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 on the Mediterranean coast of Southern-European countries. As this influx is not expected to slow down, developing national and European strategies is required to ensure appropriate and accessible health care to these vulnerable populations.1,2 The vast majority of these migrants come from areas in which sickle cell disease (SCD) and other hemoglobinopathies are highly prevalent. Limited data are available on the burden of these disorders in populations of refugees. Here, we present two pieces of evidence supporting the need for specific strategies for the early identification of SCD in refugees. First, we carried out a retrospective study of data collected during the period 2014-2017 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 and the secondary outcome was to evaluate the impact of hemoglobinopathies in refugees coming from endemic areas. The descriptive analysis of variables was performed with counts, percentages, mean and standard deviation (SD) or median and interquartile range (IQR: 25th - 75th percentile). Then, we discuss the results of a pilot study which screened all refugees seen in a single second-level refugee center during October 2017, using one of the new rapid point of care screening devices (SickleSCAN® BioMedomics, inc.). The aim was to fast-track the care of individuals with SCD and the collection of relevant demographic data.3-5 The results were then validated by HPLC, the standard gold-standard screening method.3-5