AM24-MN-02-O: A Multidisciplinary Approach to Delivering Comprehensive Care for Chronically Transfused Children and Adults with Sickle Cell Disease: An Overview of the Vanderbilt Sickle Cell Pathways Experience (Enduring)

Sickle cell disease is an inherited red blood disorder characterized by a beta globin gene mutation that can result in potentially life-threatening vaso-occlusive complications. Red blood cell transfusions are a cornerstone of management for individuals living with sickle cell disease, both in the acute and chronic setting. In this session, we provide an overview of a multidisciplinary care team that meets weekly to ensure the provision of evidence-based, cost effective transfusion therapies to children and adults with sickle cell disease. This diverse team is comprised of pediatric and adult hematologists within the United States, Ghana and Nigeria, transfusion medicine physicians, nurses, students, medical technologists, emergency medicine physicians, neurologists and data analysts. During the Vanderbilt Sickle Cell Pathways Meetings, the existing medical literature and practice guidelines are reviewed to develop internal checklists to inform optimal and uniform transfusion practices for patients. Topics covered include the diagnosis and management of delayed hemolytic transfusion reactions and hyperhemolysis, management of acute stroke and acute chest syndrome, prevention of transfusional iron overload, and approach to red cell transfusions for curative therapies such as bone marrow transplantation and gene therapy. Additionally, resource constraints, difficulties with peripheral and central venous access, pediatric to adult transition considerations, and blood inventory constraints are discussed at this multidisciplinary meeting, essentially providing a team-based approach to overcoming patient care obstacles. This platform has also been leveraged to develop educational materials for patients about the risks, benefits and overall goals of red cell transfusions, and has facilitated patient visits to the blood bank to understand the process of identifying compatible red cells for exchange procedures. The Vanderbilt Sickle Cell Pathways meetings have led to clinical care and research collaborations within and outside the institution, multiple quality improvement initiatives, development of data bases to monitor the efficacy of chronic transfusions, and opportunities for mentees to develop comprehensive transfusion medicine services within their own institution.