Oxygen‐induced marrow red cell hypoplasia leading to transfusion in sickle painful crisis

Abstract

The benefit of oxygen (O2) therapy in non-hypoxic sickle cell patients in painful crisis is uncertain. We report a case of a non-hypoxic sickle cell patient in painful crisis who developed marrow red cell hypoplasia requiring transfusion support after O2 therapy. The uncertain benefits of O2 use in such cases must be weighed against the serious and underrecognized risks of transfusion. In patients who develop O2-induced marrow red cell hypoplasia, cessation of O2 therapy may reverse the anemia and obviate the need for transfusion.

Low flow nocturnal oxygen therapy does not suppress haemoglobin levels or increase painful crises in sickle cell disease

“…In conclusion, we observed no detrimental effects on erythropoesis and painful crises with the use of NOT in sickle cell disease, contrary to previous reports (Embury et al , ; Lane et al , ). These current data differed from those previously reported as oxygen therapy was only administered at night, whereas it was administered continuously in both of the other studies.…”

“…These sequelae are a consequence of hypoxia‐induced polymerization of sickle haemoglobin and therefore nocturnal oxygen therapy (NOT) could modulate these outcomes. Previously small case series have reported that continuous oxygen therapy is harmful as it suppresses erythropoeitic drive with a subsequent fall in haemoglobin concentration and an increase in the incidence of painful crises, (Embury et al , ; Lane et al , ). This has lead to a reluctance to use oxygen therapy.…”

Pain Syndromes in Sickle Cell Disease: An Update

“…Treatment should rely on bed rest, fluid hydration, administration of analgesics according to the pain intensity [57], and complementary and nonpharmacological measures [58]. Oxygen inhalation has no effect on the duration of pain [59,60] and may involve complications [61]. Although high doses of methylprednisolone decrease the duration of severe pain, this drug has a limited role due to the rebound attacks after therapy is discontinued [62].…”

Sickle Cell Disease and the Pulmonary Circulation

“…However, there is no evidence that supranormal oxygen tensions are beneficial and, in fact, may cause suppression of erythropoiesis. 82 Pain associated with the ACS is usually treated by narcotic analgesics in doses sufficient to provide adequate pain relief, although care should be exercised to avoid excessive doses because of the possible association with the development of permeability pulmonary edema. 46 Although most studies indicate that bacterial pneumonia is an uncommon cause of ACS in adults, there are no noninvasive variables that will reliably differentiate infection from pulmonary vaso-occlusive episode and, consequently, we rec-478 ommend routine empiric antibiotic therapy in ACS.…”