Preoperative transfusion in sickle cell disease: a survey of practice in England.
OBJECTIVE
To gather data on current preoperative transfusion practice and postoperative complications in sickle cell disease (SCD) as a prelude to a randomised trial.


METHODS
A prospective one year survey of 114 SCD patients undergoing elective surgery in 31 English hospitals was undertaken.


RESULTS
43%, 39% and 23% of patients respectively [corrected] received no transfusion, top-up and exchange transfusion preoperatively. Overall postoperative complication rates were 18%, 26% and 17%, with SCD related complications of 12%, 8% and 0% respectively. 85% of patients with [corrected]HbSC/HbSss(+)thalassaemia and 71% of obstetric and gynaecology patients were not transfused preoperatively, whereas 59% patients undergoing ENT procedures and 83% of hip replacements had top-up and exchange transfusions respectively. Multivariable logistic regression analysis revealed that having moderate/high risk procedures was a predictor of postoperative complications (OR 4.9 (95% CL: 1.3 to 18), P = 0.017) [corrected] while preoperative transfusion was not (OR 1.7, (95% CL: [corrected] 0.5 to 6), P = 0.41).


CONCLUSIONS
The lack of clear benefit of transfusion confirms the need for a randomised controlled trial of transfusion vs. no transfusion in patients with HbSS and HbSss(0)thalassaemia.
Buck
Jackie
J
National Blood Service/Medical Research Council (NBS/MRC) Clinical Studies Unit, Long Road, Cambridge CB2 2PT, UK.
Casbard
Angela
A
Llewelyn
Charlotte
C
Johnson
Tony
T
Davies
Sally
S
Williamson
Lorna
L
D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000517:prevention & control; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003625:Data Collection; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D004739:England; D005078:Exchange Transfusion, Whole Blood / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D016032:Randomized Controlled Trials as Topic