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Elective surgery in children with sickle cell disease without preoperative blood transfusion
1Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063.
Insights
Preoperative red blood cell transfusions may not be necessary for most pediatric sickle cell disease patients undergoing elective surgery. This approach avoids transfusion risks and costs, with complications mainly seen in major surgeries like thoracotomy or laparotomy.
Area of Science:
- Pediatric Hematology
- Anesthesiology
- Surgical Oncology
Background:
- Standard practice recommends red blood cell (RBC) transfusions before surgery for sickle cell disease patients.
- RBC transfusions carry costs, inconvenience, and potential complications.
- Identifying patients who can safely avoid transfusions is clinically important.
Purpose of the Study:
- To evaluate the safety and outcomes of elective surgeries in pediatric sickle cell disease patients who did not receive preoperative RBC transfusions.
- To identify patient subgroups at higher risk for complications without preoperative transfusions.
Main Methods:
- Retrospective review of 54 pediatric patients with sickle cell disease undergoing 66 elective surgical procedures.
- Patients did not receive preoperative RBC transfusions.
- Perioperative outcomes, including complications, were analyzed.
Main Results:
- 86% (57/66) of procedures were performed without any perioperative transfusions.
- No intraoperative complications or postoperative deaths occurred.
- Postoperative complications occurred in 26% (17/66) of procedures, primarily minor and associated with thoracotomy, laparotomy, or tonsillectomy/adenoidectomy (T&A).
- Pulmonary complications were significantly higher in patients undergoing thoracotomy, laparotomy, or T&A.
Conclusions:
- Preoperative RBC transfusions may be safely avoided for children with sickle cell disease undergoing most elective minor surgical procedures.
- Patients undergoing thoracotomy, laparotomy, or T&A represent a higher-risk group for postoperative complications.
- Further randomized studies are warranted to evaluate transfusion strategies in these higher-risk surgical groups.
Abstract:
It is generally recommended that patients with sickle cell disease receive red blood cell (RBC) transfusions before undergoing general anesthesia and surgery. Since RBC transfusions are costly, inconvenient, and may cause serious complications, it might be useful to identify groups of patients for whom they are not absolutely necessary. We report our experience with 54 pediatric patients undergoing 66 elective surgical procedures without preoperative transfusion preparation. All patients were felt to be clinically and hematologically stable in the immediate preoperative period. For the majority of procedures (57/66, 86%) no transfusions were administered at any time during the perioperative course. There were no intraoperative complications or postoperative deaths. Overall, some type of postoperative complication was encountered after 17 procedures (26%). Complications were usually minor and were more likely to occur after procedures involving thoracotomy or laparotomy (10/20, 50%) and tonsillectomy/adenoidectomy (T&A) (5/9, 56%) than other procedures (2/37, 5%; P < .001). Pulmonary complications were especially more prevalent in the group undergoing thoracotomy, laparatomy, or T&A (9/29 v 0/37 for all other procedures, P < .001). We conclude that preoperative transfusions might be avoided in children with sickle cell disease who undergo most minor surgical procedures on an elective basis. Patients undergoing thoracotomy, laparotomy, or T&A are at a relatively higher risk of developing postoperative complications and would comprise ideal groups for evaluation of preoperative transfusion regimens in prospective carefully controlled, randomized studies.