title: Perioperative transfusion management in patients with sickle cell anaemia undergoing a total hip arthroplasty. Is there a role of red-cell exchange transfusion? A retrospective study in the CHU of Fort-de-France Martinique.
abstract: OBJECTIVE
  We conducted a retrospective study to examine the optimal regimen of transfusion and whether preoperative transfusion is needed in patients with Sickle cell anaemia (SCA) undergoing a Total hip arthroplasty (THA). Then, we assessed the incidence of perioperative complications rates among patients assigned to different transfusion regimens to propose finally the safety transfusion protocol.
  
  
  BACKGROUND
  Preoperative transfusions are usually given to reduce or prevent perioperative complications to SCA patients undergoing THA. There is no consensus however on the best regimen of transfusion.
  
  
  METHODS
  During the period of 2000 to 2010, 14 patients with SCA (sex-ratio 0.4) with a mean age of 36 years underwent 16 THA (primary or revision). Three groups were differentiated according preoperatively protocol transfusion. Group 1: exchange transfusion (EXT), group 2: simple transfusion (ST), group 3: no transfusion (NT).
  
  
  RESULTS
  Overall, preoperative transfusion was performed in 43.7% of cases and complications rate was 50%. In the group 1 (EXT) including five patients (31%), severe complications occurred in four patients (80%). in the group 2, including two patients (12.5%), no complications were observed. In the group 3, including nine patients (56%), complications occurred in four procedures (44.5%), the half of them were haemolytic complications.
  
  
  CONCLUSIONS
  Our results support the decision to transfuse, ST, preoperatively only if the patient is significantly below their steady-state haemoglobin (Hb) level. Transfusion can be used intraoperatively according Hb level and/or the blood loss volume. Exchange transfusion appeared mostly to be related to postoperative morbidity rates.
authors.affiliation: Établissement de transfusion sanguine-martinique, rue du Coup-de-Main, CS 40511, 97206 Fort-de-France, Martinique. karim.ouldamar@efs.sante.fr
authors.forename: K
authors.initials: K
authors.lastname: Ould Amar
authors.forename: J-L
authors.initials: JL
authors.lastname: Rouvillain
authors.forename: G
authors.initials: G
authors.lastname: Loko
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications / Q000601:surgery / Q000628:therapy*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D017707:Erythrocyte Transfusion / Q000009:adverse effects / Q000379:methods*; D005078:Exchange Transfusion, Whole Blood / Q000379:methods*; D005260:Female; D005602:France; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012189:Retrospective Studies; D055815:Young Adult