Preoperative transfusions for patients with sickle cell disease?BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f545 (Published 30 January 2013) Cite this as: BMJ 2013;346:f545
Adults and children with sickle cell disease have a high risk of complications during and after surgery. Preoperative transfusions of red blood cells may reduce the risk, but good evidence is proving elusive. A recent international trial was slow to recruit, then ended early after an unscheduled interim analysis signalled possible harm to controls. At this point, the authors had data on just 70 of the 405 participants specified in the sample size calculation. Controls managed without preoperative transfusion had significantly more complications (39% (13/33) v 15% (5/34); P=0.023) and significantly more serious adverse events (mostly acute chest syndrome) than participants given red blood cell transfusions before surgery.
Most of the participants were children and young adults with haemoglobin SS type disease who were scheduled for medium risk operations. They had a median haemoglobin concentration of 79 g/L at baseline. Three quarters of those assigned preoperative transfusions needed top-ups rather than the partial exchange reserved for participants with concentrations of at least 90 g/L.
Questions remain about how to manage adults and children with other sickle cell types, and about the role of transfusion before low risk surgery, says a linked comment. (doi:10.1016/S0140-6736(12)61995-3). Further trials look unlikely given the difficulties that truncated this one, and evidence obtained through national haemoglobinopathy registries may be the best way forward.
Cite this as: BMJ 2013;346:f545