Anemia, Author Interviews, Hematology, JAMA, Pain Research, Pediatrics / 03.09.2025
Nemours Study: Early Opioid Administration For Sickle Cell Children in Crisis Decreased Hospitalization Rate
MedicalResearch.com Interview with:
[caption id="attachment_70522" align="alignleft" width="150"]
Dr. Gwarzo[/caption]
Ibrahim Gwarzo, DrPH, MPH, MBBS
Research Scientist at Nemours Children’s Health
Delaware Valley, Delaware USA
MedicalResearch.com: What is the background for this study? Would you briefly explain the condition of sickle cell disease and why young people frequently present to the ER with severe pain?
Response: Sickle cell disease is an inherited blood disorder that affects red blood cells. It is passed down as an autosomal recessive disorder, meaning a person must inherit the defective gene from both parents to have the disease. The condition primarily impacts hemoglobin, the protein responsible for carrying oxygen in red blood cells, which leads to changes in the shape and stability of these cells. The complications associated with the disease, including recurrent and severe pain episodes, are a direct result of these changes. These pain episodes are debilitating and unpredictable, resulting in frequent emergency department visits where they are typically treated with pain medications, including opioids. It is estimated that around 100,000 people in the United States have sickle cell disease, with about 40,000 being children. The disease has a significant prevalence in the Afro-Latino population.
Dr. Gwarzo[/caption]
Ibrahim Gwarzo, DrPH, MPH, MBBS
Research Scientist at Nemours Children’s Health
Delaware Valley, Delaware USA
MedicalResearch.com: What is the background for this study? Would you briefly explain the condition of sickle cell disease and why young people frequently present to the ER with severe pain?
Response: Sickle cell disease is an inherited blood disorder that affects red blood cells. It is passed down as an autosomal recessive disorder, meaning a person must inherit the defective gene from both parents to have the disease. The condition primarily impacts hemoglobin, the protein responsible for carrying oxygen in red blood cells, which leads to changes in the shape and stability of these cells. The complications associated with the disease, including recurrent and severe pain episodes, are a direct result of these changes. These pain episodes are debilitating and unpredictable, resulting in frequent emergency department visits where they are typically treated with pain medications, including opioids. It is estimated that around 100,000 people in the United States have sickle cell disease, with about 40,000 being children. The disease has a significant prevalence in the Afro-Latino population.
Dr. Davis[/caption]
Esa M. Davis, M.D., M.P.H , F.A.A.F.P
Professor of Medicine and Family and Community Medicine
Associate Vice President of Community Health and
Senior Associate Dean of pPopulation Health and Community Medicine
University of Maryland School of Medicine
Dr. Davis joined the U.S. Preventive Services Task Force in January 2021
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Iron is important to overall health, and people need more iron when they are pregnant. This can make pregnant people at increased risk for iron deficiency, which can progress to anemia and cause complications for both moms and their babies. After reviewing the latest available research, the Task Force found that there is not enough evidence on whether pregnant people who do not have signs or symptoms of iron deficiency or anemia should be screened—or take iron supplements—to improve their health or the health of their baby. 
Prof. Hiddo Lambers Heerspink, PhD PHARMD
Department of Clinical Pharmacy and Pharmacology
University Medical Center Groningen
Groningen
Dr. Samir Ballas[/caption]
Samir K. Ballas MD FACP
Emeritus Professor of Medicine and Pediatrics
Department of Medicine/Cardeza Foundation for Hematologic Research
Thomas Jefferson University
Philadelphia, PA
Medicalresearch.com: What is the background for this study?
Dr. Ballas: Previous studies have shown that the incidence of overt stroke is about 11% in children with sickle cell anemia by ages 2 - 20 years. Untreated stokes recur periodically with increasing severity and mortality. Transfusion therapy has been documented to decrease the frequency and morbidity of stroke in children by 90%. Accordingly, children who develop overt stroke are treated with chronic blood exchange transfusion to prevent the recurrence of additional strokes. When children reach the age of 18-20 years their medical care is transitioned to adult programs. This transition process is associated with several issues one of which is the discontinuation of chronic blood exchange transfusion in patients with history of overt stokes partly due to logistic considerations and partly due to lack of research in strokes in adult patients and the complications of chronic blood transfusion .
Medicalresearch.com: What are the main findings?
Dr. Ballas: The major finding of the study is that the discontinuation of chronic blood exchange after transition to adult programs is associated with increased mortality. All the patients who discontinued blood transfusion died within 3-5 years after transition whereas patients who continued having blood exchange transfusion survived to a mean age of 36 years at the time of writing this study.
Dr. Walter Dzik[/caption]
MedicalResearch.com Interview with:
Dr. Walter H. Dzik MD
Associate Pathologist, Massachusetts General Hospital
Associate Professor of Pathology
Harvard Medical School
Medical Research: What is the background for this study? What are the main findings?
Dr. Dzik: Millions of Red Blood Cell transfusions are given each year. To maintain adequate blood inventories worldwide, Red Blood Cell units are stored under refrigerated conditions. Previous animal and laboratory research has highlighted the fact that red cells undergo biochemical, morphologic, and biophysical changes during prolonged refrigerated blood storage. Researchers and clnicians have questioned whether the changes that occur during storage would impair the ability of transfused Red Cells to delivery oxygen to tissues.
Our study was a randomized controlled trial conducted in patients with extreme anemia and insufficient global tissue oxygenation. We randomly assigned children with severe anemia and lactic acidosis to receive Red Blood Cells stored 1-10 days versus Red Blood Cells stored 25-35 days. We measured the recovery from lactic acidosis in response to transfusion in the two groups. We also measured cerebral tissue oxygenation using a non-invasive tissue oximeter. We found that the proportion of patients who achieved reversal of lactic acidosis was the same in the two RBC storage-duration groups. The rate of decline of lactic acidosis was also equal. There was also no difference in cerebral oxygenation, resolution of acidosis, correction of vital signs, clinical recovery, survival and 30-day followup.
Dr. Wang[/caption]
MedicalResearch.com Interview with:
Cunlin Wang, MD, PhD
Division of Epidemiology I,
Office of Surveillance and Epidemiology,
Center for Drug Evaluation and Research
US Food and Drug Administration
MedicalResearch: What is the background for this study? What are the main findings?
Dr. Wang: IV Iron has been known for its risk of anaphylactic reaction, but there has been little research on the comparative safety of individual IV Iron products from a large population-based study. This study included 688,183 new users of IV iron not on dialysis from the U.S. Medicare program over a ten-year span (January 2003 to December 2013). The main findings of the study are: the risk for anaphylaxis at first exposure was higher for iron dextran than non-dextran IV iron products combined (iron sucrose, gluconate and ferumoxytol). When individual IV Iron products were compared, the data suggested that iron dextran has the highest risk of anaphylaxis and Iron sucrose has the lowest risk, estimated both at the first time exposure and after cumulative exposures. The low and high molecular weight dextran products could not be individually identified during most of study period. However, from January 2006 through March 2008, during which the use of two dextran products could be distinguished, there was very low use of high molecular weight dextran (Dexferrum@). This suggested that the study results likely represent the risk of the low molecular weight dextran (Infed@).
