Elevated steady state WBC and platelet counts are associated with frequent emergency room use in adults with sickle cell anemia

Susanna A. Curtis, Neeraja Danda, Zipora Etzion, Hillel W. Cohen, Henny H. Billett

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Introduction Sickle cell anemia has many sequelae that result in emergency department (ED) use, but a minority of patients with sickle cell disease are frequent utilizers and make up the majority of ED visits. If patients who are likely to be frequent ED can be identified in steady state, they can be treated with disease modifying agents in an attempt to reduce ED use frequency. We sought to identify steady state markers for frequent ED use. Methods We identified all patients with SS/Sβ0 seen at our facilities in 2012. Health care utilization over the entire year was calculated and ED visit numbers categorized as either 0-1, 2-5, or 6 or more visits a year. Steady state and acutely active laboratory parameters were collected and analyzed using analysis of variance models and odds ratios. Results 432 adult sickle cell patients were identified, ages 18-87, 54% female, and 38% had been prescribed hydroxyurea. Of the 432 patients,192 had 0-1 visits in the year, 144 had 2-5 visits in the year, and 96 had >6 visits for a total of 2259 visits. Those who had >6 visits accounted for 1750 (77%) of the total visits for the year. When steady state laboratory markers were examined, each additional 50x109/L platelets was associated with 22% greater risk (p < .001); each 1x109/L of WBC was associated with 11% greater risk (p = .003), and each 1g/dL Hb was associated with 23% lower risk (p = .007) of >6 ED visits/year. We did not observe a relationship between baseline HbF, LDH or reticulocyte count with >6 ED visits. Conclusion Patients with elevated white blood cell counts, elevated platelet counts, and low hemoglobin levels exhibited higher risk for frequent ED utilization and could be candidates for early and aggressive therapy with disease modifying agents.

Original languageEnglish (US)
Article numbere0133116
JournalPLoS One
Volume10
Issue number8
DOIs
StatePublished - Aug 6 2015

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Emergency rooms
sickle cell anemia
blood platelet count
Sickle Cell Anemia
Platelets
Platelet Count
leukocyte count
Hospital Emergency Service
Hydroxyurea
Analysis of variance (ANOVA)
Health care
Hemoglobins
Blood
Cells
hydroxyurea
reticulocytes
complications (disease)
Patient Acceptance of Health Care
odds ratio
health services

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Elevated steady state WBC and platelet counts are associated with frequent emergency room use in adults with sickle cell anemia. / Curtis, Susanna A.; Danda, Neeraja; Etzion, Zipora; Cohen, Hillel W.; Billett, Henny H.

In: PLoS One, Vol. 10, No. 8, e0133116, 06.08.2015.

Research output: Contribution to journalArticle

Curtis, Susanna A. ; Danda, Neeraja ; Etzion, Zipora ; Cohen, Hillel W. ; Billett, Henny H. / Elevated steady state WBC and platelet counts are associated with frequent emergency room use in adults with sickle cell anemia. In: PLoS One. 2015 ; Vol. 10, No. 8.
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abstract = "Introduction Sickle cell anemia has many sequelae that result in emergency department (ED) use, but a minority of patients with sickle cell disease are frequent utilizers and make up the majority of ED visits. If patients who are likely to be frequent ED can be identified in steady state, they can be treated with disease modifying agents in an attempt to reduce ED use frequency. We sought to identify steady state markers for frequent ED use. Methods We identified all patients with SS/Sβ0 seen at our facilities in 2012. Health care utilization over the entire year was calculated and ED visit numbers categorized as either 0-1, 2-5, or 6 or more visits a year. Steady state and acutely active laboratory parameters were collected and analyzed using analysis of variance models and odds ratios. Results 432 adult sickle cell patients were identified, ages 18-87, 54{\%} female, and 38{\%} had been prescribed hydroxyurea. Of the 432 patients,192 had 0-1 visits in the year, 144 had 2-5 visits in the year, and 96 had >6 visits for a total of 2259 visits. Those who had >6 visits accounted for 1750 (77{\%}) of the total visits for the year. When steady state laboratory markers were examined, each additional 50x109/L platelets was associated with 22{\%} greater risk (p < .001); each 1x109/L of WBC was associated with 11{\%} greater risk (p = .003), and each 1g/dL Hb was associated with 23{\%} lower risk (p = .007) of >6 ED visits/year. We did not observe a relationship between baseline HbF, LDH or reticulocyte count with >6 ED visits. Conclusion Patients with elevated white blood cell counts, elevated platelet counts, and low hemoglobin levels exhibited higher risk for frequent ED utilization and could be candidates for early and aggressive therapy with disease modifying agents.",
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