Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul;97(7):E260-E264.
doi: 10.1002/ajh.26563. Epub 2022 Apr 15.

Blood exchange transfusion with dexamethasone and Tocilizumab for management of hospitalized patients with sickle cell disease and severe COVID-19: Preliminary evaluation of a novel algorithm

Gonzalo De Luna  1 , Anoosha Habibi  1 , Marie-Hélène Odièvre  2 , Henri Guillet  1 , Vincent Guiraud  1 , Pierre Cougoul  3 , Benjamin Carpentier  4 , Gylna Loko  5 , Isabelle Guichard  6 , Clément Ourghanlian  7 , Jean Michel Pawlotsky  8 , Matthieu Mahevas  9 , Nicolas Limal  9 , Marc Michel  9 , Armand Mekontso-Dessap  10 , Jean-Benoît Arlet  11 , Pablo Bartolucci  1
Affiliations

Blood exchange transfusion with dexamethasone and Tocilizumab for management of hospitalized patients with sickle cell disease and severe COVID-19: Preliminary evaluation of a novel algorithm

Gonzalo De Luna et al. Am J Hematol. 2022 Jul.
No abstract available

PubMed Disclaimer

Conflict of interest statement

Pr Bartolucci discloses the following: (a) consulting agreement for F. Hoffmann‐La Roche,Addmedica, Novartis, Roche, Gbt, Bluebird, Emmaus, Hemanext, Agios; (b) Lecture fees from Novartis, Addmedica, Jazzpharma; (c) Steering committee for Novartis; (d) Research support from Addmedica, Foundation Fabre, Novartis, Bluebird; (e) cofounder of Innovhem.

Figures

FIGURE 1
FIGURE 1
(A) Therapeutic algorithm for corticosteroid management in SCD hospitalized patients with COVID‐19 who require supplemental oxygen, depending on the severity of COVID‐19 infection, ACS diagnosis, and DHTR risk. Standard of care (SOC); Low molecular weight heparin (LMWH); Sickle Cell Disease (SCD); Acute Chest Syndrome (ACS); Delayed hemolytic transfusion reaction (DHTR). (B) Computerized tomography scan of the chest of an acute chest syndrome and COVID‐19‐induced pneumonia. Areas of ground‐glass opacities (arrows) in the lower lungs with regard to areas of consolidation, but also in the middle lobe (arrowhead). (C) Sickle cell hospitalized patients with COVID‐19 treated by Tocilizumab. Data are n (%), or median (range). Percentages do not always equal 100% because of rounding. Around 11 patients were collected from March 13, 2020 to 17 January 2022 with a median age of 40 [17–50] years, 54% female; one pregnant woman is described. Concerning genotype HbSS was reported in 64%, HbSC in 27% and one HbS/BetaThal°; median IMC was 23.9 kg/m2, Hydroxyurea (HU) treatment was reported in 62% of HbSS and HbS/BetaThal° genotype. The median length of hospitalization stay was 12.5 days [6–55], with intensive care unit admission in 73%. ACS related to COVID‐19 was reported in eight patients with blood exchange transfusion (BET) performed in 75% of them and no BET in 25% due to dramatic improvement after Tocilizumab (one Jehovah's Witness patient is described). VTE or PE was reported in 27%. Tocilizumab infusion was related to history of DHTR (n = 1), high DHTR risk development (n = 5) and BET not available in the 24 h before corticosteroid infusion (n = 5). Corticosteroids were prescribed in 27% after BET due to infection severity despite Tocilizumab, required mechanical ventilation in 45% and extracorporeal membrane oxygenation (ECMO) in 18%. Two death were reported in a 48 years‐old kidney transplant homozygous (HbSS) patient, and in a 50 years‐old heterozygous (HbSC) patient with a severe PE successive to COVID‐19 infection
See this image and copyright information in PMC

References

    1. Arlet J‐B, Lionnet F, Khimoud D, et al. Risk factors for severe COVID‐19 in hospitalized sickle cell disease patients: a study of 319 patients in France. Am J Hematol. 2021;97(3):E86‐E91. doi:10.1002/ajh.26432 - DOI - PMC - PubMed
    1. Masson, E. Étude SISTER: sickle cell disease and steroïds. Risque d'hospitalisation pour crise vaso‐occlusive chez les patients atteints de drépanocytose après exposition ambulatoire aux corticoïdes systémiques en France. EM‐Consulte https://www.em‐consulte.com/article/1486161/etude‐sister‐sickle‐cell‐dis....
    1. Odièvre M‐H, Marcellus C, Pointe HD, et al. Dramatic improvement after Tocilizumab of severe COVID‐19 in a child with sickle cell disease and acute chest syndrome. Am J Hematol. 2020;95:E192‐E194. - PMC - PubMed
    1. Allali S, Montalembert M, Rignault‐Bricard R, et al. IL‐6 levels are dramatically high in the sputum from children with sickle cell disease during acute chest syndrome. Blood Adv. 2020;4:6130‐6134. - PMC - PubMed
    1. Allali S, Chhun S, Montalembert M, et al. Tocilizumab for severe acute chest syndrome in a child with sickle cell disease and dramatically high interleukin‐6 values in endotracheal and pleural fluids. Am J Hematol. 2021;97(3):E81‐E83. doi:10.1002/ajh.26433 - DOI - PubMed

MeSH terms