New Sickle Cell Anemia Night Hospital Opened At Montefiore Medical Center
August 5 - August 11,1999
 
For the many patients with sickle cell anemia who suffer excruciating episodes of acute pain, called crises, the six-bed "day hospital" at Montefiore Medical Center's Comprehensive Sickle Cell Center (CSCC) has been a treatment sanctuary for over a decade. The success of the day hospital, created in 1988 through a National Institutes of Health grant, has inspired the recent development of a precedent-setting sickle cell "night hospital."
 
" Sickle cell crises occur 24 hours a day, and many patients have jobs, are care-givers or in school and cannot take time off to be treated in the day hospital," said Dr. Lennette Benjamin, founding director and clinical director of the CSCC. "This is why we opened the night hospital six months ago and it has been filled almost every night since."
 
In both the day hospital (open 9 a.m.-5 p.m.) and night hospital (open 11 p.m.-7 a.m.), physicians, nurse practitioners and nurses, all specialists in sickle cell disease, provide aggressive treatment to relieve pain, monitor each patient at frequent intervals, provide titrated medications and establish a post-hospital treatment plan to help patients cope.
 
The new night hospital is operated at the same site as the day hospital, a special unit in Montefiore Medical Center's Moses Division. Patients treated previously at the unit admit themselves, while others are referred by their physicians or from the emergency room.
 
"Patients at the sickle cell hospital receive care from specialists in pain management who provide treatment at half'hour intervals. This type of monitoring in a dedicated facility is not available in general care areas such as in the emergency room or on an inpatient unit," said Benjamin. "In addition, the cost of care in our daybed setting is significantly less."
 
Says Benjamin, the chief medical officer of the Sickle Cell Disease Association of America, "The mission of montifiore's CSCC extends beyond the provision of quality patient care to advancing clinical research, educating other professionals about the great need for pain management and conducting basic research."
 
Basic research into sickle cell disease is under the direction of Dr. Ronald Nagel, director and principal investigator of the CSCC grant and head of Hematology at Montefiore.
 
After appropriate evaluation, each patient at the night hospital receives a pain management plan that includes options for stronger medications delivered intramuscularly, intravenously or subcutaneously for health maintenance, and treatment to prevent complications. The range of treatments for sickle cell acute episodes include blood transfusions to increase the circulation of red blood cells in the bone marrow and hydroxyurea to reduce the occurrence of acute pain episodes.
 
Sickle cell disease, most prevalent among AfricanAmericans and Hispanic-Americans from the Caribbean, Central America and parts of South America, may also occur in people of Mediterranean, Indian and Middle Eastern heritage.
 
Sickle cell disease is a hereditary blood disease in which the red blood cells can take on a sickle shape. Normally, red blood cells, which carry oxygen throughout the body, are shaped like donuts and are very flexible, which makes it easy for them to move through small blood vessels. When red blood cells carry a preponderance of hemoglobin-S, some of them will assume sickle shapes when they are deprived of oxygen. These sickle-shaped cells plug up the blood vessels and not enough oxygen can get through to the tissues. The result may be pain or damage to organs.
 
One in 10 African-Americans has the sickle cell trait. If two persons with the trait have a child, however, the chances are one in four that the child will have sickle cell disease.