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/jca.20294"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.15188"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/trf.16225"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1401731"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2019001142"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mph.0000157789.73706.53"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1067\/mpd.2001.119593"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.10517"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-0968.2002.00396.x"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1182\/asheducation-2014.1.450"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/00043426-199602000-00009"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14575"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/2327-6924.12221"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.17762"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1093\/pm\/pnx214"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.3288"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2021.03.004"},{"key":"e_1_2_8_26_1","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1377\/hlthaff.2021.00561","article-title":"National Trends in ED visits, hospital admissions, and mortality for Medicare patients during the COVID\u201019 pandemic: study examines trends in emergency department visits, hospital admissions, and mortality for medicare patients during the COVDI\u201019 pandemic","volume":"40","author":"Smulowitz PB","year":"2021","journal-title":"Health Aff"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17227"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMms2009984"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0260381"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1182\/bloodadvances.2021004395"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.3109\/03630269.2015.1040493"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajh.25405"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood.V86.10.3997.bloodjournal86103997"}],"container-title":["Transfusion"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/trf.17007","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/trf.17007","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/trf.17007","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T22:11:05Z","timestamp":1692655865000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/trf.17007"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,15]]},"references-count":32,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["10.1111\/trf.17007"],"URL":"https:\/\/doi.org\/10.1111\/trf.17007","archive":["Portico"],"relation":{},"ISSN":["0041-1132","1537-2995"],"issn-type":[{"value":"0041-1132","type":"print"},{"value":"1537-2995","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,15]]},"assertion":[{"value":"2022-03-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-05-27","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-07-15","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}