What are your recommendations for adult sickle cell patients who end up being admitted several times a year for pain crises despite hydroxyurea, crizanlizumab, voxelotor, etc?  

This is the problem that vexes all people treating sickle cell disease. First, is to be sure that drug dosing is optimized. Both voxelotor and crizanlizumab can be added to hydroxyurea. All three drugs could be used together. Perhaps equally important as drug therapy is to cope as best as possible w...

Unfortunately, none of the existing disease modifying drugs reduces pain episodes by more than 50%, so it is not surprising that many patients continue to experience pain episodes despite receiving the appropriate therapy. In these settings, it is appropriate to consider a chronic transfusion regime...