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Previous Volume 333:206-214 July 27, 1995 Number 4 Next

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ABSTRACT

Background Preoperative transfusions are frequently given to prevent perioperative morbidity in patients with sickle cell anemia. There is no consensus, however, on the best regimen of transfusions for this purpose.

Methods We conducted a multicenter study to compare the rates of perioperative complications among patients randomly assigned to receive either an aggressive transfusion regimen designed to decrease the hemoglobin S level to less than 30 percent (group 1) or a conservative regimen designed to increase the hemoglobin level to 10 g per deciliter (group 2).

Results Patients undergoing a total of 604 operations were randomly assigned to group 1 or group 2. The severity of the disease, compliance with the protocol, and the types of operations were similar in the two groups. The preoperative hemoglobin level was 11 g per deciliter in group 1 and 10.6 g per deciliter in group 2. The preoperative value for hemoglobin S was 31 percent in group 1 and 59 percent in group 2. The most frequent operations were cholecystectomies (232), head and neck surgery (156), and orthopedic surgery (72). With the exception of transfusion-related complications, which occurred in 14 percent of the operations in group 1 and in 7 percent of those in group 2, the frequency of serious complications was similar in the two groups (31 percent in group 1 and 35 percent in group 2). The acute chest syndrome developed in 10 percent of both groups and resulted in two deaths in group 1. A history of pulmonary disease and a higher risk associated with surgery were significant predictors of the acute chest syndrome.

Conclusions A conservative transfusion regimen was as effective as an aggressive regimen in preventing perioperative complications in patients with sickle cell anemia, and the conservative approach resulted in only half as many transfusion-associated complications.

Source Information

From the Department of Hematology/Oncology, Children's Hospital Oakland, Oakland, Calif. (E.P.V., L.N., A.N.E.); the Departments of Anesthesia and Pediatrics, University of Washington and Children's Hospital and Medical Center, Seattle (C.M.H.); the Prevention Sciences Group, University of California, San Francisco (D.B.); the Department of Medicine, University of Illinois, Chicago (M.K.); the Department of Pediatrics, University of Miami, Miami (C.P.); the Department of Pediatrics, Medical University of South Carolina, Charleston (M.A.); the Department of Hematology, Children's Hospital, Philadelphia (K.O.-F.); and the Pediatric Hematology Department, University of Mississippi, Jackson (R.V.I.).

Address reprint requests to Dr. Vichinsky at the Department of Hematology/Oncology, Children's Hospital Oakland, 747 52nd St., Oakland, CA 94609.

Full Text of this Article

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Conservative versus Aggressive Transfusion Regimens in Sickle Cell Disease
Buchanan G. R., Rogers Z. R., Apfelroth S., Vichinsky E., Neumayr L., Black D.
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N Engl J Med 1995; 333:1641-1642, Dec 14, 1995. Correspondence

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