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Lorenza Torti, Edoardo Petrone, Francesco Sorrentino, Laura Maffei, Paolo De Fabritiis, Elisabetta Abruzzese
Hemoglobinopathies Unit, Hematology Department, S. Eugenio Hospital (ASL Roma 2), Tor Vergata University, Italy Anesthesia and Resuscitation Unit, S. Eugenio Hospital, (ASL Roma 2), Italy
Scientific Tracks Abstracts: J Hematol Thromb Dis
Multiple-processes result in pain-onset and persistence in hemoglobinopathies,impacting on quality-life and emergency-room(ER) access. Pain can be acute,chronic or combined. Generally acute-pain come from somatic or visceral-origin,chronic is of neuropathic-origin.Vaso-occlusion is hallmark-feature of sicklecell- disease(SCD)with acute-pain-episodes named vaso-occlusive-crises(VOC). Several SCD-patients develop VOC and chronic-pain,persisting at least 6 months. Thalassemia-bone-disease is a morbidity-reason presenting with osteoporosis, fractures,nerve-compression. We aimed to study different-origin of severe-painevents, trigger-factors, pharmacologic and non-pharmacological-strategies and also pandemic-impact. We reviewed 170 patients(F:M 101:69), 92 with majorthalassemia (TM), 35 with thalassemia-intermedia, 26 with SCD and 17 with microdrepanocytosis,followed at our Center from 2000 to 2021. We reported 186 events in SCD-patients, divided by etiology and SCD-type .94 VOC were treated with opioids+nonsteroidal anti-inflammatory-drugs(NSAID), 12 aseptic-bonenecrosis with infiltrations of hyaluronic acid+corticosteroids and transcutaneous-electrical-nerve-stimulation,6 headaches with paracetamol+NSAID, 3 acute-chestsyndromes with opioids,65 arthromyalgias with tramadol +pregabalin, 3 lower-limb-ulcers and 3 priapism with ibuprofen.130 episodes were referred as acute and 56 as chronic.Triggers-elements for acute were cold-temperatures,infections,dehydratation;for chronic-pain anxiety and depression. Thalassemic-patients presented 75 episodes, mostly of chronic-type, respectively at spine, hips and knee -levels.Pain episodes were related to spontaneous-fractures (65%), arthrosis (10%), degeneration and collapse of vertebral-bodies (10%), lower-limbs-ulcers (10%), osteomyelitis and arthritis(5%). Osteoporosis was present in 88% of cases and hypovitaminosis-D in 91%.Chronic-pain was prevalent (90%),treated with paracetamol and opioids. Pain-specialist was consulted. While in previous-years we described an average of 2 visits per month to the ER(medium-value of 25/year), especially in SCD-patients, in the last 2 years they have been considerably reduced, with only 7 access reported.A different-approach was adopted due to pandemic.Some VOC were managed at home, building a personalized home-painmanagement- plan,50 patients requested access to psychological-support, restricting hospital-access, but providing full-care. Pain-syndromes are a common-cause of referral in SCD and in TM. Pankillers have side-effects, including drug-dependency.Multidisciplinary-approach and cognitive behavioral-therapy were searched as other therapeutic-options. During pandemic such approach with remote-consultation helped reducing ER-access.
Lorenza Torti has completed her PhD from Catholic University in Rome and Post-doctoral studies from Catholic University School of Medicine in Rome. She is MD at Thalassaemia Unit, Hematology Department Sant'Eugenio Hospital, Rome, Italy, Regional-Center for the Diagnosis and Treatment of Rare Anemias and Disorders of Iron- Metabolism. Her research activities and interests are clinical management of hemoglobinopathic patients with thalassemia and sickle-cell-anemia, infectious complications and course of the SARSCov2-coronavirus in these patients. She also showed interest in reproductive and fertility aspects in hemoglobinopathies.