Obadina Mofiyin A, Owens Iman, Chang Ada, Miller Vanessa, Little Jane A
Division of Hematology, Department of Medicine, University of North Carolina, Chapel Hill, NC 27514, United States.
UNC Blood Research Center, University of North Carolina, Chapel Hill, NC 27514, United States.
J Sick Cell Dis. 2025 Jan 31;2(1):yoaf003. doi: 10.1093/jscdis/yoaf003. eCollection 2025.
High-risk SCD may be managed with chronic red blood cell exchange transfusions. We examined the prevalence of sleep-associated hypoxemia (≥5 minutes at SpO ≤88%) or nocturnal Hb desaturation (NHD) in chronically transfused adults with SCD. Of 41 identified participants, 15 (36.6%) had tested positive for NHD at some point prior to enrollment. The median duration of desaturation (SpO ≤88%) in those that tested positive was 88.3 minutes (IQR 27.9-226.0 minutes). Participants with and without NHD were compared using non-parametric statistical tests. Compared to participants without NHD, those with NHD had higher absolute reticulocyte counts ( = .018) and white blood counts ( = .05) and tended to be older. They had more anemia ( = .11) and higher lactate dehydrogenase levels ( = .072). Older age at initiation of chronic red blood cell transfusions associated the strongest with a longer duration of NHD (ρ = 0.4253, = .0067), while prior history of cerebrovascular events associated with a shorter duration of NHD ( = .0315). Our results demonstrate that NHD is common in adults being treated with red blood cell exchange for high-risk SCD and associates with laboratory evidence of increased disease activity. Increased awareness of this complication and appropriate screening may provide an additional simple, low-cost, and physiologically relevant treatment intervention, that is oxygen therapy.
高危镰状细胞病（SCD）可通过慢性红细胞置换输血进行治疗。我们研究了接受慢性输血的成年SCD患者中睡眠相关低氧血症（SpO₂≤88%持续≥5分钟）或夜间血红蛋白饱和度降低（NHD）的患病率。在41名确定的参与者中，15名（36.6%）在入组前的某个时间点NHD检测呈阳性。检测呈阳性者的饱和度降低（SpO₂≤88%）的中位持续时间为88.3分钟（四分位间距27.9 - 226.0分钟）。使用非参数统计检验对有和没有NHD的参与者进行比较。与没有NHD的参与者相比，有NHD的参与者网织红细胞绝对计数更高（P = 0.018）、白细胞计数更高（P = 0.05），且年龄往往更大。他们贫血更严重（P = 0.11），乳酸脱氢酶水平更高（P = 0.072）。开始慢性红细胞输血时年龄较大与NHD持续时间较长关联最强（ρ = 0.4253，P = 0.0067），而脑血管事件既往史与NHD持续时间较短相关（P = 0.0315）。我们的结果表明，NHD在接受红细胞置换治疗高危SCD的成年人中很常见，并且与疾病活动增加的实验室证据相关。提高对这种并发症的认识并进行适当筛查可能会提供一种额外的简单、低成本且生理相关的治疗干预措施，即氧疗。
