Strategies to identify sickle cell disease among refugees could reduce complications, costs
Refugees arriving in Europe from countries with high rates of sickle cell disease should be immediately screened for the disease to help prevent acute crises and potentially fatal complications, according to results of a retrospective study published in Blood.
“Our data underscore the need to more systematically screen refugees coming from areas where sickle cell disease is endemic and suggest a strong national network might help to spur action,” Lucia De Franceschi, MD, of the department of medicine at University of Verona in Italy, said in a press release. “Early identification of cases can help prevent severe sickle cell disease-related events and life-threatening complications and redirect patients to comprehensive centers for specialty clinical management, follow-up and timely initiation of treatment.”
De Franceschi and colleagues analyzed refugee data collected between 2014 and 2017 from 13 Italian reference centers. They reported that 624,688 refugees landed on the coast of Italy during this 4-year period, and among them identified 70 patients with hemoglobin disorders. Half of these patients were adults (median age, 21 years; 86% men) and half were children (median age, 10 years; 80% male). Most came from Egypt, Morocco, Nigeria, Senegal and Tunisia.
Most of these refugees were diagnosed with sickle cell disease due to ED visits for acute sickle cell-related events. Anemia, the second-leading cause of ED visits among the study population, also led to the diagnosis of sickle cell disease.
Among 46 patients with sickle cell disease and available hemoglobin data, 85% had levels of 8 g/dL or greater. Although historic patient hematologic data was not available, researchers noted that malnutrition could have contributed to anemia among the refugees.
Most refugees (83%) received a diagnosis of sickle cell disease within 11 months of arriving in Italy. About 14% were diagnosed in the second year after arrival.
The data support sickle cell screening for all refugees from areas endemic for the disease, according to researchers. They recommended:
developing flow charts outlining symptoms and signs of sickle cell disease and placing them at refugee arrival locations and in refugee camps;
educating ED physicians, pediatricians, internal medicine doctors and hematologists about early identification and treatment of acute vaso-occlusive events;
rapidly referring refugees with sickle cell disease or symptomatic HbS carriers to a comprehensive medical center for treatment and follow up; and
rapidly starting treatment for the disease among these these patients to help prevent severe medical complications and cut down on the overall health care costs.
“We hope our data might open international political and social discussions about the accessibility of health care for refugees to treat both acute and chronic complications related to sickle cell disease,” De Franceschi said. – by John DeRosier
Disclosures: The authors report no relevant financial disclosures.