预防性红细胞输血治疗状细胞疾病怀孕:增加治疗使用可能会改变结果
Sheinei Alan1, Deva Sharma2,3, Lydia H Pecker4,5
1INOVA Adult Sickle Cell Program, Inova Schar Cancer Institute, Fairfax, Virginia.
Current opinion in hematology
|August 23, 2024
概括
输血治疗显著改善了患有状细胞疾病 (SCD) 的孕妇的结果,降低了产妇和胎儿死亡率. 由于其已证明的好处和低风险,建议更广泛地使用这些输血.
科学领域:
- 血液学 血液学 血液学
- 产科 产科 产科 产科 产科
- 孕产妇和胎儿医学 孕产妇和胎儿医学
背景情况:
- 患有状细胞疾病 (SCD) 个体的怀孕具有巨大的孕产妇和胎儿死亡率和发病率风险.
- 输血疗法是研究最多的干预措施,而氧尿素一般是避免由于产性问题.
- 红细胞输血的获取和利用在高资源和低资源环境之间有很大差异.
研究的目的:
- 审查预防性输血治疗对患有SCD的孕妇的益处和风险.
- 评估输血对SCD怀孕中母亲和胎儿结果的影响.
- 倡导在这个高风险人群中增加慢性输血治疗的使用.
主要方法:
- 随机对照试验和元分析的分析,证明了输血治疗的疗效.
- 对下游益处的证据的审查,包括贫血改善和减少住院治疗.
- 对输血风险的评估,如与免疫接种,以及缓解策略.
主要成果:
- 输血治疗显著减少了孕产妇和胎儿死亡,痛苦的危机,血栓形成和急性呼吸衰竭.
- 潜在的益处包括改善母亲贫血,减少阿片类药物暴露,避免住院相关并发症.
- 同免疫是公认的风险,但存在有效的缓解策略,导致美国血液学会的低风险分类.
结论:
- 慢性输血治疗SCD怀孕是由于其低风险分类和深刻的潜在益处表明.
- 缺乏替代疗法和持续不良的妊娠结果强调需要更广泛地采用输血.
- 实施预防性输血对于改变SCD患者的妊娠结果至关重要.
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