Selective prophylactic transfusion in sickle cell disease

Abstract

OBJECTIVE. To record feto-maternal complications following the use of selective prophylactic transfusions in women with major sickle cell disease (SCD) and determine whether selective prophylactic transfusion reduces these complications, through a comparison with a population of women who received transfusions for complications only. DESIGN. A retrospective cohort study. SETTING. Public regional referral hospital in western French Guyana. POPULATION. Between 1992 and 2004, in all 29 women, 55 pregnancies, and 56 neonates. METHODS. Close obstetric follow-up and selective prophylactic transfusions after 26 weeks. Main outcome measures. Adverse obstetric outcome (pre-eclampsia, preterm delivery, intrauterine growth restriction (IUGR), intrauterine fetal death (IUFD), cesarean delivery, neonatal and maternal mortality) and end-points for SCD outcome (vaso-occlusive crisis (VOC), acute chest syndrome, and infections). RESULTS. Complications involved the different major SCD types to an equal extent. Comparison with the control group showed that women who had received prophylactic transfusions had lower rates of VOC (p=0.002) and preterm deliveries (p=0.036), but a significant increase in IUGR cases (p=0.048). CONCLUSION. Selective prophylactic transfusion seems to reduce certain maternal and fetal complications in women with severe forms of SCD. These results can only be confirmed through a randomized prospective study.

Improvement of maternal and fetal outcomes in women with sickle cell disease treated with early prophylactic erythrocytapheresis

“…A recent meta‐analysis on pregnancy in SCD supports the positive impact of a prophylactic transfusion regimen on sickle cell–related clinical manifestations with an improvement of maternal morbidity but with limited effect on IUGR . Partial red blood cell (RBC) exchange or automatic erythrocytapheresis (ECP) have also been reported to be relevant in management of SCD women during pregnancy, also improving perinatal outcomes . In these studies, ECP was started at different time of pregnancy, ranging from 22 to 28 weeks of gestation.…”

The effects of exchange transfusion for prevention of complications during pregnancy of sickle hemoglobin C disease patients

“…Despite prophylactic transfusions, preeclampsia was higher in the SS group than among controls (9.4% vs. 2.3%, p = 0.03) . In a French cohort, women who had received prophylactic transfusions had lower rates of vasoocclusive crisis (p = 0.002) and preterm deliveries (p = 0.036); unexpectedly, however, there was a significant increase in cases of intrauterine growth restriction (p = 0.048) …”

“…A significant decrease in maternal mortality and in the incidence of vasoocclusive crisis between patients undergoing prophylactic transfusions and control groups has also been demonstrated . Another retrospective cohort involving 55 pregnancies showed that women who had received prophylactic transfusions had lower rates of vasoocclusive crisis and preterm deliveries, although no improvement regarding intrauterine growth restriction was established …”

Acute Chest Syndrome in Sickle Cell Disease Patients Post Caesarean Delivery

“…Exchange transfusions replace sickled RBCs with normal RBCs without altering blood viscosity and, consequently, improve delivery of oxygen to oxygen-deprived tissues. The decision for simple or exchange transfusion ideally should depend on the severity of the situation (6,13). Exchange transfusion is recommended in the treatment of severe complications such as ACS, stroke and multi-organ failure in patients with SCD.…”