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August 13, 2003

Universal Consent for Invasive Procedures in the Intensive Care Unit—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(6):752. doi:10.1001/jama.290.6.752-a

In Reply: We agree with Dr Spell that more follow-up is necessary to assess the risk of leukemia associated with hydroxyurea treatment for SCA. We plan to pursue 5 additional years of follow-up.

Like Dr Feldman and colleagues, we would be interested in CD4 and CD8 cell counts in patients with less clinically severe SCA.

Dr Hagar is concerned that the use of cocaine may account for substantial mortality among patients not taking hydroxyurea. However, this is not supported by 29 available case autopsies. Metabolites of cocaine were reported in only 2. We do not have enough data to estimate therapeutic window thresholds. Generalized estimating equation analyses indicate that hydroxyurea's effect on mortality is not changed in magnitude or direction by adjustment for baseline fetal hemoglobin, but such analyses have low statistical power.