title: Prophylactic red blood cell exchange may be beneficial in the management of sickle cell disease in pregnancy.
abstract: BACKGROUND
  Sickle cell disease (SCD) is associated with chronic hemolysis and painful episodes. Pregnancy accelerates sickle cell complications, including prepartum and postpartum vasoocclusive crisis, pulmonary complications, and preeclampsia or eclampsia. Fetal complications include preterm birth and its associated risks, intrauterine growth restriction, and a high rate of perinatal mortality. The purpose of this study was to evaluate pregnancy outcomes in patients with SCD who underwent planned preventive red blood cell exchange (RBCX).
  
  
  METHODS
  We retrospectively evaluated the complications of SCD in 37 pregnant patients. Patients with SCD who had undergone prophylactic RBCX were compared with a control group who had not undergone RBCX during pregnancy.
  
  
  RESULTS
  Forty-three exchange procedures were performed in 24 patients. The control group comprised 13 patients with a mean age of 27.4 ± 3.3 years who had not undergone RBCX during pregnancy. Four of the five patients who developed a vasoocclusive crisis died. There was a significant difference in maternal mortality between the study and control groups (p = 0.011). There was also a significant difference in the incidence of vasoocclusive crisis between the study and control groups. One fetal death occurred in the 20th gestational week in a patient in the control group, although there were no postpartum complications in either the babies or the mothers in the control group.
  
  
  CONCLUSIONS
  This study has demonstrated that prophylactic RBCX during pregnancy is a feasible and safe procedure for prevention of complications. Given the decrease in the risks of transfusion, RBCX warrants further study.
authors: Clinical Unit, Baskent University Adana Adult Bone Marrow Transplantation Center, Ankara, Turkey; Department of Family Medicine, Baskent University Medical Faculty, Ankara, Turkey.
authors: Suheyl
authors: S
authors: Asma
authors: Ilknur
authors: I
authors: Kozanoglu
authors: Ebru
authors: E
authors: Tarım
authors: Cagla
authors: C
authors: Sarıturk
authors: Cigdem
authors: C
authors: Gereklioglu
authors: Aydan
authors: A
authors: Akdeniz
authors: Mutlu
authors: M
authors: Kasar
authors: Nurhilal H
authors: NH
authors: Turgut
authors: Mahmut
authors: M
authors: Yeral
authors: Fatih
authors: F
authors: Kandemir
authors: Can
authors: C
authors: Boga
authors: Hakan
authors: H
authors: Ozdogu
mesh_terms: D056586:Acute Chest Syndrome / Q000209:etiology / Q000401:mortality; D000755:Anemia, Sickle Cell / Q000150:complications / Q000628:therapy*; D001157:Arterial Occlusive Diseases / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D002585:Cesarean Section; D003430:Cross-Sectional Studies; D017707:Erythrocyte Transfusion / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005312:Fetal Blood / Q000737:chemistry; D005313:Fetal Death; D006801:Humans; D007231:Infant, Newborn; D007511:Ischemia / Q000209:etiology / Q000517:prevention & control; D007751:Labor, Induced; D007744:Obstetric Labor Complications / Q000517:prevention & control; D011247:Pregnancy; D011250:Pregnancy Complications, Hematologic / Q000401:mortality / Q000517:prevention & control / Q000628:therapy*; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D055815:Young Adult