Prophylactic red blood cell exchange may be beneficial in the management of sickle cell disease in pregnancy

Asma, Süheyl; Kozanoğlu, İlknur; Tarım, Ebru; Sarıtürk, Çağla; Gereklioğlu, Çiğdem; Akdeniz, Aydan; Kasar, Mutlu; Turgut, Nurhilal H.; Yeral, Mahmut; Kandemir, Fatih Mehmet; Boğa, Can; Özdoğu, Hakan

doi:10.1111/trf.12780

Cited by 44 publications

(73 citation statements)

References 48 publications

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“…10,15 The proportion of patients receiving prophylactic transfusion and needing additional on-demand transfusions was not reported in the majority of studies and varied widely in the studies in which it was reported (5.6-60.7%). 14 In the single RCT conducted by Koshy et al, 16 the prophylactic transfusion group received simple or partial exchange transfusions to achieve the following targets: hemoglobin of 100 to 110 g/L, Hct of 33%, and HbS ,35%. Transfusions were initiated between 8 and 14 weeks of GA in three quarters and between 20 and 26 weeks in one quarter of participants.…”

Section: Summary Of Management and Transfusion Protocolsmentioning

confidence: 99%

“…13 Furthermore, reports assessing the effect of prophylactic RBC transfusions on pregnancy outcomes in SCD have been inconsistent. [14][15][16][17][18][19] Thus, the objective of this study was to systematically review the impact of prophylactic transfusion compared with on-demand transfusion (defined as transfusion instituted to treat complications) on maternal and neonatal adverse pregnancy outcomes in pregnant women with SCD.…”

Section: Introductionmentioning

confidence: 99%

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Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and meta-analysis

Malinowski

Shehata

D’Souza

et al. 2015

Blood

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Key Points• Prophylactic transfusion in pregnant women with SCD may reduce maternal mortality, vaso-occlusive pain events, and pulmonary complications.• Prophylactic transfusion in pregnant women with SCD may similarly reduce perinatal mortality, neonatal death, and preterm birth.Pregnancy in women with sickle cell disease is associated with adverse maternal and neonatal outcomes. Studies assessing the effects of prophylactic red blood cell transfusions on these outcomes have drawn inconsistent conclusions. The objective of this systematic review was to assess the effect of prophylactic compared with on-demand red blood cell transfusions on maternal and neonatal outcomes in women with sickle cell disease. A systematic search of several medical literature databases was conducted. Twelve studies involving 1291 participants met inclusion criteria. , and preterm birth (9 studies, 1123 participants; OR, 0.59; 95% CI, 0.37-0.96). Event rates for most of the results were low. Prophylactic transfusions may positively impact several adverse maternal and neonatal outcomes in women with sickle cell disease; however, the evidence stems from a relatively small number of studies with methodologic limitations. A prospective, multicenter, randomized trial is needed to determine whether the potential benefits balance the risks of prophylactic transfusions. (Blood. 2015;126(21):2424-2435

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Section: Summary Of Management and Transfusion Protocolsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and meta-analysis

Malinowski

Shehata

D’Souza

et al. 2015

Blood

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“…The HbS gene is found in high frequency in many parts of Africa, India, the Middle East, the Mediterranean area, and aparts of Turkey 8 . The primary manifestations of SCD are chronic hemolytic anemia and episodes of severe pain crises due to vasoocclusion 9 . Repeated vasooclusive crisis can affect multiple organ systems, and individuals with SCD have increased risks of stroke, renal dysfunction, pulmonary hypertension, retinal disease, and avascular necrosis 9 .…”

Section: Discussionmentioning

confidence: 99%

“…The primary manifestations of SCD are chronic hemolytic anemia and episodes of severe pain crises due to vasoocclusion 9 . Repeated vasooclusive crisis can affect multiple organ systems, and individuals with SCD have increased risks of stroke, renal dysfunction, pulmonary hypertension, retinal disease, and avascular necrosis 9 . RBC transfusions remain a cornerstone treatment for acute and chronic complications in SCD 10 .…”

Section: Discussionmentioning

confidence: 99%

“…RBC transfusions remain a cornerstone treatment for acute and chronic complications in SCD 10 . Approximately 90% of adults with SCD will have received at least one RBC transfusion 9 .Transfusion therapy facilitates blood and tissue oxygenation and reduces the propensity for sickling by diluting the host cells and temporarily suppresses the production of HbS-containing red cells 11 . Despite the beneficial effects of transfusion therapy in SCD, there are still adverse effects associated with transfusion that can lead to serious short and long-term complications including alloimmunization 11 .…”

Section: Discussionmentioning

confidence: 99%

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Türkiye’ de orak hücre hastalığına sahip hastalarda eritrosit alloimmünizasyonu: tek merkez geriye dönük kohort çalışması

Solmaz

Karacaoğlu

Gereklioğlu

et al. 2016

Cukurova Medical Journal (Çukurova Üniversitesi Tıp Fakültesi Dergisi)

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AbstractÖz Purpose: We aimed to investigate erythrocyte alloimmunization frequency and related factors in our region where SCD is common. Material and Methods: This study was planned as a single center, cross-sectional and retrospective cohort study. A total of 216 patients who had been followed up due to SCD [Hemoglobin (Hb) SS, Hb S-β thalassemia, Hb S-α thalassemia] were included in this study. Patients were divided to two groups according to amount of transfusion. The patients who had received less than 6 transfusions per year and who did not have the history of erythropheresis were allocated to Group 1, and the patients who had received 6 or more simple transfusion per year or who had undergone erythrocyte exchange were allocated to Group 2. Results: Of 216 SCD patients included in the study. Alloimmunization was detected in 67 (31.0%) out of 216 patients who underwent transfusion, and in 17 (30.4%) out of 56 patients in Group 1 and in 50 (31.3%) out of 160 patients in Group 2. When the patients were analyzed according to alloimmunization development, our study revealed that neither SCD complications are a risk factor for alloimmunization nor alloimmunization increases mortality rates. Conclusion: High alloimmunization frequency found in our study suggests the insufficient adherence of alloimmunization-prevention policies in RBC transfusions performed except experienced institutions. Therefore alloimmunization may be reduced or prevented through performing extended red cell typing among SCD patients.Amaç: Orak hücre hastalığının sık görüldüğü bölgemizde eritrosit alloimmmünizasyon sıklığını ve ilişkili durumları araştırmayı amaçladık. Gereç ve Yöntem: bu çalışma tek merkezli, zamansal kesitli ve geriye dönük kohort çalşıması olarak planlanmıştır.Toplamda 216 orak hücre hastalığı [Hemoglobin (Hb) SS, Hb S-β talasemi, Hb S-α talasemi] tanısı olan hasta çalışmaya dahil edilmiştir. Hastalar transfüzyon miktarına gore iki gruba ayrılmıştır. Yılda 6'dan daha az transfüzyon alan ya da eritroferez öyküsü olmayan hastalar Grup 1'e, yılda 6 ve daha fazla basit transfüzyon alan ya da eritroferez işlemine alınan hastalar Grup 2'ye dahil edilmiştir. Bulgular: Çalışmamıza 216 hasta dahil edilmiştir. Transfüzyon tedavisi alan toplam 216 hastanın 67 (%31.0)'sinde, Grup 1'deki 56 hastanın 17'sinde (%30.4), Grup 2'deki 160 hastanın 50'sinde (%31.3) tespit edilmiştir. Hastalar alloimmünizasyon gelişimi açısından analiz edildiğinde, çalışmamız ne orak hücre komplikasyonlarının alloimmünizasyon gelişimi için ne de alloimmünizasyonun ölüm için bir risk faktörü olmadığını göstermiştir. Sonuç:Çalışmamamızda bulunan yüksek alloimmünizasyon sıklığı, tecrübeli merkezler dışında yapılan transfüzyonlarda alloimmünizasyonu önleyici politikalara yeteri kadar uyulmadığı konusunda fikir vermektedir. Bu nedenle orak hücre anemili hastalarda alloimmünizasyon, ayrıntılı eritrosit antijen tanımlama işlemi yapılarak azaltılabilir veya önlenebilir.

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Transfusion‐related adverse events are decreased in pregnant women with sickle cell disease by a change in policy from systematic transfusion to prophylactic oxygen therapy at home: A retrospective survey by the international sickle cell disease observatory

et al. 2018

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Sickle cell disease (SCD) in pregnancy can be associated with adverse maternal and perinatal outcomes. Furthermore, complications of SCD can be aggravated by pregnancy. Optimal prenatal care aims to decrease the occurrence of maternal and fetal complications. A retrospective, French, two‐center study compared two care strategies for pregnant women with SCD over two time periods. In the first study period (2005‐2010), the women were systematically offered prophylactic transfusions. In the second study period (2011‐2014), a targeted transfusion strategy was applied whenever possible, and home‐based prophylactic nocturnal oxygen therapy was offered to all the pregnant women. The two periods did not differ significantly in terms of the incidence of vaso‐occlusive events. Maternal mortality, perinatal mortality, and obstetric complication rates were also similar in the two periods, as was the incidence of post‐transfusion complications (6.1% in 2005‐2010 and 1.3% in 2011‐2014, P = .15), although no de novo alloimmunizations or delayed hemolysis transfusion reactions were observed in the second period. The results of this preliminary, retrospective study indicate that targeted transfusion plus home‐based prophylactic nocturnal oxygen therapy is safe and may decrease transfusion requirements and transfusion‐associated complications.

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Prophylactic red blood cell exchange may be beneficial in the management of sickle cell disease in pregnancy

Abstract: This study has demonstrated that prophylactic RBCX during pregnancy is a feasible and safe procedure for prevention of complications. Given the decrease in the risks of transfusion, RBCX warrants further study.

Cited by 44 publications

References 48 publications

Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and meta-analysis

Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and meta-analysis

Türkiye’ de orak hücre hastalığına sahip hastalarda eritrosit alloimmünizasyonu: tek merkez geriye dönük kohort çalışması

Transfusion‐related adverse events are decreased in pregnant women with sickle cell disease by a change in policy from systematic transfusion to prophylactic oxygen therapy at home: A retrospective survey by the international sickle cell disease observatory

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