Preoperative blood transfusions for sickle cell disease

Area of Science:

• Hematology
• Genetics
• Surgical Medicine

Background:

• Sickle cell disease (SCD) is a severe monogenic disorder causing significant complications and increased surgical intervention rates.
• Surgical patients with SCD often receive preoperative blood transfusions, but optimal strategies lack consensus.
• This review updates evidence on preoperative transfusion effectiveness in SCD patients.

Purpose of the Study:

• To assess if preoperative blood transfusion reduces mortality and adverse events in SCD patients undergoing surgery.
• To compare aggressive versus conservative transfusion regimens for SCD patients.

Main Methods:

• Systematic review of randomized and quasi-randomized controlled trials.
• Searched multiple databases up to January 2020.
• Two authors independently assessed eligibility, bias, and extracted data.

Main Results:

• Three trials (990 participants) were included; evidence quality was low to very low.
• Aggressive vs. simple transfusion showed no significant difference in mortality or complications.
• Preoperative transfusion vs. no transfusion showed no difference in mortality but suggested a possible reduction in acute chest syndrome in one trial.

Conclusions:

• Insufficient evidence exists to determine the effectiveness of conservative vs. aggressive transfusion for HbSS disease.
• Very low-quality evidence suggests preoperative transfusion may prevent acute chest syndrome.
• Evidence is lacking for HbSC, HbSβ+ disease, or patients with high baseline hemoglobin.