Use of partial exchange transfusion preoperatively in patients with sickle cell hemoglobinopathies

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

“…3 As this systematic review demonstrates, maternal mortality in a majority of women with SCD occurred in the setting of vaso-occlusive pain episodes, 14,18,28 with pulmonary embolism and acute chest syndrome accounting for 2 additional cases each. 14,28 The positive impact of prophylactic transfusion on maternal morbidity may thus be the consequence of reducing the frequency of vaso-occlusive pain episodes. However, uncomplicated vaso-occlusive events in the nonpregnant state are typically self-limited and of themselves are not considered an indication for transfusion.…”

“…Studies to date have consistently supported the effectiveness of prophylactic transfusion in reducing the frequency of vaso-occlusive pain episodes, 14,15,17,19,[27][28][29][30] which tend to increase in pregnancy. 3 As this systematic review demonstrates, maternal mortality in a majority of women with SCD occurred in the setting of vaso-occlusive pain episodes, 14,18,28 with pulmonary embolism and acute chest syndrome accounting for 2 additional cases each.…”

“…19,26,27 Historical controls from the 1950s and 1960s were included in 2 studies. 19,28 Seven studies specified outcomes based on b-globin genotype. 10,15,18,19,26,28,30 Confounding variables were generally not addressed in the study design or analysis.…”

Anesthetic management of a patient with sickle cell disease for common bile duct exploration

“…Exchange transfusion is generally recommended before major surgical interventions in order to minimize sickling and reduce the circulating HbS concentration below 30%. [9] In our patient, partial exchange transfusions done before surgery reduced the HbS level from 78.3 to 36.6% which drastically improved the perioperative outcome.…”

Chronic Transfusion Programmes in Sickle Cell Disease: Problem or Panacea?

“…However, many other aspects of management in pregnancy also improved over that period, confounding conclusions based on historic controls. With almost no controlled data, prophylactic transfusion became the accepted method of managing pregnancy (Morrison & Wiser, 1976;Cunningham et al, 1983). Finally, a controlled trial in the U.S.A. (Koshy et al, 1988) and a retrospective study in the U.K. (Howard et al, 1995) comparing groups receiving prophylactic transfusions from 28 weeks of pregnancy with those transfused only for medical or obstetric emergencies, showed a significant reduction in maternal painful crises but failed to show any benefit in obstetric outcome.…”