Selective prophylactic transfusion in sickle cell disease

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.