Blood transfusion in patients with sickle cell disease requiring laparoscopic cholecystectomy.
BACKGROUND
Surgery in patients with sickle cell disease is associated with high morbidity. To reduce this high morbidity, different preoperative transfusion regimens were introduced. However, blood transfusion is associated with problems. This prospective study aims to establish  the safety of conducting laparoscopic cholecystectomy without transfusion in sickle cell disease patients.


METHODS
Forty patients (16 males and 24 females; mean age 26.6 years) undergoing laparoscopic cholecystectomy for cholelithiasis were divided into 2 matched groups:  Group I "no transfusion" (n=24 patients; 60%) and Group II "transfusion" (n=16; 40%). In Group II, 9 patients (22.5%) received a simple transfusion and 7 (17.5%) a partial exchange transfusion.


RESULTS
Group II patients had significantly higher levels of  Hb-S prior to transfusion. They developed a significantly higher complication rate (25% vs. 0%) and subsequently longer hospital stay (3.9±2 vs. 2.1±1.4). Moreover, there was no significant difference in the complications between the simple transfusion and partial  exchange transfusion subgroups.


CONCLUSIONS
Surgery in SCD patients is safe without a preoperative blood transfusion. Moreover, preoperative blood transfusion is associated with significantly higher postoperative complications and longer hospital stay. Hence, a "no transfusion"  policy is recommended.
Department of Surgery, King Fahad Specialist Hospital, Eastern Province, Saudi Arabia.
Amr Mostafa
AM
Aziz
Abdul-Wahed N
AW
Meshikhes
D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D000755:Anemia, Sickle Cell / Q000150:complications*; D001803:Blood Transfusion; D002648:Child; D017081:Cholecystectomy, Laparoscopic; D002769:Cholelithiasis / Q000601:surgery*; D000075202:Contraindications; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome