Partial manual exchange reduces iron accumulation during chronic red cell transfusions for sickle cell disease.

Iron overload is an inevitable consequence of chronic red cell transfusions without erythrocytapheresis or chelation therapy. The effectiveness of partial manual exchange, a technique used to slow iron loading, has not been evaluated. We evaluated all children with sickle cell disease (SCD) receiving chronic transfusion to identify chelation-naive subjects who had quantitative liver iron concentration (LIC) studies. Seventeen chelation-naive children with SCD received a median of 29 transfusions before first LIC determination. Serum ferritin concentrations were assessed before each transfusion. The mean volume of blood phlebotomized before each transfusion was 5.1±1.8 mL/kg, which cumulatively resulted in a calculated median of 35.0 mg/kg iron removal. Using linear regression, pretransfusion phlebotomy resulted in a statistically significant reduction in ferritin (-8.8 ng/mL of ferritin for each mg/kg of iron phlebotomized, P=0.02). A reduction in LIC from pretransfusion phlebotomy could not be established (P=0.4). Partial manual exchanges appear to be an effective strategy for slowing the pace of iron loading in the setting of chronic transfusion for SCD.

The Approved Miracle of Saint Elizabeth Ann Seton.

Saint Elizabeth Ann Seton (1774-1821) was a convert to Roman Catholicism and foundress of the Sisters of Charity, the first sisterhood native to the United States. She is also the first person born in the United States to be canonized a saint. The second of three cures attributed to the intercession of Mother Seton was of Anne Theresa O'Neill. Anne was born at Baltimore in 1947 and, at the age of four, was diagnosed with acute lymphocytic leukemia at St. Agnes Hospital, Baltimore, Maryland. At the time, acute leukemia, like other aggressive malignancies, was considered a fatal disease without any treatment that assured a cure. In essence, no effective therapy for disease control and sustained remission existed. Anne's cure, which was considered acceptable by the Sacred Congregation of Rights in 1959, would contribute directly toward Mother Seton's beatification and ultimate canonization on September 14, 1975, outside Saint Peter's Basilica in Rome by Pope Paul VI. Ms. O'Neill attended both the beatification as a thirteen-year-old girl and the canonization ceremony at age twenty-seven, as a mother of several children and accompanied by her mother and husband.