American Society for Apheresis
View all recommendations from this societyApril 25, 2018
Do not continue simple transfusions in patients with stroke from sickle cell disease who have iron overload, if red blood cell exchange is available.
Stroke is a common cause of serious morbidity in children and mortality in adults with sickle cell disease. Exchange transfusion is a more effective method than simple transfusions to prevent both recurrent strokes and the complications of iron overload.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physicians.
How The List Was Created
Recommendations were drafted by the ASFA Choosing Wisely Working Group, which consisted of nine society members from the major committees of ASFA. Guiding principles included a focus on frequent practices that should be questioned, are supported by evidence, free from harm, truly necessary and not duplicative of other procedures or tests. Nine draft statements were reviewed, rated and ranked, using a nominal group scoring approach, by 41 physician and allied health members representing a diverse cross-section of apheresis medicine practitioners and content experts. The top five draft recommendations, chosen by cumulative rating and ranking scores, were further refined before submission to the Board of Directors and the ABIM Foundation for external review. Recommendations were incorporated by the ASFA Choosing Wisely Working Group into the final list, which was ultimately approved by the Board of Directors for publication and distribution.
ASFA Choosing Wisely Working Group – (Committee representation)
Michael Linenberger, MD (Chair) – University of Washington/Fred Hutchinson Cancer Research Center
Joseph Schwartz, MD, MPH (Research Committee) – Columbia University Irving Medical Center
Sarita Joshi, MD (Communications Committee) – Cleveland Clinic Foundation
Meghan Delaney, DO, MPH (Clinical Applications Committee) – Children’s National Health System
Christine Fernandez, RN, MSN/Ed, OCN (Allied Health Committee) – Consultant
Laura Connelly-Smith, MBBCh, DM (JCA Special Issue Committee) – University of Washington/Fred Hutchinson Cancer Research Center
Vishesh Chhibber, MD (Education Committee) – Northwell Health
Yvette Tanhehco, MD, PhD, MS (Apheresis Physicians Committee) – Columbia University Irving Medical Center
Quentin Eichbaum, MD, PhD, MPH (International Affairs Committee) – Vanderbilt University
Sources
Sarode R, Ballas SK, Garcia A, Kim HC, King K, Sachais B, Williams LA. Red blood cell exchange: 2015 American Society for Apheresis consensus conference on the management of patients with sickle cell disease. J Clin Apher. 2017;32(5):342-67.
Howard J. Sickle cell disease: when and how to transfuse. Hematology Am Soc Hematol Educ Program. 2016;2016(1):625-31.
National Heart, Lung, and Blood Institute. Evidence-Based Management of Sickle Cell Disease. Expert Panel Report, 2014.
