Assessment of the Use of Transfusion Therapy Perioperatively in Patients with Sickle Cell Hemoglobinopathies

Abstract

During the period of 1978 to 1986, 66 patients (31 men, 35 women) with a mean age of 28.4 years and various sickle cell hemoglobinopathies underwent 82 surgical procedures; 28 were emergencies. Fifty of the 66 patients had HbSS, 13/66 had HbSC, and 3/66 had HbS-thalassemia. All 66 patients received transfusions, although not for all procedures. In 48 patients, transfusion therapy was only administered preoperatively. Simple transfusions (1 to 10 units) were administered in 31 of 48 procedures. Exchange transfusions (1 to 6 units) were performed in nine of 48 procedures. Preoperative hematocrit ranged from 7.0% to 54.2%; of those receiving transfusions the hematocrit ranged from 22.6% to 53.7%. Intraoperative transfusions (1 to 10 units) were performed in 14 of 82 procedures; postoperative transfusions (1 to 6 units) were performed in 13 of 82 procedures. No advantage was noted in preoperative exchange transfusion as measured by a decrease in postoperative complications; a slight increase was seen in atelectasis in this group of patients with preoperative transfusions. An increase was reported in the complication rate of patients with an hematocrit of less than 30%. The type of transfusion (preoperative, intraoperative, or postoperative) administered did not appear to be related to postoperative morbidity rates. The complication rate for simple transfusions was 51.6% and for multiple transfusions, 55.6%. HbSS hemoglobinopathy had the higher complication rate. The hepatitis B surface antigen was demonstrated in four of 66 (6.1%) patients; ten of 66 (15.2%) developed alloantibodies. The benefits of transfusion therapy should be judged according to clinical needs; not all sickle cell patients need exchange or preoperative transfusion.

Blood bank management of sickle cell patients at comprehensive sickle cell centers

“…The authors of these studies therefore concluded that conservative treatment with simple transfusions to a target Hct level of less than 30 percent is the preferred choice. Other authors, however, have questioned the need for preoperative transfusion for all SCD patients 37‐39 . Recent studies suggest that SCD patients undergoing laparoscopic cholecystectomy without preoperative transfusion have comparable complication rates to those who have been transfused 40,41 .…”

A nontransfusional perioperative management regimen for patients with sickle cell disease undergoing laparoscopic cholecystectomy

“…Several studies have reported that patients with SCD have a higher incidence of postoperative morbidity and mortality than patients without hematologic abnormalities [4,12,13,15,19,20,22]. In one such study, the risk of postoperative complications in patients with SCD ranged from 7% to 32% [7].…”

“…However, many clinicians practice successfully with minimal use of transfusions [4,5,12]. Nonrandomized comparisons of sickle cell patients undergoing minor procedures such as myringotomy and adenotonsillectomy have shown lower or equivalent complication rates in nontransfused patients [19].…”

The Role of Red Blood Cell Exchange Transfusion in the Treatment and Prevention of Complications of Sickle Cell Disease

“…Patients with SCD are at risk for perioperative complications including ACS, renal failure, pain episodes, and stroke. Preoperative transfusions have been reported beneficial and are usually, but certainly not universally, recommended if the patient is to receive general anesthesia or is to have surgery on the posterior segment of the eye (23,(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57). The optimal transfusion regimen, however, remains controversial.…”