Despite the advent of new drug options in sickle cell disease, red cell transfusion remains a mainstay of treatment. Its recommended indications- for example, for silent stroke- are in fact increasing. A major issue with transfusion, however, is lack of clinical methodologies and algorithms to provide a “personalized medicine” approach to target Hct and HbS% goals; this lack may contribute, for example, to progressive cerebral infarction or vasculopathy despite transfusion in up to 45% of patients. Transfusion targets may need to be tailored to the end-organ most at risk in a particular patient. In this session, three experts will discuss methodologies with potential to inform personalized transfusion targets for prevention or treatment of end-organ damage. Dr. Fields will explain current MR imaging methodologies to assess vascular hemodynamics in the brain, which can potentially be used to assess stroke risk. Dr. Detterich will describe various potentially real-time peripheral blood measurements to assess transfusion needs and response. Dr. Wood will appraise methods being developed in his lab to quantitate polymerized Hb and its effects in various organ-specific vascular beds.
Explain magnetic resonance imaging (MRI) measurements, including cerebral blood flow, oxygen extraction fraction and cerebral metabolic rate of oxygen utilization, that can be used to assess the effect of clinical intervention with transfusion or drugs on the vascular hemodynamics of the brain.
Describe the insights that peripheral blood measures of aggregate blood flow and vascular dysfunction, such as hematocrit to viscosity ratio, flow-mediated dilation, and red cell deformability, can reveal about Hct and HbS targets in transfusion.
Appraise developing lab methodologies to quantify hemoglobin polymer in individual RBCs and whole blood rheology in physiologically relevant vascular mimics to inform Hct and HbS targets in transfusion.