Automatic depletion with Spectra Optia allows a safe 16% reduction of red blood cell pack consumption in exchanged sickle cell anemia patients.

BACKGROUND: Chronic red blood cell exchanges (RBCXs) are frequently used to prevent complications in patients with sickle cell anemia, but the scarcity of matched red blood cell packs (RBCPs) is a serious concern. The main goal of this study was to compare the number of RBCPs used during RBCXs between the Spectra Optia (SO) device (with the automatic depletion step) and the former Cobe Spectra (CSP) device. STUDY DESIGN AND METHODS: The performances and safety of 300 SO sessions using the automatic depletion step (SO/DE) in 50 patients with sickle cell anemia under a chronic transfusion program over a 1-year period were prospectively analyzed. The numbers of RBCPs saved using this protocol compared to the SO device without depletion and to the CSP device were determined. RESULTS: The SO/DE protocol appeared to be safe, as only 5% and 17% of the sessions were characterized by a significant decrease in blood pressure and increase in heart rate (grade 2 adverse events), respectively. Postapheresis hematocrit and fraction of cells remaining reached expected values. The SO/DE protocol required 16% fewer RBCPs compared to SO without depletion, allowing a mean saving of 12 RBCPs per patient and per year and 13% fewer compared to CSP device. Interestingly, the saving was more important for patients with high total blood volume and/or high preapheresis hematocrit. CONCLUSION: The SO/DE protocol is an efficient, safe and cost-effective procedure for patients with sickle cell anemia under a chronic transfusion program.

[Influence of hospitalisation on the elderly people polypharmacy]. / Influence de l'hospitalisation sur la polymédication des sujets de plus de 60 ans.

INTRODUCTION: The objective of this study was to analyse the influence of hospitalisation on the polypharmacy of elderly people in internal medicine. METHODS: Prescriptions before hospitalisation and after discharge were prospectively collected and analysed. The percentages of pharmaceutical medication classes used before and after hospitalisation were compared using marginal homogeneity's test for paired series. RESULTS: One hundred and sixteen patients (mean age: 79 years) were included in this study. The number of drugs prescribed amounted to 6.4 before hospitalisation and 6.7 at discharge. Hospitalisation did not lead to reduction in the amount of prescribed drugs but some medications were modified. We observed a significant reduction in beta-blockers (25 to 19.8%, P=0.035) and lipid-lowering drugs (21.6 to 15.5%, P=0.058). On the other hand, the laxative medication was increased at discharge (19.8 to 34.5%, P=0.001). Similarly, there was an increase in psycholeptic drugs after hospitalisation (34.5 to 44%, P=0.007). CONCLUSION: These results pointed out firstly the polypharmacy observed in elderly patients and secondly the difficulty to reassess prescriptions. Our results should heighten clinicians' awareness of polypharmacy of elderly patients and of the usefulness of performing an individual assessment of the various drugs prescribed to a patient. The hierarchical organisation of disorders and drugs should allow to optimise the safety of the medications and decrease iatrogenic events.