[Assessment of the use of transfusion therapy and complications in orthopedic surgery in patients with sickle-cell anemia: retrospective study].
Red blood cells (RBCs) transfusion is a common practice in the treatment or for the prevention of complications of patients with sickle-cell disease. In surgery, pre-operative transfusions are frequently given to prevent peri-operative complications. There is no consensus however on the best regimen of transfusion for this purpose. The transfusion techniques are muliple. In addition, pre-operative transfusion therapy is reported to be largely responsible for an increased morbidity and mortality in patients with sickle cell anemia undergoing surgery. During the period 1990-2000, 16 patients (4 men and 12 women) with a mean age of 37 years and various major sickle cell hemoglobinopathies underwent 32 total hip arthroplasty for femoral head necrosis. Nine patients with sickle-cell trait were included as control group. Twelve of them had haemoglobin SS (HbSS), 2/16 had HbSC, 2/16 had HbS/betathalassemia. Operative transfusion were given in only 12/32 procedures, 4 were performed pre-operatively and 8 intra-operatively. Simple transfusion (mean: 2.5 packed red cells) were administered in all the procedures. The main complications observed in our patients were anemia by hemolysis and haemorrhagic shock, vaso-occlusive crisis and chest syndrome. Anemia requiring transfusions was significatively related to the procedures with pre-operative transfusion. In the light of our result, we would like to propose transfusional protocol--if needed--only intra-operatively.
Ould amar
A K
AK
Etablissement français du sang de la Martinique, hôpital P.-Zobda-Quitman, BP 632, 97261 cedex, Fort-de-France, Martinique. ould.amar.karim@caramail.com <ould.amar.karim@caramail.com>
Delattre
O
O
Godbille
C
C
Béra
O
O
Halbout
P A
PA
Catonné
Y
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D000743:Anemia, Hemolytic / Q000453:epidemiology / Q000209:etiology; D000755:Anemia, Sickle Cell / Q000150:complications / Q000628:therapy*; D019644:Arthroplasty, Replacement, Hip; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology; D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D002648:Child; D017707:Erythrocyte Transfusion; D005260:Female; D005271:Femur Head Necrosis / Q000209:etiology / Q000601:surgery*; D005838:Genotype; D006445:Hemoglobin C Disease / Q000150:complications / Q000235:genetics / Q000628:therapy; D006801:Humans; D007430:Intraoperative Care / Q000706:statistics & numerical data; D007431:Intraoperative Complications / Q000517:prevention & control; D007511:Ischemia / Q000453:epidemiology / Q000209:etiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011300:Preoperative Care / Q000009:adverse effects / Q000706:statistics & numerical data; D011446:Prospective Studies; D012771:Shock, Hemorrhagic / Q000453:epidemiology / Q000209:etiology; D012805:Sickle Cell Trait / Q000150:complications / Q000235:genetics / Q000628:therapy; D017086:beta-Thalassemia / Q000150:complications / Q000235:genetics / Q000628:therapy