Outcomes of a preoperative risk-based transfusion assignment protocol in sickle cell disease patients: a single-center retrospective study from Saudi Arabia

Many patients with sickle cell disease (SCD) need surgical management during their lifetime. The best approach for preoperative transfusion in SCD is still to be determined. In this single-center retrospective study, we included HBSS/HBS-Beta 0 -thalassemia patients younger than 16 years of age who...

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Published in:Pediatric hematology and oncology 2020-10, Vol.37 (7), p.599-609
Main Authors: Albolowi, Naif, Mustafa, Omima, Almohammadi, Mohammed, Al-Hindi, Mohammed Yasir, Jastaniah, Wasil
Format: Article
Language:English
Subjects:
Anemia, Sickle Cell - surgery
Anemia, Sickle Cell - therapy
Blood Transfusion - methods
Child
Child, Preschool
Exchange
Female
Fetal Hemoglobin - analysis
Hemoglobins - analysis
Humans
Male
Postoperative Complications - epidemiology
preoperative
Preoperative Care - methods
Retrospective Studies
Risk Assessment
Risk Factors
Saudi Arabia
sickle cell
surgery
Thalassemia - surgery
Thalassemia - therapy
transfusion
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Summary:Many patients with sickle cell disease (SCD) need surgical management during their lifetime. The best approach for preoperative transfusion in SCD is still to be determined. In this single-center retrospective study, we included HBSS/HBS-Beta 0 -thalassemia patients younger than 16 years of age who underwent surgery between January 2008 and July 2019. Preoperative transfusion assignment (PTA) was based on SCD severity and surgical risk. Patients were assigned to no transfusion, simple transfusion, or exchange transfusion. A total of 284 patients were identified and 66 (23%) underwent 78 procedures. Mean age at the time of procedure was 8 (5-11) years, mean baseline hemoglobin was 8.5 (7.8-9.3) g/dl, and mean hemoglobin F was 18.4 ± 8.2%. SCD severity was low-risk in 57 (73%) and high-risk in 21 (27%) patients. Surgical risk was low-risk in 20 (25.6%) and medium-risk in 58 (74.4%) procedures. PTA was no transfusion in 17 (22%), simple transfusion in 40 (51%), and exchange transfusion in 21 (27%) procedures. Postoperative complications occurred in five (6.4%) of procedures only in the simple transfusion group (three acute chest syndrome, one hemolytic anemia, one pain crisis) undergoing medium-risk surgery. Preoperative risk-based transfusion assignment is feasible. Despite a high baseline hemoglobin level in the no transfusion group, none of the patients developed postoperative complications. It is possible that the high baseline hemoglobin F phenotype was protective and indicates the need to study the risk/benefit of interventions used in this phenotype.
ISSN:0888-0018
1521-0669
DOI:10.1080/08880018.2020.1767738