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Risks and Benefits of Prophylactic Transfusion before Cholecystectomy in Sickle Cell Disease
Elise Rambaud1, Brigitte Ranque1, Sofia Tsiakyroudi2
1Reference Center for Sickle Cell Disease, Thalassemia and Other Red Blood Cell and Erythropoiesis Diseases, Department of Internal Medicine, European Georges Pompidou University Hospital (AP-HP), European Georges Pompidou Hospital (AP-HP), Paris Cité University, F-75015 Paris, France.
Journal of Clinical Medicine
|July 27, 2022
Summary
Preoperative transfusion in sickle cell disease patients before gallbladder surgery did not significantly reduce postoperative events but carried risks of alloimmunization and transfusion reactions. Recent crises may indicate higher risk for these patients.
Area of Science:
- Hematology
- Surgical Oncology
- Transfusion Medicine
Background:
- Preoperative transfusion (PT) is used in sickle cell disease (SCD) to prevent vaso-occlusive events (VOE) post-surgery.
- However, PT carries risks like alloimmunization, leading to transfusion-sparing strategies.
- The benefit-risk of PT before cholecystectomy in SCD requires evaluation.
Purpose of the Study:
- To assess the benefit-risk ratio of preoperative transfusion (PT) before cholecystectomy in adult sickle cell disease (SCD) patients.
- To compare the occurrence of postoperative vaso-occlusive events (VOE) between transfused and non-transfused SCD patients.
- To identify risk factors for postoperative VOE in SCD patients undergoing cholecystectomy.
Main Methods:
- Retrospective study of adult SCD patients who underwent cholecystectomy from 2008-2019.
- Comparison of patient characteristics and outcomes based on preoperative transfusion status.
- Analysis of postoperative vaso-occlusive events (VOE) and transfusion-related complications.
Main Results:
- Of 79 patients, 66% received preoperative transfusion (PT).
- PT patients had more urgent surgeries and recent painful crises (p=0.05).
- Postoperative VOE rates were similar (19.2% vs 29.6%, p=0.45); alloimmunization occurred in 8.5% (2 DHTR).
Conclusions:
- Preoperative transfusion (PT) before cholecystectomy in SCD patients poses risks of alloimmunization and delayed hemolytic transfusion reactions (DHTR).
- Postoperative VOE rates were similar between transfused and non-transfused groups.
- Recent VOCs may suggest higher postoperative VOE risk, warranting careful consideration for preemptive transfusion.
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