Access to emergency department for acute events and identification of sickle cell disease in refugees

Throughout the last decade, thousands of refugees arrived on a daily basis at the Mediterranean coast of Southern European countries. The vast majority of these migrants come from areas in which sickle cell disease (SCD) and other hemo- globinopathies are highly prevalent. we carried out a retrospective study of data collected from 2014 to 2017 across 13 Italian reference centers for SCD and hemoglobinopathies. The primary outcome of this study was to identify events associated with the new diagnosis of SCD in refugees; the secondary outcome was to evaluate the impact of hemoglobinopathies in refugees coming from endemic areas. Our retrospective study shows that SCD is relatively common in refugees visiting EDs for acute sickle cell–related events. Over the 4 years studied, we identified 70 patients with hemoglo- binopathies: 50% were adults (86% male; 14% female; median age, 21 years; IQR, 18.5-19 years), and 50% were children (80% male; 20% female; median age, 10 years; IQR, 1-16 years). The overall genotypic distribution was as follow: SS(n549),SC(n59),Sb-thalassemia(n53),CC(n52),AS(n5 1), and transfusion-dependent b-thalassemia (TDT; n 5 6). Acute events were primarily responsible for the identification of SCD in refugees. The main reasons for access to ED of previously un- diagnosed SCD were qualitatively similar to those seen in the native Italian SCD population11 or other SCD groups,12,13 with the exception of anemia, which was the second main cause of visits to the ED in our study population. Although we did not have access to historical patient hematologic data, we cannot exclude the possible contribution of malnutrition to anemia in refugees with SCD. A total of 82.9% of patients was diagnosed with SCD within the first 11 months after their arrival in Italy, and 14.3% were diagnosed during the second year. Our prospective study screening asymptomatic refugees in a second-level refugee center identified 3% SCD patients and 20% AS individuals over 400 screened individuals. Collectively, our results indicate the need for screening for SCD in refugees at their arrival to prevent severe acute and life-threatening clinical manifestations.