Minor elective surgical procedures using general anesthesia in children with sickle cell anemia without pre-operative blood transfusion.
BACKGROUND
Pre-operative red blood cell (RBC) transfusions are often recommended for patients with sickle cell disease (SCD) who require elective surgery under general anesthesia. However, definitive randomized studies demonstrating the benefit of transfusions in this setting have not been conducted. In particular, the merits of transfusion prior to minor or low-risk surgical procedures in children with SCD have not been demonstrated.


METHODS
We hypothesized that children with sickle cell anemia (Hb SS) who have minor elective surgical procedures develop few complications even without pre-operative transfusion. We accessed our Comprehensive Sickle Cell Program's Database to identify all such procedures performed during a 13-year period. Medical records were reviewed to characterize the surgical procedure, the use of transfusions, and perioperative complications.


RESULTS
Twenty-eight children with Hb SS had a total of 38 minor surgical procedures. No perioperative transfusions were given in 34 of the cases (85%). Five of these 34 surgeries (15%) were associated with minor post-operative complications (fever or transient pain). No post-operative acute chest syndrome was encountered.


CONCLUSIONS
Minor or low-risk elective surgical procedures in children with Hb SS may not routinely require pre-operative transfusion. A randomized clinical trial to compare transfusion with no transfusion for minor surgical procedures is needed.
Fu
Teresa
T
Department of Pediatrics, Division of Hematology-Oncology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9063, USA.
Corrigan
Nicole J
NJ
Quinn
Charles T
CT
Rogers
Zora R
ZR
Buchanan
George R
GR
D000293:Adolescent; D000755:Anemia, Sickle Cell; D000768:Anesthesia, General; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D017558:Elective Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D013511:Minor Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D012189:Retrospective Studies; D012449:Safety