A survey of perioperative management of sickle cell disease in North America

Firth, Paul G.; McMillan, Kristen Nelson; Haberkern, Charles M.; Yaster, Myron; Bender, Michael A.; Goodwin, Salvatore R.

doi:10.1111/j.1460-9592.2010.03415.x

Cited by 19 publications

(11 citation statements)

References 22 publications

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“…In this study, significant variation in intraoperative and postoperative RBC transfusion practices existed between hospitals participating in ACS-NSQIP-P even after controlling for patient and procedural characteristics. Although there are survey data documenting the variation in transfusion threshold among pediatric providers, [17][18][19] the finding of hospital-level variation has not been demonstrated previously in pediatric surgical patients. These findings reinforce that different hospitals have dramatically different transfusion practices even in similar patient and procedural circumstances.…”

Section: Discussionmentioning

confidence: 99%

Variation in intraoperative and postoperative red blood cell transfusion in pediatric surgery

et al. 2016

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Section: Discussionmentioning

confidence: 99%

Variation in intraoperative and postoperative red blood cell transfusion in pediatric surgery

et al. 2016

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“…In a survey of North American Pediatric anesthetists, it has been found that 17 to 51% of the contributing clinicians would transfuse the patient to a hemoglobin concentration of 10 g/dL preoperatively. This wide range (17%‐51%) depends on disease severity and the type of surgery . Moreover, the National Institute of Health (NIH) evidence‐based guideline of sickle cell disease management recommends that expert opinion should be sought for appropriate preoperative transfusion decision in patients with Hb SS disease who have a hemoglobin level more than 8.5 g/dL, indicating that transfusion decision can be individualized based on various factors …”

Section: Discussionmentioning

confidence: 99%

“…This wide range (17%-51%) depends on disease severity and the type of surgery. 20 Moreover, the National Institute of Health (NIH) evidence-based guideline of sickle cell disease management recommends that expert opinion should be sought for appropriate preoperative transfusion decision in patients with Hb SS disease who have a hemoglobin level more than 8.5 g/dL, indicating that transfusion decision can be individualized based on various factors. 8 A number of previous studies have elucidated the need for preoperative transfusion in SCD.…”

Section: Discussionmentioning

confidence: 99%

Preoperative transfusion versus no transfusion policy in sickle cell disease patients: a randomized trial

et al. 2020

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BACKGROUND Many children with sickle cell disease (SCD) indicated for adenotonsillectomy receive pre‐operative transfusion therapy, either simple or exchange transfusion, in order to reduce surgical and sickle cell disease‐related complications. SUBJECTS AND METHODS This is a prospective randomized controlled clinical trial aiming to compare between preoperative simple transfusion and no transfusion in pediatric patients with sickle SCD admitted in Sultan Qaboos University Hospital, Muscat, Oman for adenotonsillectomy during the period from January 2014 through June 2018. They were randomly assigned into two arms (simple transfusion and no transfusion). RESULTS Postoperative SCD‐related complications have been encountered in 6 out of 138 patients (4.3%). There was no statistically significant difference between the two studied groups as regards the development of surgical or SCD‐related complications (p = 0.6 and 0.8 respectively). The length of postoperative hospital stay was comparable in the two groups. (p = 0.607). SCD‐related complications occurred exclusively in cases with homozygous sickle anemia (4 out of 81 = 4.9%). CONCLUSION Sickle cell disease patients with a hemoglobin level above 7.5 g/dL do not need PRBCs transfusion prior to adenotonsillectomy. This approach did not increase the risk of postoperative surgical or SCD‐related complications.

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“…Variance in the responses for adult-oriented practitioners compared to the pediatric practice respondents was similarly reflected in the more generic preoperative clinical scenario queried in the survey section on acute transfusion indications. A contemporary survey of North American members of the Society for Pediatric Anesthesia using clinical vignettes showed preference for preoperative transfusion for patients with increasing sickle-cell-related severity and invasiveness of procedures, but there was a considerable variability of responses [19]. The results of a recent RCT showing the benefit of preoperative transfusion compared to no transfusion in patients undergoing cholecystectomy and other moderate risk procedures was not available at the time of the current or previously mentioned survey [7].…”

Section: Discussionmentioning

confidence: 99%

Transfusion Practices in the Management of Sickle Cell Disease: A Survey of Florida Hematologists/Oncologists

et al. 2012

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The purpose of this study was to characterize transfusion practices in the management of sickle cell disease and to identify factors attributing to differences in prescribing practices among Florida hematologists/oncologists. A cross-sectional study was performed in 2005-2006 utilizing a mail survey. The survey instrument addressed practice characteristics, sickle cell patient populations, transfusion settings, indications and techniques, red blood cell phenotype specifications/modifications, use of practice guidelines, and educational resource utilization. One hundred fifty two physicians (75% adult-oriented, 25% pediatric) completed the survey. Non-academic practice settings (78 %) were the primary location. Pediatric practices had a larger percentage of patients with overt strokes, and receiving hydroxyurea therapy than adult-oriented practices. The majority of survey respondents did not request limited phenotypically matched red blood cells on a routine basis. The majority of pediatric practices (60%) had individually defined transfusion practice guidelines in contrast to 8% of adult-oriented practices. There were statistically significant differences for pediatric and adult-oriented practices in managing certain acute and chronic transfusion indications. Analysis of clinical vignette data revealed variation among hematologists/oncologists in the transfusion management of common clinical scenarios. The study underscores the need for the development and dissemination of comprehensive sickle cell transfusion guidelines and protocols.

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A survey of perioperative management of sickle cell disease in North America

Abstract: There is a wide variation in the management of children with sickle cell disease. Clinicians differentiate management based on disease severity and procedure type.

Cited by 19 publications

References 22 publications

Variation in intraoperative and postoperative red blood cell transfusion in pediatric surgery

Variation in intraoperative and postoperative red blood cell transfusion in pediatric surgery

Preoperative transfusion versus no transfusion policy in sickle cell disease patients: a randomized trial

Transfusion Practices in the Management of Sickle Cell Disease: A Survey of Florida Hematologists/Oncologists

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