Preoperative blood transfusions for sickle cell disease

Area of Science:

• Hematology
• Surgical Medicine
• Evidence-Based Medicine

Background:

• Sickle cell disease (SCD) is a common, severe monogenic disorder with significant morbidity and mortality.
• SCD patients undergo surgery more frequently and at younger ages than the general population.
• Preoperative blood transfusions are common for SCD patients, but optimal strategies lack consensus.

Purpose of the Study:

• To evaluate evidence on whether preoperative blood transfusion reduces mortality and adverse events in SCD patients undergoing surgery.
• To compare aggressive versus conservative transfusion regimens for SCD patients requiring preoperative transfusions.

Main Methods:

• Systematic review of randomized and quasi-randomized controlled trials.
• Searches included major databases up to March 2016.
• Two authors independently assessed eligibility, risk of bias, and extracted data.

Main Results:

• Three trials (990 participants) were included; evidence quality was low to very low.
• No significant difference in mortality or most adverse events (acute chest syndrome, vaso-occlusive crisis, infection) between aggressive and conservative transfusion regimens.
• Preoperative transfusion showed no mortality benefit; one trial suggested reduced acute chest syndrome, but results were heterogeneous and evidence quality was very low.

Conclusions:

• Insufficient evidence exists to determine the comparative effectiveness of aggressive versus conservative preoperative transfusion strategies for HbSS disease.
• Very low quality evidence suggests preoperative transfusion may prevent acute chest syndrome.
• The review cannot provide guidance for HbSC or HbSβ(+) disease or for patients with high baseline hemoglobin.