Therapeutic phlebotomy is safe in children with sickle cell anaemia and can be effective treatment for transfusional iron overload

• Authors: Banu Aygun, Steven and Alexandra Cohen Children's Medical Center; Nicole A. Mortier, Cincinnati Children's Hospital Medical Center; Karen Kesler, Rho Inc.; Alexandre Lockhart, Rho Inc.; William H. Schultz, Cincinnati Children's Hospital Medical Center; Alan R. Cohen, Children's Hospital of Philadelphia; Ofelia Alvarez, University of Miami; Zora R. Rogers, University of Texas Southwestern Medical Center; Janet L. Kwiatkowski, Children's Hospital of Philadelphia; Scott T. Miller, SUNY Downstate; Pamela Sylvestre, Duckworth Pathology Group; Rathi Iyer, University of Mississippi; Peter Lane, Emory University; Russell E. Ware, Cincinnati Children's Hospital Medical Center; Stroke With Transfusions Changing to Hydroxyurea (SWiTCH) Trial Investigators
• Journal Title: British Journal of Haematology
• Volume: Volume 169, Number 2
• Publisher: Wiley | 2015-04-01, Pages 262-266
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/bjh.13280
• Subjects: Health Sciences, General; Health Sciences, Pathology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Hematology; sickle cell; iron overload; phlebotomy; liver iron; HYDROXYUREA SWITCH; SECONDARY STROKE; PREVENTION; DISEASE; EFFICACY

Abstract

Serial phlebotomy was performed on sixty children with sickle cell anaemia, stroke and transfusional iron overload randomized to hydroxycarbamide in the Stroke With Transfusions Changing to Hydroxyurea trial. There were 927 phlebotomy procedures with only 33 adverse events, all of which were grade 2. Among 23 children completing 30 months of study treatment, the net iron balance was favourable (-8·7 mg Fe/kg) with significant decrease in ferritin, although liver iron concentration remained unchanged. Therapeutic phlebotomy was safe and well-tolerated, with net iron removal in most children who completed 30 months of protocol-directed treatment.