Manual Exchange Transfusion Role in the Management of a Pregnancy Compromised by Sickle Cell Disease in a Tertiary Hospital in Burkina Faso: A Case Report

Abstract

Sickle cell disease in pregnant women can lead to potentially serious complications for both the mother and fetus. Its management remains a major public health challenge, particularly in resource-limited regions. Here, we report the management of a case at the Regional University Hospital (RUH) of Ouahigouya. A 30-year-old patient with 2 pregnancies, 1 miscarriage following a vaso-occlusive crisis. The current pregnancy was monitored at a peripheral health center until 25 weeks of gestation when the patient experienced a vaso-occlusive crisis, prompting her evacuation to the CHUR-OHG. Electrophoresis of hemoglobin revealed 53% hemoglobin S fraction and 47% hemoglobin C fraction, with mild anemia at 9.6g/dl. After symptomatic treatment and hydration, the first crisis improved; however, due to the succession of crises, manual exchange transfusion was discussed and indicated by the care team. Initially, this exchange was not performed due to a lack of blood products. Thanks to the opening of the new transfusion center in the region, the required blood bags were available for the procedure. Manual exchange transfusion was performed, using AA red blood cell concentrate. The immediate aftermath of the exchange transfusion was straightforward, and the patient was able to carry her pregnancy to term without further complications. Delivery was by caesarean section, at 38 weeks of gestation. The newborn, a female, had Apgar scores of 9/10 and 10/10, with a weight of 2600 grams. Postoperative recovery was uneventful with no vaso-occlusive crises.