17 May 2019

Medical professionals in Italy have called for routine sickle cell disease (SCD) screening for refugees entering southern Europe, warning of high prevalence among these migrants.

A study, led by a team from the University of Verona, has found that most of the migrants arriving in Italy are from areas where SCD is highly prevalent, such as sub-Saharan countries.

Dr Lucia De Franceschi warned that migrants with known or undiagnosed SCD can suffer severe pain crises because of the extreme conditions they experienced when travelling, including dehydration, psychological stress, and exposure to very high or low temperatures.

Writing in the journal Blood, she says delays in care can lead to severe organ complications and death.

Analysis of 2014-2017 data from 13 Italian reference centres for haemaglobinopathies revealed that SCD was relatively common in refugees, and was primarily identified when individuals went to emergency departments for acute sickle cell-related events.

The study identified 70 patients with haemoglobin disorders, the majority of whom were male. Half were adults with the median age of 21 years and the other half were children. Most came from Senegal and Nigeria, as well as Morocco, Egypt, and Tunisia, and Syria.

“Our data underscore the need to more systematically screen refugees coming from areas where SCD is endemic and suggest a strong national network might help to spur action,” said Dr De Franceschi.

“Early identification of cases can help prevent severe SCD-related events and life-threatening complications and redirect patients to comprehensive SCD centres for specialty clinical management, follow-up, and timely initiation of treatment.”

The team also piloted a program that screened all refugees at a single refugee centre using a rapid point-of-care screening device. The results were also validated in gold-standard laboratory tests. Front-line health providers in refugee centres and emergency departments were trained to recognise the signs and symptoms of SCD.

Dr De Franceschi said that, based on their findings, efforts should focus on routine screening for SCD in refugees from countries endemic for SCD within 10-14 days from their arrival, and educating emergency department physicians to identify and treat acute SCD-related events.


Source: De Franceschi, L., Lux, C., Piel, F.B., Gianesin, B., Bonetti, F., Casale, M., Graziadei, G., Lisi, R., Pinto, V., Putti, M.C., Rigano, P., Rosso, R., Russo, G., Spadola, V., Pulvirenti, C., Rizzi, M., Mazzi, F., Ruffo, G., Forni, G.L. (2019) “Access to emergency departments for acute events and identification of sickle cell disease in refugees”, Blood, available from doi: 10.1182/blood-2018-09-876508


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