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

Abstract

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.

Fetomaternal Outcomes among Patients with Sickle Cell Disease: A Retrospective Study

“…19 Nocturnal oxygen supplementation also shows decreased need for red cell transfusions as per recent research reports. 20 About 68.75% patients were admitted for obstetrics-related complications. The commonest complication in this study was preterm delivery with 56.25% of patients.…”

Antigen matching for transfusion support in Brazilian female patients with sickle cell disease to reduce RBC alloimmunization

“…The fetal morbidity rate is also higher in female patients with SCD than in general population; fetal growth retardation and induced and spontaneous prematurity are the most common risks 41 . RBC transfusion could be an important treatment and can be administered as prophylactic or therapeutic blood transfusions initiated only if adverse events related to SCD or obstetric complications occur 18 . Consequently, the transfusion demand during pregnancy is generally greater than at regular periods.…”

“…Fetal complications include premature birth, low intrauterine growth, fetal distress, and high rates of perinatal mortality. Support for prophylactic transfusion is commonly used during pregnancy in patients with hemoglobinopathies 18 . Studies have shown that prophylactic blood transfusion reduces complications by correcting severe anemia and the extent of sickling in both the maternal and placental circulation, which consequently preserves intrauterine growth, reduces oligohydramnios and the incidence of vaso‐occlusive crises, and also decreases maternal mortality 18–21 …”

Impact of prenatal corticosteroid therapy on sickle cell disease in pregnant women

“…12,33 Hydroxyurea at conception and during pregnancy was associated with a two-fold increase in miscarriage and stillbirth 34 low birthweight, 34 but there is no evidence of increased congenital anomalies in live-born infants. 34,35 Prophylactic oxygen therapy is being evaluated in a randomized clinical trial based on promising observational data from Ribeil et al 36 Pregnancies with major sickle cell syndromes should be managed in reference centers that include obstetricians and anesthesiologists trained in SCD, an adult critical care unit, and a blood transfusion team.…”