{"doi":"10.1111/bjh.17798","title":"Concordance with comprehensive iron assessment, hepatitis A vaccination, and hepatitis B vaccination recommendations among patients with sickle cell disease and thalassaemia receiving chronic transfusions: an analysis from the Centers for Disease Control haemoglobinopathy blood safety project","abstract":"Non-concordance with preventive recommendations is common among patients with chronic conditions, including sickle cell disease (SCD) and transfusion-dependent thalassaemia (TDT).1, 2 Iron overload is common among chronically transfused patients with SCD and TDT leading to increased morbidity, mortality and cost of care, especially as they live longer.3-5 The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) recommendations support completion of hepatitis A (HepA) and hepatitis B (HepB) vaccinations, including SCD and TDT.6, 7 Cardiac iron overload is the leading cause of mortality in TDT,8 while it is rare in SCD.9 Guidelines recommend liver iron overload assessment every 1–2 years for patients with SCD receiving chronic transfusions.10, 11 The recommendation for TDT is annual assessment of liver and cardiac iron concentration.3, 8 However, there are limited data on concordance with these recommendations. In the present study, our objective was to evaluate concordance with these preventive recommendations among chronically transfused patients with SCD and TDT. We hypothesised that concordance is suboptimal. The Blood Safety Surveillance among People with Blood Disorders project was funded by the CDC and was conducted at four large academic medical centres with comprehensive haemoglobinopathy programmes for SCD and TDT in the United States (January 2013 to December 2014). Demographics, medical and vaccination history were obtained. Patients with SCD (HbSS/HbSβ0) or TDT were included if they received eight or more transfusions annually. Concordance definitions for comprehensive iron assessment and HepA/B vaccination recommendations are summarised in Data S1. Our present study cohort included 267 patients, 209 with SCD and 58 with TDT (Table I). Among 126 chronically transfused children/adolescents with SCD, 32% (40/126) had a documented complete iron assessment during the study period. Concordance with vaccine recommendations was higher than concordance with iron assessment recommendations; 65% (64/99) of patients with vaccination information had documentation of completion of the HepA series and 86% (108/126) had documentation of completion of the HepB series or vaccine-type serological testing response (Fig 1A). Overall, 9% (nine of 99) with information available for all three preventive services were concordant with all three preventive service recommendations (Fig 1B). Similarly, among 83 chronically transfused adults with SCD, less than half (41%; 34/83) had a documented complete iron assessment during the study period. Concordance with vaccine recommendations was lower among adult patients compared with children/adolescents; 27% (15/56) had documentation of completion of the HepA series and 70% (57/82) had documentation of completion of the HepB series or documentation of vaccine-type serological testing response (Fig 1A). In all, 11% (five of 56) of adult patients were concordant with all three preventive service recommendations (Fig 1B). Among 25 children/adolescents with TDT, the majority had a documented iron assessment (76%; 19/25) and had documentation of completion of the HepB series or demonstrated vaccine-type serological testing response (86%; 19/22). Only 38% (three of eight) had documentation of completion of the HepA series. Child/adolescent patients with TDT who were concordant with HepA vaccination recommendations were concordant with the other two preventive service recommendations (Fig 1B). All children/adolescents with TDT with complete information were concordant with at least one preventive service recommendation (Fig 1B). Similarly, among 33 adult patients with TDT, the majority had a documented iron assessment (88; 29/33) and had documented completion of the HepB series or demonstrated vaccine-type serological testing response (85%; 28/33) (Fig 1A). All adult patients were concordant with at least two preventive service recommendations (Fig 1B). A hi","journal":"British Journal of Haematology","year":2021,"id":210723,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":3,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9538,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2021-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":271554,"name":"Amanda B. Payne","orcid":"0000-0003-1027-7639","position":1,"is_corresponding":false},{"id":537057,"name":"Mary Hulihan","orcid":null,"position":2,"is_corresponding":false},{"id":390157,"name":"Thomas D. Coates","orcid":"0000-0001-9878-6029","position":3,"is_corresponding":false},{"id":431651,"name":"Suvankar Majumdar","orcid":"0000-0003-1471-738X","position":4,"is_corresponding":false},{"id":799672,"name":"Dominic Smith","orcid":null,"position":5,"is_corresponding":false},{"id":426531,"name":"Alexis A. Thompson","orcid":"0000-0003-4961-8103","position":6,"is_corresponding":false},{"id":263623,"name":"Sherif M. Badawy","orcid":"0000-0002-4739-265X","position":0,"is_corresponding":true}],"reference_count":14,"raw_metadata":null,"created_at":"2026-07-18T23:52:12.491146Z","pmid":"34431082","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}