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Published on: March 14, 2017
Preoperative Transfusion in Sickle Cell Disease Children Undergoing Adenotonsillectomy
Sonika Kanotra1, Samuel H Muller2, Jhanvi Kanotra3
1Department of ENT, Government Medical College, Jammu, India.
Insights
For children with sickle cell disease undergoing adenotonsillectomy, an aggressive transfusion regimen is not more effective than a conservative one in preventing post-operative complications. A conservative approach is recommended to minimize transfusion risks.
Area of Science:
- Pediatric Hematology
- Surgical Oncology
- Transfusion Medicine
Background:
- Sickle cell disease (SCD) patients undergoing adenotonsillectomy face risks of post-operative complications.
- Pre-operative transfusion strategies aim to mitigate these risks, with debated efficacy between conservative and aggressive approaches.
Purpose of the Study:
- To systematically review and meta-analyze the efficacy of conservative versus aggressive pre-operative transfusion regimens in pediatric SCD patients undergoing adenotonsillectomy.
- To compare post-operative complications, SCD-related events, and transfusion-related complications between the two regimens.
Main Methods:
- A comprehensive literature search was conducted across PubMed, EMBASE, Cochrane, and Ovid databases.
- Seven articles were selected for systematic review, and two controlled trials were included in the meta-analysis based on predefined criteria.
Main Results:
- No statistically significant difference was found in primary/secondary hemorrhage rates between aggressive and conservative transfusion groups (p=0.089).
- SCD-related complications (vaso-occlusive crisis, acute chest syndrome) also showed no significant difference (p=0.339).
- While not statistically significant, the aggressive transfusion group exhibited a higher rate of transfusion-related complications.
Conclusions:
- Aggressive transfusion regimens (HbS <30%) do not offer superior protection against post-operative complications in pediatric SCD patients undergoing adenotonsillectomy compared to conservative regimens.
- A conservative transfusion strategy is advisable to reduce the overall risk of transfusion-associated complications.
Objective:
To perform a systematic review and meta-analysis comparing two pre-operative transfusion regimens (conservative versus aggressive) in children with sickle cell disease(SCD) undergoing adenotonsillectomy in terms of post-operative complications, complications related to SCD and transfusion related complications.
Data Sources And Review Methods:
A literature review was performed through PubMed, EMBASE, Cochrane, and Ovid databases using the following phrases: (Adenotonsillectomy OR Tonsillectomy) AND (Sickle Cell Disease OR Sickle Cell Trait). Using predetermined inclusion and exclusion criteria, seven articles were selected for systemic review and two control trials were included in meta-analysis.
Results:
Out of a total of 3,146 results, seven articles were selected for review and two controlled trials were included in the meta-analysis. There was no statistically significant difference in the rate of primary and secondary hemorrhage between the aggressive and conservative transfusion regimens (RR = 3.1, CI = 0.84-11.4, p-value = 0.089). The rate of sickle cell disease related complications including vaso-occlusive crisis and acute chest syndrome was also not statistically significant between the two transfusion groups (RR = 1.4, CI = 0.7-2.8, p-value = 0.339). Even though, the transfusion related complications did not reach statistical significance, there was a higher complication rate in the group receiving aggressive blood transfusion.
Conclusion:
In SCD children undergoing adenotonsillectomy, an aggressive transfusion regimen that focuses on reducing the Hemoglobin S ratio to below 30% has not been shown to be more effective in reducing post-operative complications when compared to a conservative transfusion regimen. Therefore, it is reasonable to utilize a conservative transfusion regimen, thereby reducing the transfusion-associated risks.
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