Evidence for Prophylactic Transfusion during Pregnancy for Women with Sickle Cell Disease

The management of pregnant sickle cell patients has been debated. Both prophylactic and emergent transfusion have been used. The authors analyzed prior studies with maternal and neonatal outcomes reported and found there may be clinical benefits to prophylactic transfusions in pregnant patients with sickle cell disease. Abstract The objective of this study was to examine prior studies on maternal and neonatal outcomes with prophylactic compared with emergent blood transfusion in pregnant women with sickle cell disease. A review of the literature was performed. Twenty-one articles were identified and included in the analysis. A generalized linear mixed-effects model was used to analyze the outcomes. Pregnancy outcomes assessed were preeclampsia, pneumonia, pyelonephritis, pain crises, intrauterine growth restriction, neonatal death, perinatal death, and maternal mortality. Women who underwent emergent transfusion were more likely than women who underwent prophylactic transfusion to have the following adverse perinatal outcomes: preterm delivery (adjusted odds ratio [aOR 2.04], 95% confidence interval [CI] 1.14–3.63), pneumonia (aOR 2.98, 95% CI 1.44–6.15), pain crises (aOR 1.67, 95% CI 1.18–2.38), and perinatal death (aOR 1.84, 95% CI 1.06–3.07). Prophylactic transfusion should be reexamined as a potentially beneficial approach to the management of sickle cell disease in pregnancy.