Sickle cell disease can be severe and disabling. When properly treated, patients live longer and with better quality life. This is a US government publication intended to provide evidence-based guidelines for the care of these patients for the use of all concerned providers as well as patients and family members. This book is available in print here for convenience.

Sickle Cell Pain is a panoramic, in-depth exploration of every scientific, human, and social dimension of this cruel disease. This comprehensive, definitive work is unique in that it is the only book devoted to sickle cell pain, as opposed to general aspects of the disease. The 752-page book links sickle cell pain to basic, clinical, and translational research, addressing various aspects of sickle pain from molecular biology to the psychosocial aspects of the disease. Supplemented with patient narratives, case studies, and visual art, Sickle Cell Pain’s scientific rigor extends through its discussion of analgesic pharmacology, including abuse-deterrent formulations. The book also addresses in great detail inequities in access to care, stereotyping and stigmatization of patients, the implications of rapidly evolving models of care, and recent legislation and litigation and their consequences.

#1 Best Seller on Sickle Cell Disease (SCD). Sickle cell disease is a group of blood disorders passed down from parents to children. Sickle cell anemia shortens life expectancy by 30 years via bacterial infections, painful swellings, fever, arthritis, leg ulcers, eye, lung & heart damage. Over 100,000 people, mostly African-Americans, in the United States have sickle cell disease. Over 2 million people have sickle cell trait in America. It is estimated that more than 300,000 children are born each year with SCD around the world. This edition of The Management of Sickle Cell Disease (SCD) is organized into four parts: 1. Diagnosis and Counseling 2. Health Maintenance 3. Treatment of Acute and Chronic Complications 4. Special Topics. The original intent was to incorporate evidence-based medicine into each chapter, but there was variation among evidence-level scales, and some authors felt recommendations could be made, based on accepted practice, without formal trials in this rare disorder. The best evidence still is represented by randomized, controlled trials (RCTs), but variations exist in their design, conduct, endpoints, and analyses. It should be emphasized that selected people enter a trial, and results should apply in practice specifically to populations with the same characteristics as those in the trial. Randomization is used to reduce imbalances between groups, but unexpected factors sometimes may confound analysis or interpretation. In addition, a trial may last only a short period of time, but long-term clinical implications may exist. Another issue is treatment variation, for example, a new pneumococcal vaccine developed after the trial, which has not been tested formally in a sickle cell population. Earlier trial results may be accepted, based on the assumption that the change is small. In some cases, RCTs cannot be done satisfactorily (e.g., for ethical reasons, an insufficient number of patients, or a lack of objective measures for sickle cell "crises"). Thus the bulk of clinical experience in SCD still remains in the moderately strong and weaker categories of evidence. Not everyone has an efficacious outcome in a clinical trial, and the frequency of adverse events, such as with long-term transfusion programs or hematopoietic transplants, might not be considered. Thus, an assessment of benefit-to-risk ratio should enter into translation of evidence levels into practice recommendations. A final issue is that there may be two alternative approaches that are competitive (e.g., transfusions and hydroxyurea). In this case the pros and cons of each course of treatment should be discussed with the patient. This book is B&W copy of the government agency publication.

Thousands of HIV-positive women give birth every year. Further, because many pregnant women are not tested for HIV and therefore do not receive treatment, the number of children born with HIV is still unacceptably high. What can we do to eliminate this tragic and costly inheritance? In response to a congressional request, this book evaluates the extent to which state efforts have been effective in reducing the perinatal transmission of HIV. The committee recommends that testing HIV be a routine part of prenatal care, and that health care providers notify women that HIV testing is part of the usual array of prenatal tests and that they have an opportunity to refuse the HIV test. This approach could help both reduce the number of pediatric AIDS cases and improve treatment for mothers with AIDS. Reducing the Odds will be of special interest to federal, state, and local health policymakers, prenatal care providers, maternal and child health specialists, public health practitioners, and advocates for HIV/AIDS patients. January

Red blood cells in humans—and most other mammals—have a tendency to form aggregates with a characteristic face-to-face morphology, similar to a stack of coins. Known as rouleaux, these aggregates are a normally occurring phenomenon and have a major impact on blood rheology. What is the underlying mechanism that produces this pattern? Does this really happen in blood circulation? And do these rouleaux formations have a useful function? The first book to offer a comprehensive review of the subject, Red Blood Cell Aggregation tackles these and other questions related to red blood cell (RBC) aggregates. The book covers basic, clinical, and physiological aspects of this important biophysical phenomenon and integrates these areas with concepts in bioengineering. It brings together state-of-the-art research on the determinants, mechanisms, and measurement and effects of RBC aggregation as well as on variations and comparative aspects. After an introductory overview, the book outlines factors and conditions that affect RBC aggregation. It presents the two hypotheses—the bridging model and the depletion model—that provide potential mechanisms for the adhesive forces that lead to the regular packing of the cells in rouleaux formations. The book also reviews the methods used to quantify RBC aggregation in vitro, focusing on their importance in clinical practice. Chapters discuss the effect of RBC aggregation on the in vitro rheology of blood as well as on tube flow. The book also looks at what happens in the circulation when red blood cells aggregate and examines variations due to physiological and pathophysiological challenges. The concluding chapter explores the formation of red blood cell aggregates in other mammals. Written by leading researchers in the field, this is an invaluable resource for basic science, medical, and clinical researchers; graduate students; and clinicians interested in mammalian red blood cells.