Prophylactic red‐cell transfusions in pregnant patients with sickle cell disease. A randomized cooperative study

Koshy, Mabel; Burd, Larry; Wallace, David; Moawad, Ashraf; Baron, Joel

doi:10.1016/0020-7292(89)90280-4

Cited by 67 publications

(115 citation statements)

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“…We observed a significant difference in the rates and the indications for Cesarean delivery between the uncomplicated vs the complicated groups. The rate of Cesarean delivery in the SCD population is generally higher than in the whole population, 4,6,18 and it varies widely amongst studies, with rates ranging from 15 to 59%. 4,6,7,18 In our study, this rate was 47%.…”

Section: Discussionmentioning

confidence: 98%

“…The rate of Cesarean delivery in the SCD population is generally higher than in the whole population, 4,6,18 and it varies widely amongst studies, with rates ranging from 15 to 59%. 4,6,7,18 In our study, this rate was 47%. These results suggest that general anesthesia was a risk factor for the occurrence of postnatal sickling complications, while neuraxial anesthesia was not identified as such.…”

Section: Discussionmentioning

confidence: 98%

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Anesthetic management of pregnant women with sickle cell disease — effect on postnatal sickling complications

Camous

N’da

Etienne‐Julan³

et al. 2008

Can J Anesth/J Can Anesth

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Purpose: Currently, there is no consensus regarding the choice of anesthetic technique for parturients with sickle cell disease (SCD). The aim of the study was to determine the impact of the anesthetic technique on the occurrence of postnatal sickling complications. Methods:We reviewed the charts of all pregnant women with SCD who had given birth in our institution between January 2002 and January 2007. Data related to pregnancy and anesthetic management and complications related, or unrelated, to SCD were recorded. Full blood count and lactate dehydrogenase values were recorded on the day of delivery. Risk factors for postnatal sickling complications were evaluated using a logistic regression analysis to estimate odds ratios (OR) and their 95% confidence intervals (95% CI). Results:Fourteen of the 55 women (24%) experienced at least one postnatal sickling complication. Women who developed postnatal sickling complications were found to have a higher leukocyte count (17.0 ± 6.1 × 10 9 ·L -1 vs 12.8 ± 4.4 ×10 9 ·L -1 , P = 0.008) and a lower hemoglobin level (7.8 ± 1.1 vs 8.9 ± 1.0 g.dL -1 , P = 0.002). General anesthesia (OR = 16.0; 95% CI, 1.6 to 165.6) and a leukocyte count ≥ 15 × 10 9 ·L -1 (OR = 8.4; 95% CI, 1.6 to 44.5) were identified as risk factors. Neuraxial anesthesia and use of ephedrine were not identified as risk factors. There were no deaths. Conclusion: Our study suggests that general anesthesia could be associated with postnatal sickling complications, even when the severity of illness was taken into account.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

Anesthetic management of pregnant women with sickle cell disease — effect on postnatal sickling complications

Camous

N’da

Etienne‐Julan³

et al. 2008

Can J Anesth/J Can Anesth

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“…15 Prophylactic transfusion in pregnancy was not found to be helpful in a randomized trial of simple transfusion. 22 Automated red cell exchange has been used with good results, but the study was not randomized and we cannot determine its true efficacy. 23 Red cell exchange may be useful in patients with a dramatic increase in pain episodes during pregnancy, or possibly in those with preeclampsia.…”

Section: Chronic Maintenance Of Low S Levelsmentioning

confidence: 99%

Red Cell Exchange in Sickle Cell Disease

Swerdlow¹

2006

Hematology

146

131

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Red cell exchange transfusions remain an effective but possibly underutilized therapy in the acute and chronic treatment of sickle cell disease. In sickle cell disease, increased blood viscosity can cause complications when the hemoglobin exceeds 10 g/dL even if this is due to simple transfusion. Red cell exchange can provide needed oxygen carrying capacity while reducing the overall viscosity of blood. Acute red cell exchange is useful in acute infarctive stroke, in acute chest and the multi-organ failure syndromes, the right upper quadrant syndrome, and possibly priapism. Neither simple or exchange transfusions are likely to hasten resolution of an acute pain episode.

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“…A more recent systematic review and meta-analysis by Malinowski, et al looked at 12 studies (including the same Randomized Controlled Trial (RCT) [21] in the prior Cochrane Review) comparing the risks and benefits of prophylactic versus on-demand PRBC transfusion in pregnant SCD patients [22]. In a meta-analysis of the 12 studies, prophylactic transfusion was associated with a reduction in maternal mortality (7 It is likely that the discordance between the 2013 Cochrane Review and the meta-analysis from Malinowski, et al is attributed to the difference in the number of studies analyzed.…”

Section: Acute Chest Syndrome Epidemiology and Diagnosismentioning

confidence: 99%

Pulmonary Complications of Sickle Cell Disease in the Pregnant Patient

Lazo¹

2017

Int J Respir Pulm Med

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Respiratory complaints are common symptoms in pregnancy, and it is important to delineate whether the causative factor is cardiac, pulmonary, or physiologic in origin. The pathophysiology of Sickle Cell Disease (SCD) can further complicate the differential diagnosis. To our knowledge, there is little to no literature devoted to the management of pulmonary complications in the pregnant sickle cell patient. Therefore we present a review of the current literature and feature reports on the incidence and prevalence of the pulmonary complications in a sickle cell pregnancy. These include Acute Chest Syndrome (ACS), Pulmonary Hypertension (PH), Pulmonary Embolism (PE), and sickle cell chronic lung disease. We also aim to recommend management strategies that address the SCD-related pulmonary complications in the pregnant state.

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Prophylactic red‐cell transfusions in pregnant patients with sickle cell disease. A randomized cooperative study

Cited by 67 publications

References 0 publications

Anesthetic management of pregnant women with sickle cell disease — effect on postnatal sickling complications

Anesthetic management of pregnant women with sickle cell disease — effect on postnatal sickling complications

Red Cell Exchange in Sickle Cell Disease

Pulmonary Complications of Sickle Cell Disease in the Pregnant Patient

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