Preoperative blood transfusions for sickle cell disease

Estcourt, Lise J; Kimber, Catherine; Trivella, Marialena; Dorée, Carolyn; Hopewell, Sally

doi:10.1002/14651858.cd003149.pub4

Cited by 8 publications

(5 citation statements)

References 46 publications

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“…According to the 2018 Frankfurt Consensus Conference, the transfusion threshold for cardiac surgery patients is set at PHB <75 g/L [ 20 ]. Studies have also demonstrated that raising PHB to 100 g/L has the same efficacy as reducing sickle hemoglobin to less than 30% (more allogeneic blood transfusions) and reduces the immune transfusion reaction, due to reduced transfusion [ 21 ]. Older individuals have less tolerance for anemia and require higher hemoglobin levels to achieve peak oxygen capacity, comparable to younger individuals [ 22 ].…”

Section: Discussionmentioning

confidence: 99%

Preoperative Blood Transfusion Requirements for Hemorrhoidal Severe Anemia: A Retrospective Study of 128 Patients

Deng,

Fang,

Wang

et al. 2024

Med Sci Monit

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Background Severe anemia caused by hemorrhoidal hematochezia is typically treated preoperatively with reference to severe anemia treatment strategies from other etiologies. This retrospective cohort study included 128 patients with hemorrhoidal severe anemia admitted to 3 hospitals from September 1, 2018, to August 1, 2023, and aimed to evaluate preoperative blood transfusion requirements. Material/Methods Of 5120 patients with hemorrhoids, 128 (2.25%; male/female: 72/56) experienced hemorrhoidal severe anemia, transfusion, and Milligan-Morgan surgery. Patients were categorized into 2 groups based on their preoperative hemoglobin (PHB) levels after transfusion: PHB ≥70 g/L as the liberal-transfusion group (LG), and PHB <70 as the restrictive-threshold group (RG). The general condition, bleeding duration, hemoglobin level on admission, transfusion volume, length of stay, immune transfusion reaction, surgical duration, and hospitalization cost were compared between the 2 groups. Results Patients with severe anemia (age: 41.07±14.76) tended to be younger than those with common hemorrhoids (age: 49.431±15.59 years). The LG had a significantly higher transfusion volume (4.77±2.22 units), frequency of immune transfusion reactions (1.22±0.58), and hospitalization costs (16.69±3.31 thousand yuan) than the RG, which had a transfusion volume of 3.77±2.09 units, frequency of immune transfusion reactions of 0.44±0.51, and hospitalization costs of 15.00±3.06 thousand yuan. Surgical duration in the LG (25.69±14.71 min) was significantly lower than that of the RG (35.24±18.72 min). Conclusions Patients with hemorrhoids with severe anemia might require a lower preoperative transfusion threshold than the currently recognized threshold, with an undifferentiated treatment effect and additional benefits.

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Section: Discussionmentioning

confidence: 99%

Preoperative Blood Transfusion Requirements for Hemorrhoidal Severe Anemia: A Retrospective Study of 128 Patients

Deng,

Fang,

Wang

et al. 2024

Med Sci Monit

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“…The main recommendations for RBC transfusion for patients with SCA are as follows: a decrease in Hb ≥2 g/dL compared to baseline values and/or the presence of an acute complication such as a vaso-occlusive refractory crisis to conventional treatment, acute chest syndrome, splenic or hepatic sequestration, transitory aplastic crisis, or hemodynamic decompensation 10 , 12 . RBC transfusion for asymptomatic patients should be performed in restricted situations such as preoperative preparation and prophylaxis for primary and secondary ischemic stroke 15 , 16 , 17 .…”

Section: Discussionmentioning

confidence: 99%

Transfusion of packed red blood cells in adults with sickle cell anemia treated at an emergency hospital

Cansian,

Faria,

Sarni

2024

Rev. Assoc. Med. Bras.

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SUMMARY OBJECTIVE: The aim of this study was to analyze the prescription of packed red blood cells performed by emergency physicians for adults with sickle cell anemia. METHODS: Transfusions performed in adults with sickle cell anemia treated at an emergency service in São Bernardo do Campo, São Paulo Brazil, between January 2018 and January 2022 were evaluated. For data comparison, the chi-square 2 test was used. The significance level adopted was 5%. RESULTS: A total of 114 transfusions were performed. The mean age was 41.8±16.4 years, and pretransfusion hemoglobin was 6.1±1.23 g/dL. Regarding the indication, the adequacy of transfusions performed in symptomatic individuals was significantly higher compared to asymptomatic individuals (100% vs. 3.9%, p<0.001). Symptomatic individuals received excessive volumes of packed red blood cells less frequently than asymptomatic individuals (17.5% vs. 56.9%, p<0.001). The filtered subtype, indicated for sickle cell anemia, was prescribed in only a quarter of the patients. However, non-indicated subtypes were frequently prescribed. CONCLUSION: This study found low adequacy in the indication and calculation of the transfusion volume of packed red blood cells in asymptomatic individuals. Few patients received filtered red blood cells, resulting in increased risks of transfusion reactions. On the contrary, non-indicated subtypes were prescribed in a quarter of transfusions, which resulted in higher costs and delay in receiving packed red blood cells.

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“… 20 The idea of using preoperative exchange transfusions emerged later, as it was found that the filterability of blood in SCD patients is normal when HbS is < 40% and that vaso-occlusive crises occur only when HbS is > 50%. 21 22 A 2020 Cochrane meta-analysis found insufficient evidence to recommend aggressive preoperative blood transfusions in SCD to prevent sickle-related or surgery-related complications, 23 but it should be strongly considered in free tissue transfer where the risk of sickling and thrombosis should be minimized.…”

Section: Discussionmentioning

confidence: 99%

Free Tissue Transfer in Sickle Cell Disease: A Case Report and Systematic Review

2023

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Hemoglobinopathies such as sickle cell disease (SCD) are traditionally considered a relative contraindication to free tissue transfer, due to concerns that erythrocyte sickling will increase the risk of microvascular thrombosis and flap failure. This article describes a case report with the successful use of free tissue transfer in a patient with SCD and provides a systematic literature review on free tissue transfer in SCD. A retrospective chart review was performed of a patient with SCD who underwent free tissue transfer at the authors' institution. A systematic literature review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed using the keywords “free tissue transfer,” “free flap,” or “microsurgery” and “sickle cell” on PubMed, Ovid/Medline, and Scopus. A 29-year-old male with delayed presentation of an electrical burn to the face and scalp underwent wound closure with a free anterolateral thigh flap. Key management principles included red blood cell transfusion to keep hemoglobin S under 30% and hemoglobin greater than 10 g/dL, maintenance of hydration, normothermia, adequate analgesia, and postoperative anticoagulation. Systematic literature review identified 7 articles describing 13 cases of free tissue transfer in 10 patients with SCD, with combined complete free flap success in 10 of the 13 flaps. Free tissue transfer can be successfully performed in patients with SCD. However, evidence on the optimal management of this unique patient population in the perioperative period after free tissue transfer is limited to case reports in the literature.

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Preoperative blood transfusions for sickle cell disease

Abstract: Preoperative blood transfusions for sickle cell disease.

Cited by 8 publications

References 46 publications

Preoperative Blood Transfusion Requirements for Hemorrhoidal Severe Anemia: A Retrospective Study of 128 Patients

Preoperative Blood Transfusion Requirements for Hemorrhoidal Severe Anemia: A Retrospective Study of 128 Patients

Transfusion of packed red blood cells in adults with sickle cell anemia treated at an emergency hospital

Free Tissue Transfer in Sickle Cell Disease: A Case Report and Systematic Review

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