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Marhoon BJ, Marzooq AA, Alasfoor HA, Albalooshi S. Pregnancy Outcomes Among Women With Sickle Cell Disease in Bahrain: A Case-Control Study. Cureus 2024; 16:e64995. [PMID: 39161493 PMCID: PMC11332693 DOI: 10.7759/cureus.64995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2024] [Indexed: 08/21/2024] Open
Abstract
Objectives The study sought to evaluate and compare the maternal and fetal outcomes of pregnancy in women with sickle cell disease (SCD) versus healthy pregnant women in Bahrain. The objective was to update the available data in order to come up with a strategy to implement a multidisciplinary management program, which will enhance pregnancy outcomes for the SCD patient population. Materials and methods This retrospective case-control study was conducted in the Obstetrics and Gynecology Department at Salmaniya Medical Complex (SMC) in Bahrain. The study group consisted of all pregnant women with homozygous SCD (HbSS) who delivered at SMC between January 1, 2019, and December 31, 2021. The control group comprised pregnant women who delivered at SMC during the same period but did not have SCD or trait. Data for the study were collected from the healthcare system records at SMC, specifically the I-Seha electronic medical record system and the labor room registry book. A thorough review and analysis of the data were conducted, encompassing 217 cases of SCD and 200 controls. The variables examined included nationality, age, gravidity, parity, gestational age, reason for admission, antenatal/postnatal complications (such as urinary tract infection, pneumonia, acute chest syndrome, thromboembolism, premature rupture of membranes, hypertension, pre-eclampsia, and intrauterine growth restriction), type of delivery, birth weight, newborn outcome, and postnatal complications. Results Pregnant women with SCD experienced significantly higher rates of antenatal hospitalization compared to controls - 69.6% were admitted at least twice versus only 16.5%. Vaso-occlusive crises were the primary reason for admission in over half of SCD patients, with 22.6% having one episode, 11.1% having two, and 20.3% having more than two during pregnancy. Low hemoglobin levels also necessitated admission in 11.1% of SCD women, while no controls required hospitalization for this. The burden of maternal morbidity was substantially greater in the SCD group, with only 20.3% free of complications versus 94% in controls. SCD women had elevated rates of blood transfusions, acute chest syndrome, and urinary tract infections. Adverse pregnancy outcomes were also more common, including higher risks of preterm birth, low birth weight, and intrauterine growth restriction. Despite these increased maternal and fetal risks, there was no significant difference in the incidence of hypertensive disorders between groups. Interestingly, our data showed a significantly lower incidence of gestational diabetes in the SCD group compared to controls (8.3% vs. 18%). Tragically, one maternal death occurred in the SCD group, although the overall maternal mortality did not differ significantly. Conclusion SCD poses substantial risks for mother and fetus. Careful monitoring with a multidisciplinary team and patient education are crucial. Early detection can reduce morbidity and mortality. Further research is needed on interventions to improve outcomes.
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Affiliation(s)
- Batool J Marhoon
- Obstetrics and Gynecology, Salmaniya Medical Complex, Manama, BHR
| | - Aalaa A Marzooq
- Obstetrics and Gynecology, Salmaniya Medical Complex, Manama, BHR
| | - Heba A Alasfoor
- Obstetrics and Gynecology, Salmaniya Medical Complex, Manama, BHR
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2
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Shegekar T, Pajai S. A Comprehensive Review of Pregnancy in Sickle Cell Disease. Cureus 2023; 15:e41165. [PMID: 37525766 PMCID: PMC10387184 DOI: 10.7759/cureus.41165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 06/29/2023] [Indexed: 08/02/2023] Open
Abstract
Sickle cell hemoglobinopathies encompass a range of qualitative and quantitative hemoglobin disorders that are inherited genetically. This group of disorders includes sickle cell beta thalassemia, sickle cell trait, and sickle cell disease (SCD). Globally, SCD is the most common disorder. Even epidemiological data suggests the majority of diseases, as well as traits, are concentrated in Sub-Saharan Africa, North-East Africa, the Middle East, and India. The physiological changes in pregnancy predispose to an increased risk of catastrophic events like a vaso-occlusive crisis, thromboembolic events, and their related sequelae, leading eventually to villous infarction, necrosis, and fibrosis leading to compromising uteroplacental circulation. Conversely, the mother may exhibit exacerbated symptoms of gestational hypertension, placental abruption, preterm labor, and venous thromboembolism. Although this disease is manageable, it has the potential to adversely impact maternal and child health on a national level. The chances of severe complications in the pregnant state affecting both mother and fetus attract due attention of health services towards redefining and researching this disease and its management frequently. The literature review on the following situation advocates the general treatment to be observed under the headings of preconceptual care, strengthened antenatal care, strict intranatal care, and compliant post-natal care. Preconceptually, genetic screening of couples, with education on the adverse effects of the disease, comes as the first line of management. Newer facilities like preimplantation genetic diagnosis and celocentesis may even allow for early diagnosis as well as help patients who do not wish to terminate the pregnancy by selective transfer of unaffected embryos. This may be combined with an extensive evaluation of the psychosocial aspect and socioeconomic status of couples who administer vaccines as prophylaxis for preventable diseases. Strengthening antenatal care is associated with routine blood investigations for every registered antenatal patient with adequate awareness about the conditions that precipitate the crisis. All patients should be prophylactically treated with appropriate doses of aspirin, iron, folic acid, and multivitamins. Radiological examinations by ultrasonography may be used to monitor placenta previa, abruption, or preterm labor. Later in pregnancy, it should be recommended to perform biophysical profiling and assessment of umbilical artery flow. Intranatal care deals with strict-term institutional delivery of all sickle cell-diseased mothers with a preference for vaginal delivery. Post-natal care requires a precise assessment of blood loss during labor to initiate transfusion therapy as soon as needed. Exclusive breastfeeding, with the importance of early initiation of it, must be emphasized. Screening of neonates as quickly as possible must be done for hemoglobinopathies. Through this review, authors are trying to make aware of the complications that can be faced during pregnancy in SCD patients, its prevention, and its treatment according to various new guidelines and research available.
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Affiliation(s)
- Tejas Shegekar
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Sandhya Pajai
- Obstetrics and Gynecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
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Figueira CO, Surita FG, Fertrin K, Nobrega GDM, Costa ML. Main Complications during Pregnancy and Recommendations for Adequate Antenatal Care in Sickle Cell Disease: A Literature Review. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRICIA : REVISTA DA FEDERACAO BRASILEIRA DAS SOCIEDADES DE GINECOLOGIA E OBSTETRICIA 2022; 44:593-601. [PMID: 35139577 PMCID: PMC9948053 DOI: 10.1055/s-0042-1742314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Sickle cell disease (SCD) is the most common monogenic disease worldwide, with a variable prevalence in each continent. A single nucleotide substitution leads to an amino-acid change in the β-globin chain, altering the normal structure ofhemoglobin, which is then called hemoglobin S inherited in homozygosity (HbSS) or double heterozygosity (HbSC, HbSβ), and leads to chronic hemolysis, vaso-occlusion, inflammation, and endothelium activation. Pregnant women with SCD are at a higher risk of developing maternal and perinatal complications. We performed a narrative review of the literature considering SCD and pregnancy, the main clinical and obstetrical complications, the specific antenatal care, and the follow-up for maternal and fetal surveillance. Pregnant women with SCD are at a higher risk of developing clinical and obstetric complications such as pain episodes, pulmonary complications, infections, thromboembolic events, preeclampsia, and maternal death. Their newborns are also at an increased risk of developing neonatal complications: fetal growth restriction, preterm birth, stillbirth. Severe complications can occur in patients of any genotype. We concluded that SCD is a high-risk condition that increases maternal and perinatal morbidity and mortality. A multidisciplinary approach during pregnancy and the postpartum period is key to adequately diagnose and treat complications.
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Affiliation(s)
| | | | - Kleber Fertrin
- Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington, United States
| | | | - Maria Laura Costa
- Department of Obstetrics and Gynecology, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Whittington JR, Magann EF, Ounpraseuth ST, Chang JN, Whitcombe DD, Morrison JC. Evidence for Prophylactic Transfusion during Pregnancy for Women with Sickle Cell Disease. South Med J 2021; 114:231-236. [PMID: 33787937 DOI: 10.14423/smj.0000000000001233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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.
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Affiliation(s)
- Julie R Whittington
- From the Departments of Obstetrics and Gynecology and Biostatistics, University of Arkansas for the Medical Sciences, Little Rock, and the Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson
| | - Everett F Magann
- From the Departments of Obstetrics and Gynecology and Biostatistics, University of Arkansas for the Medical Sciences, Little Rock, and the Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson
| | - Songthip T Ounpraseuth
- From the Departments of Obstetrics and Gynecology and Biostatistics, University of Arkansas for the Medical Sciences, Little Rock, and the Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson
| | - Jon N Chang
- From the Departments of Obstetrics and Gynecology and Biostatistics, University of Arkansas for the Medical Sciences, Little Rock, and the Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson
| | - Dayna D Whitcombe
- From the Departments of Obstetrics and Gynecology and Biostatistics, University of Arkansas for the Medical Sciences, Little Rock, and the Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson
| | - John C Morrison
- From the Departments of Obstetrics and Gynecology and Biostatistics, University of Arkansas for the Medical Sciences, Little Rock, and the Department of Obstetrics and Gynecology, University of Mississippi Medical Center, Jackson
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Singh Y, Chabra A, Venkateswaran V, Trikha A. Sickle cell disease in pregnancy and anaesthetic implications: A narrative review. JOURNAL OF OBSTETRIC ANAESTHESIA AND CRITICAL CARE 2021. [DOI: 10.4103/joacc.joacc_76_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Montironi R, Cupaiolo R, Kadji C, Badr DA, Deleers M, Charles V, Vanderhulst J, El Kenz H, Jani JC. Management of sickle cell disease during pregnancy: experience in a third-level hospital and future recommendations. J Matern Fetal Neonatal Med 2020; 35:2345-2354. [PMID: 32627603 DOI: 10.1080/14767058.2020.1786054] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: To describe the outcomes of sickle-cell disease in pregnancy according to the different treatments adopted before and during pregnancy and to propose a systematic approach to treat sickle-cell disease (SCD) during pregnancy.Methods: A retrospective descriptive study compared pregnancy outcomes among women with SCD who stopped hydroxyurea (HU) once pregnant (Group 1), were never treated before and during pregnancy (Group 2) or were treated by HU before conception who received prophylactic transfusion during pregnancy (Group 3). For each group we recorded the population's characteristics and the transfusion-related, obstetrical, perinatal and SCD complications.Results: We found 11 patients for group 1 (9/11 with at least 3 painful crises during the 12 months before conception), 4 for group 2 (3/4 with no sickle-cell complications during the year before pregnancy) and 2 for group 3 (one with previous multiorgan failure (MOF), one with previous stroke). No transfusion-related complication occurred. Group 1 and 2 developed SCD complications and a high number of acute transfusions and hospital admissions. Group 3 showed none of these complications, but one patient developed preeclampsia and preterm birth. Several obstetrical and perinatal complications occurred in group 1.Conclusion: Not treating sickle-cell during pregnancy increases maternal and perinatal morbidity, even in mildly affected women. All sickle-cell pregnancies should be treated, according to the treatment adopted before but also to patient's SCD-history. We propose chronic transfusion to women with previous stroke or MOF or already under transfusion program, and HU for severely and mildly affected patients, respectively from the second and third trimesters. Additional prospective studies are needed to validate the results of the proposed protocol.
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Affiliation(s)
- Ramona Montironi
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Roberto Cupaiolo
- Department of Blood Transfusion, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Caroline Kadji
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Dominique A Badr
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Marie Deleers
- Department of Blood Transfusion, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Valérie Charles
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Julien Vanderhulst
- Department of Internal Medicine, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Hanane El Kenz
- Department of Blood Transfusion, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Jacques C Jani
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Chou ST, Alsawas M, Fasano RM, Field JJ, Hendrickson JE, Howard J, Kameka M, Kwiatkowski JL, Pirenne F, Shi PA, Stowell SR, Thein SL, Westhoff CM, Wong TE, Akl EA. American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Blood Adv 2020; 4:327-355. [PMID: 31985807 PMCID: PMC6988392 DOI: 10.1182/bloodadvances.2019001143] [Citation(s) in RCA: 225] [Impact Index Per Article: 56.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/20/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Red cell transfusions remain a mainstay of therapy for patients with sickle cell disease (SCD), but pose significant clinical challenges. Guidance for specific indications and administration of transfusion, as well as screening, prevention, and management of alloimmunization, delayed hemolytic transfusion reactions (DHTRs), and iron overload may improve outcomes. OBJECTIVE Our objective was to develop evidence-based guidelines to support patients, clinicians, and other healthcare professionals in their decisions about transfusion support for SCD and the management of transfusion-related complications. METHODS The American Society of Hematology formed a multidisciplinary panel that was balanced to minimize bias from conflicts of interest and that included a patient representative. The panel prioritized clinical questions and outcomes. The Mayo Clinic Evidence-Based Practice Research Program supported the guideline development process. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to form recommendations, which were subject to public comment. RESULTS The panel developed 10 recommendations focused on red cell antigen typing and matching, indications, and mode of administration (simple vs red cell exchange), as well as screening, prevention, and management of alloimmunization, DHTRs, and iron overload. CONCLUSIONS The majority of panel recommendations were conditional due to the paucity of direct, high-certainty evidence for outcomes of interest. Research priorities were identified, including prospective studies to understand the role of serologic vs genotypic red cell matching, the mechanism of HTRs resulting from specific alloantigens to inform therapy, the role and timing of regular transfusions during pregnancy for women, and the optimal treatment of transfusional iron overload in SCD.
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Affiliation(s)
- Stella T Chou
- Division of Hematology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mouaz Alsawas
- Mayo Clinic Evidence-Based Practice Research Program, Mayo Clinic, Rochester, MN
| | - Ross M Fasano
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Joshua J Field
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine and
- Department of Pediatrics, Yale University School of Medicine, New Haven, CT
| | - Jo Howard
- Department of Haematological Medicine, King's College London, London, United Kingdom
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Michelle Kameka
- Nicole Wertheim College of Nursing and Health Sciences, Florida International University, Miami, FL
| | - Janet L Kwiatkowski
- Division of Hematology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - France Pirenne
- INSERM-U955, Laboratory of Excellence, French Blood Establishment, Créteil, France
| | | | - Sean R Stowell
- Center for Transfusion and Cellular Therapy, Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA
| | - Swee Lay Thein
- Sickle Cell Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Connie M Westhoff
- Laboratory of Immunohematology and Genomics, New York Blood Center, New York, NY
| | - Trisha E Wong
- Division of Hematology/Oncology, Department of Pediatrics, Oregon Health and Science University, Portland, OR; and
| | - Elie A Akl
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
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Aboagye S, Torto M, Asah-Opoku K, Nuamah MA, Oppong SA, Samba A. Sickle Cell Education: A Survey of Antenatal Healthcare Givers. Am J Trop Med Hyg 2019; 101:684-688. [PMID: 31333164 PMCID: PMC6726940 DOI: 10.4269/ajtmh.18-0408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 06/02/2019] [Indexed: 11/07/2022] Open
Abstract
To explore the educational practices of antenatal care providers toward pregnant women with sickle cell disease (SCD) and sickle cell trait (SCT), a survey was conducted among selected doctors and midwives who provide antenatal care at the outpatient clinic of the Obstetric Department of the Korle-Bu Teaching Hospital, Accra, Ghana. The study explored their practices of screening for and patient education about SCD and SCT. Of the 102 respondents, 100(98%) stated that they were knowledgeable in the medical and genetic aspects of the disease. Regarding screening, 82(80.4%) reported mandatory screening for SCD, 9(8.8%) did not offer screening as routine, and 11(10.8%) gave patients the choice. The majority (93.1%) always informed patients when the test was positive but health-care providers less than six years experience were less likely to communicate SCT status to patients without the trait (odds ratio [OR] = 0.41, 95% CI [0.18-0.93]). Nurses/midwives were less likely to tell patients their carrier status (OR = 0.25, 95% CI [0.10-0.59]). There was also variation in referral practices for genetic counseling, with 26.5% always referring, 28.4% never doing so, and 45.1% only referring if the patient had questions. This may affect patients' awareness of this genetic condition. Therefore, continuous medical education on SCD/SCT and standardization of counseling may help inform couples' family planning choices and reduce the burden of the disease on future generation and health care.
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Affiliation(s)
- Serwah Aboagye
- Cardiff School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Wales, United Kingdom
| | - Magdalene Torto
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Kwaku Asah-Opoku
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Mercy Anna Nuamah
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Samuel Antwi Oppong
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ali Samba
- Department of Obstetrics and Gynecology, Korle Bu Teaching Hospital, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
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9
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Chang JN, Magann EF, Novotny SA, Cooley CE, Gauss CH, Parrish MR, Morrison JC. Maternal/Perinatal Outcome in Women with Sickle Cell Disease: A Comparison of Two Time Periods. South Med J 2018; 111:742-745. [DOI: 10.14423/smj.0000000000000900] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Cardosa D, Ridout A, Nanda S, Howard J, Robinson SE, Oteng-Ntim E. Maternal sickle cell disease and twin pregnancy: a case series and review of the literature. Hematology 2018; 24:148-158. [DOI: 10.1080/10245332.2018.1535534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- Deyna Cardosa
- Department of Haematology, Southwark Wing, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Alexandra Ridout
- Women’s Health, St Thomas’ Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Surabhi Nanda
- Liverpool Women’s NHS Foundation Trust, University of Liverpool, Liverpool, UK
| | - Jo Howard
- Department of Haematology, Southwark Wing, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Susan E. Robinson
- Department of Haematology, Southwark Wing, Guy’s Hospital, Guy’s and St. Thomas’ NHS Foundation Trust, London, UK
| | - Eugene Oteng-Ntim
- Women’s Health, St. Thomas’ Hospital, King's Health Partners, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
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Aroke D, Tchouakam DN, Kadia BM, Choukem SP. Iron supplementation in pregnant sicklers: an opinion. BMC Pregnancy Childbirth 2018; 18:256. [PMID: 29929479 PMCID: PMC6013963 DOI: 10.1186/s12884-018-1894-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 06/12/2018] [Indexed: 01/28/2023] Open
Abstract
Morbidity associated with iron deficiency anaemia in pregnancy is increased in the presence of sickle cell anaemia. Iron supplementation in pregnant sicklers in a bid to resolve iron deficiency anaemia is recommended only after laboratory confirmation of iron deficiency. However, the greatest burden of sickle cell disease is seen in low and middle income countries where equipment for measuring body iron indices are unavailable.Sickle cell anaemia is an inherited disorder of haemoglobin synthesis characterized by life-long severe haemolytic anaemia. People with sickle cell anaemia are at increased risk of iron overload from haemolysis and recurrent multiple transfusions. Iron overload a complication of sickle cell disease, which is more often in thalassemias, is typically given undue fear in sickle cell anaemia especially in patients with no recent transfusion history. About a third of the haemolysis in sickle cell anaemia is intravascular, and the resulting excess iron is lost in urine. This may lead to a negative iron balance and iron deficiency. There is little evidence of iron overload in pregnant sicklers, and iron deficiency may be more common than suspected. Even when iron overload does occur in a condition called siderosis, the deposited iron is irreversible and thus cannot be reused by the body in case of susceptibility to iron deficiency. More so, in pregnancy there is an increase in the body's iron requirement by about 1000-1200 mg which is usually not met by dietary intake. Iron supplements could be given to pregnant sicklers, caution should however be taken in patients with history of recurrent transfusion.Anaemia is a common and feared complication in pregnancy. The co-existence of iron deficiency anaemia and sickle cell anaemia worsens prognosis of pregnancy. Iron overload a possible complication of sickle cell anaemia is related to multiple transfusions. The urinary losses from intravascular haemolysis and increased dietary requirement in pregnancy predispose even pregnant sicklers to iron deficiency anaemia. Iron supplements should thus conveniently be given to pregnant sicklers with no history of recurrent transfusions.
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Affiliation(s)
- Desmond Aroke
- Fontem District Hospital, Fontem, Cameroon
- Health and Human Development (2HD) Research Group, Douala, Cameroon
| | - Diego Nitcheu Tchouakam
- Health and Human Development (2HD) Research Group, Douala, Cameroon
- Roua District Hospital, Roua, Cameroon
| | | | - Simeon Pierre Choukem
- Health and Human Development (2HD) Research Group, Douala, Cameroon
- Faculty of Health Sciences, University of Buea, Buea, Cameroon
- Department of Internal Medicine, Douala General Hospital, Douala, Cameroon
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Dschang, Cameroon
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12
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Current Evidence for the Use of Prophylactic Transfusion to Treat Sickle Cell Disease During Pregnancy. Transfus Med Rev 2018; 32:220-224. [PMID: 30029813 DOI: 10.1016/j.tmrv.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/25/2018] [Accepted: 06/02/2018] [Indexed: 11/22/2022]
Abstract
The role of prophylactic transfusion therapy for the treatment of sickle cell disease during pregnancy is unclear. An analysis of the existing literature shows a limited number of publications that address this issue and specifically compare clinical outcomes in this population based on a treatment strategy of prophylactic transfusion versus transfusion only for clinical indications (on-demand transfusion). The existing studies show a wide variation in study design and outcomes measured. The results of this analysis suggest that there are insufficient data to support a clinically significant difference in morbidity and mortality outcomes based on transfusion strategy. Additional prospective clinical studies need to be performed to adequately address the risks and benefits of prophylactic transfusion and guide clinical decision making.
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13
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Okusanya BO, Oladapo OT. Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy. Cochrane Database Syst Rev 2016; 12:CD010378. [PMID: 28005272 PMCID: PMC6463955 DOI: 10.1002/14651858.cd010378.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pregnant women with sickle cell disease (HbSS, HbSC and HbSβThal) may require blood transfusion to prevent severe anaemia or to manage potential medical complications. Preventive blood transfusion in the absence of complications starting from the early weeks of pregnancy or blood transfusion only for medical or obstetric indications have been used as management policies. There is currently no consensus on the blood transfusion policy that guarantees optimal clinical benefits with minimal risks for such women and their babies. This is an update of a Cochrane review that was published in 2013. OBJECTIVES To assess the benefits and harms of a policy of prophylactic versus selective blood transfusion in pregnant women with sickle cell disease. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 May 2016) and reference lists of retrieved studies. We did not apply any language or date restrictions. SELECTION CRITERIA Randomised controlled trials evaluating the effects of prophylactic versus selective (emergency) blood transfusion in pregnant women with sickle cell disease (SCD). Quasi-randomised trials and trials using a cluster-randomised design were eligible for inclusion but none were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two review authors independently assessed the quality of the evidence using the GRADE approach. MAIN RESULTS Out of six relevant reports identified by the search strategy, one trial involving 72 women with sickle cell anaemia (HbSS) met our inclusion criteria. The trial was at unclear risk of bias. Overall, there were few events for most of the reported outcomes and the results were generally imprecise. The included trial reported no maternal mortality occurring in women who received either prophylactic or selective blood transfusion. Very low-quality evidence indicated no clear differences in maternal mortality, perinatal mortality (risk ratio (RR) 2.85, 95% confidence interval (CI) 0.61 to 13.22; very low-quality evidence) or markers of severe maternal morbidity (pulmonary embolism (no events); congestive cardiac failure (RR 1.00, 95% CI 0.07 to 15.38; very low-quality evidence); acute chest syndrome (RR 0.67, 95% CI 0.12 to 3.75)) between the treatment groups (prophylactic blood transfusion versus selective blood transfusion). Low-quality evidence indicated that prophylactic blood transfusion reduced the risk of pain crisis compared with selective blood transfusion (RR 0.28, 95% CI 0.12 to 0.67, one trial, 72 women; low-quality evidence), and no differences in the occurrence of acute splenic sequestration (RR 0.33, 95% CI 0.01 to 7.92; low-quality evidence), haemolytic crises (RR 0.33, 95% CI 0.04 to 3.06) or delayed blood transfusion reaction (RR 2.00, 95% CI 0.54 to 7.39; very low-quality evidence) between the comparison groups.Other relevant maternal outcomes pre-specified for this review such as cumulative duration of hospital stay, postpartum haemorrhage and iron overload, and infant outcomes, admission to neonatal intensive care unit (NICU) and haemolytic disease of the newborn, were not reported by the trial. AUTHORS' CONCLUSIONS Evidence from one small trial of very low quality suggests that prophylactic blood transfusion to pregnant women with sickle cell anaemia (HbSS) confers no clear clinical benefits when compared with selective transfusion. Currently, there is no evidence from randomised or quasi-randomised trials to provide reliable advice on the optimal blood transfusion policy for women with other variants of sickle cell disease (i.e. HbSC and HbSβThal). The available data and quality of evidence on this subject are insufficient to advocate for a change in existing clinical practice and policy.
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Affiliation(s)
- Babasola O Okusanya
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi‐ArabaExperimental and Maternal Medicine Unit, Department of Obstetrics and GynaecologyLagosNigeria
| | - Olufemi T Oladapo
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and ResearchAvenue Appia 20GenevaSwitzerlandCH‐1211
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Asma S, Kozanoglu I, Tarım E, Sarıturk C, Gereklioglu C, Akdeniz A, Kasar M, Turgut NH, Yeral M, Kandemir F, Boga C, Ozdogu H. Prophylactic red blood cell exchange may be beneficial in the management of sickle cell disease in pregnancy. Transfusion 2014; 55:36-44. [DOI: 10.1111/trf.12780] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Revised: 05/28/2014] [Accepted: 05/28/2014] [Indexed: 02/06/2023]
Affiliation(s)
- Suheyl Asma
- Clinical Unit; Baskent University Adana Adult Bone Marrow Transplantation Center; Ankara Turkey
- Department of Family Medicine; Baskent University Medical Faculty; Ankara Turkey
| | - Ilknur Kozanoglu
- Cell Collecting and Therapeutic Apheresis Unit; Baskent University Adana Adult Bone Marrow Transplantation Center; Ankara Turkey
- Department of Physiology; Baskent University Medical Faculty; Ankara Turkey
| | - Ebru Tarım
- Department of Obstetrics and Gynecology; Baskent University Medical Faculty; Ankara Turkey
| | - Cagla Sarıturk
- Biostatistics Specialist; Baskent University Adana Hospital; Ankara Turkey
| | - Cigdem Gereklioglu
- Clinical Unit; Baskent University Adana Adult Bone Marrow Transplantation Center; Ankara Turkey
- Department of Family Medicine; Baskent University Medical Faculty; Ankara Turkey
| | - Aydan Akdeniz
- Department of Hematology; Mersin University Medical Faculty; Mersin Turkey
| | - Mutlu Kasar
- Clinical Unit; Baskent University Adana Adult Bone Marrow Transplantation Center; Ankara Turkey
| | - Nurhilal H. Turgut
- Clinical Unit; Baskent University Adana Adult Bone Marrow Transplantation Center; Ankara Turkey
| | - Mahmut Yeral
- Clinical Unit; Baskent University Adana Adult Bone Marrow Transplantation Center; Ankara Turkey
| | - Fatih Kandemir
- Department of Family Medicine; Baskent University Medical Faculty; Ankara Turkey
| | - Can Boga
- Clinical Unit; Baskent University Adana Adult Bone Marrow Transplantation Center; Ankara Turkey
| | - Hakan Ozdogu
- Clinical Unit; Baskent University Adana Adult Bone Marrow Transplantation Center; Ankara Turkey
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Silva-Pinto AC, de Oliveira Domingues Ladeira S, Brunetta DM, De Santis GC, de Lucena Angulo I, Covas DT. Sickle cell disease and pregnancy: analysis of 34 patients followed at the Regional Blood Center of Ribeirão Preto, Brazil. Rev Bras Hematol Hemoter 2014; 36:329-33. [PMID: 25305164 PMCID: PMC4318372 DOI: 10.1016/j.bjhh.2014.07.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 06/09/2014] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The objective of this study was to verify the evolution of pregnancies in sickle cell patients followed at one institution over a period of 12 years (January 2000 to June 2012). METHODS The study evaluated 34 pregnant women with sickle cell disease with a mean age of 23.9±5.3 years. The incidence of obstetric complications, non-obstetric complications linked to sickle cell disease and complications in the newborn were analyzed. RESULTS A total of 26% of the cases reported previous miscarriages, 20% had preterm labor, 10% had pre-eclampsia, and 5% had gestational diabetes. Forty-one percent of the deliveries were cesarean sections and 29% of patients required blood transfusions. In respect to sickle cell disease, 62% of patients had vaso-occlusive crises, 29% had acute chest syndrome, 23% had urinary tract infection, 15% had impaired cardiac function and 6% developed pulmonary hypertension. Only one patient died in the postnatal period due to acute chest syndrome. The mean gestational age was 37.8±2.63 weeks, and mean newborn weight was 2.809±643.8g. There were seven fetal losses, including three stillbirths and four miscarriages. The impact of transfusion therapy on the incidence of maternal-fetal complications during pregnancy was evaluated. CONCLUSIONS Pregnancy in sickle cell patients is still associated with complications. Although no statistical difference was observed between transfused and non-transfused women, there were no deaths (fetal or maternal) in transfused patients whereas one maternal death and three stillbirths occurred in non-transfused women. A larger study of sickle cell pregnant women will be necessary to elucidate the actual role of transfusion during pregnancy in sickle cell disease.
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Affiliation(s)
- Ana Cristina Silva-Pinto
- Hemocentro de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil.
| | | | - Denise Menezes Brunetta
- Hemocentro de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Gil Cunha De Santis
- Hemocentro de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Ivan de Lucena Angulo
- Hemocentro de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Dimas Tadeu Covas
- Hemocentro de Ribeirão Preto, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil; Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo (USP), Ribeirão Preto, SP, Brazil
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Costa VMF, Viana MB, Aguiar RALP. Pregnancy in patients with sickle cell disease: maternal and perinatal outcomes. J Matern Fetal Neonatal Med 2014; 28:685-9. [PMID: 24866352 DOI: 10.3109/14767058.2014.928855] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To compare obstetrical, hematological and neonatal outcomes of pregnant women with or without sickle cell disease (SCD). METHODS A prospective study of 60 pregnancies of 58 women with SCD (29 SCD-SS and 29 SCD-SC) compared with 192 pregnancies in 187 healthy pregnant women was carried out from January 2009 to August 2011. RESULTS Compared to controls, the SCD group had higher rate of preterm delivery (p < 0.001, OR = 4.96, 95% CI 2.57-9.59), higher cesarean rate (p < 0.001, OR = 5.00, CI 2.65-9.45), more frequent deep vein thrombosis (p = 0.003), and urinary infection (p = 0.001, OR = 3.31, CI 1.63-6.73), higher prevalence of small for gestational age babies (p = 0.019, OR = 2.66, CI 1.15-6.17), and more frequent baby admissions to progressive care unit (p < 0.001, OR = 4.89, CI 2.26-10.6). Maternal death rate was also higher among women with SCD (p = 0.056). All adverse events were more frequent in the SS subgroup. Babies from the SS subgroup had the lowest weight at birth (2080 g) compared to SC (2737 g; p < 0.001) and controls (3035 g). A multivariate analysis confirmed painful episodes and SS genotype as factors contributing to preterm delivery. CONCLUSION SCD pregnant women - especially those in the SS subgroup - are more prone to experience perinatal and maternal complications in comparison with pregnant women without SCD.
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Okusanya BO, Oladapo OT. Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy. Cochrane Database Syst Rev 2013:CD010378. [PMID: 24297507 DOI: 10.1002/14651858.cd010378.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pregnant women with sickle cell disease (HbSS, HbSC and HbSβThal) may require blood transfusion to prevent severe anaemia or to manage potential medical complications. Preventive blood transfusion in the absence of complications starting from the early weeks of pregnancy or blood transfusion only for medical or obstetric indications have been used as management policies. There is currently no consensus on the blood transfusion policy that guarantees optimal clinical benefits with minimal risks for such women and their babies. The present review replaces and updates a Cochrane review that was withdrawn in 2006. OBJECTIVES To assess the benefits and harms of a policy of prophylactic versus selective blood transfusion in pregnant women with sickle cell disease. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2013) and reference lists of retrieved studies. We did not apply any language restrictions. SELECTION CRITERIA Randomised and quasi-randomised trials evaluating the effects of prophylactic versus selective (emergency) blood transfusion in pregnant women with sickle cell disease. Trials were considered for inclusion whether the unit of randomisation was at individual or cluster level, however, no cluster-randomised trials were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and assessed trial quality. Two review authors independently extracted data. Data were checked for accuracy. MAIN RESULTS Out of six relevant reports identified by the search strategy, two trials involving 98 women with sickle cell anaemia (HbSS) met our inclusion criteria. The two trials were at moderate risk of bias. Overall, there were few events for most of the reported outcomes and the results were generally imprecise. One trial (involving 72 women) reported no maternal mortality occurring in women who received either prophylactic or selective blood transfusion. The same trial (involving 72 women) indicated no clear differences in maternal mortality, perinatal mortality (risk ratio (RR) 2.85, 95% confidence interval (CI) 0.61 to 13.22) or markers of severe maternal morbidity [pulmonary embolism (no events); congestive cardiac failure (RR 1.00, 95% CI 0.07 to 15.38); acute chest syndrome (RR 0.67, 95% CI 0.12 to 3.75)] between the treatment groups (prophylactic blood transfusion versus selective blood transfusion). Prophylactic blood transfusion reduced the risk of pain crisis compared with selective blood transfusion (RR 0.42, 95% CI 0.17 to 0.99, two trials, 98 women); however, the margin of uncertainty around the effect estimate ranged from very small to substantial reduction. One trial (involving 72 women) indicated no differences in the occurrence of acute splenic sequestration (RR 0.33, 95% CI 0.01 to 7.92) and haemolytic crises (RR 0.33, 95% CI 0.04 to 3.06) and delayed blood transfusion reaction (RR 2.00, 95% CI 0.54 to 7.39) between the comparison groups. AUTHORS' CONCLUSIONS Evidence from two small trials of low quality suggests that prophylactic blood transfusion to pregnant women with sickle cell anaemia (HbSS) confers no clear clinical benefits when compared with selective transfusion. Currently, there is no evidence from randomised or quasi-randomised trials to provide reliable advice on the optimal blood transfusion policy for women with other variants of sickle cell disease (i.e. HbSC and HbSβThal). The available data and quality of evidence on this subject are insufficient to advocate for a change in existing clinical practice and policy.
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Affiliation(s)
- Babasola O Okusanya
- Experimental and Maternal Medicine Unit, Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria
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Wilson NO, Ceesay FK, Hibbert JM, Driss A, Obed SA, Adjei AA, Gyasi RK, Anderson WA, Stiles JK. Pregnancy outcomes among patients with sickle cell disease at Korle-Bu Teaching Hospital, Accra, Ghana: retrospective cohort study. Am J Trop Med Hyg 2012; 86:936-42. [PMID: 22665597 DOI: 10.4269/ajtmh.2012.11-0625] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Pregnancy in sickle cell disease (SCD) patients is associated with increased risk of maternal and fetal mortality. This study determines pregnancy outcomes among women with SCD delivering at Korle-Bu Teaching Hospital, Accra, Ghana. Nine hundred sixty (960) medical records of pregnant women (131 HbSS, 112 HbSC, and 717 comparison group) from 2007 to 2008 were reviewed. The HbSS women were at increased risk of eclampsia (adjusted odds ratio [AOR] = 10.56, 95% confidence interval [CI] = 3.60-30.96, P < 0.001), intrauterine growth restriction (AOR = 4.00, 95% CI = 1.38-11.64, P = 0.011), and placenta previa (AOR = 22.03, 95% CI = 9.87-49.14, P < 0.001) compared with the comparison group. The HbSC women had increased risk for intrauterine fetal death (AOR = 3.38, 95% CI = 1.15-9.96, P = 0.027) and decreased risk of delivering low birth weight babies (AOR = 0.21, 95% CI = 0.06-0.73, P = 0.014). Women with SCD in Ghana are at a greater risk of morbidity and mortality in pregnancy compared with women without hemoglobinopathies. Improved maternal and fetal outcomes in Ghanaian women with SCD can be achieved through effective intervention by health care providers with thorough knowledge about predisposing factors toward adverse outcomes.
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Affiliation(s)
- Nana O Wilson
- Morehouse School of Medicine, Department of Microbiology, Biochemistry and Immunology, Atlanta, GA 30310, USA.
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Ehiozie-Osifo AA, Olatosi JO, Kushimo OT. Emergency Caesarean section in a patient with known sickle-cell disease and myasthenia gravis. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2010. [DOI: 10.1080/22201173.2010.10872715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Motta S, Perseghin P, Consonni S, Regalia AL, Masera N. A Case Report of a Successful Monochorionic Diamniotic Twin Pregnancy in a Patient Affected by Sickle Cell Disease Treated With Erythrocytapheresis. Ther Apher Dial 2010; 14:112-5. [DOI: 10.1111/j.1744-9987.2009.00712.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Chanelles O, Koskas M, Chitrit Y, Riehl-Duvinage C, Saint-Leger S. Hemoglobin S-C disease and fetal well-being: a case report. J Matern Fetal Neonatal Med 2009; 22:465-8. [PMID: 19530008 DOI: 10.1080/14767050802610310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Sickle cell disease (SCD) is the most commonly inherited hemoglobinopathy in the United States. Blood transfusion is a critical part of the multidisciplinary approach necessary in the management of SCD; however, blood transfusions are not without complications. The successful use of transfusion as a treatment strategy in SCD requires the critical review and knowledge of transfusion methods, generally accepted indications, clinical situations in which transfusion generally is not considered, the selection of blood products, and strategies to prevent transfusion-related complications.
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Affiliation(s)
- Sam O Wanko
- Duke University Medical Center, DUMC Box 3841, Durham, NC 27710, USA
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Abstract
With advances in management, men and women with sickle cell disease are enjoying an improved quality of life well into adulthood, when they may elect to plan a family. Pregnancy has been associated with exacerbation of sickle cell disease and may place women, especially those with sickle cell anemia (HbSS), at an additional risk for obstetric complications. Appropriate management by health care providers familiar with sickle cell diseases and high-risk obstetric care can result in a successful pregnancy for most women with sickle cell disease.
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Affiliation(s)
- Kathryn Hassell
- Colorado Sickle Cell Treatment and Research Center, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
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Effect of active prenatal management on pregnancy outcome in sickle cell disease in an African setting. Blood 2000. [DOI: 10.1182/blood.v96.5.1685] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Sickle cell disease (SCD) is associated with an increased risk of medical complications during pregnancy. In sub-Saharan Africa, fetal and maternal mortality rates are particularly high. This study evaluated the effect of an active prenatal management program on pregnancy outcome in patients with SCD in an African setting. Pregnant women with SCD attending the National Teaching Hospital in Cotonou (The Republic of Benin, West Africa) were recruited before the 28th week of gestation. Management was based on providing information and education about SCD and improving nutritional status, malaria prevention, early detection of bacterial infections, and restricted use of blood transfusion. Maternal and fetal mortality rates and SCD-related morbidity were the principal variables assessed. One hundred and eight patients (42 SS and 66 SC) with 111 fetuses were included in the study. Thirteen fetal deaths (from 9 SS and 4 SC mothers) were recorded and 2 deaths of SC mothers. The maternal mortality rate of 1.8% was comparable with the overall maternal mortality rate for this maternity unit (1.2%). Few SCD-related events were recorded. Plasmodium falciparum malaria infection was the major cause of morbidity. Sixty-three patients (19 SS and 44 SC) successfully completed their pregnancy (58.3%) without requiring transfusion. Providing pregnant SCD patients with relevant medical care based on simple cost-effective approaches can have a positive impact on SCD-associated morbidity and mortality in an otherwise difficult setting in Africa.
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Effect of active prenatal management on pregnancy outcome in sickle cell disease in an African setting. Blood 2000. [DOI: 10.1182/blood.v96.5.1685.h8001685_1685_1689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Sickle cell disease (SCD) is associated with an increased risk of medical complications during pregnancy. In sub-Saharan Africa, fetal and maternal mortality rates are particularly high. This study evaluated the effect of an active prenatal management program on pregnancy outcome in patients with SCD in an African setting. Pregnant women with SCD attending the National Teaching Hospital in Cotonou (The Republic of Benin, West Africa) were recruited before the 28th week of gestation. Management was based on providing information and education about SCD and improving nutritional status, malaria prevention, early detection of bacterial infections, and restricted use of blood transfusion. Maternal and fetal mortality rates and SCD-related morbidity were the principal variables assessed. One hundred and eight patients (42 SS and 66 SC) with 111 fetuses were included in the study. Thirteen fetal deaths (from 9 SS and 4 SC mothers) were recorded and 2 deaths of SC mothers. The maternal mortality rate of 1.8% was comparable with the overall maternal mortality rate for this maternity unit (1.2%). Few SCD-related events were recorded. Plasmodium falciparum malaria infection was the major cause of morbidity. Sixty-three patients (19 SS and 44 SC) successfully completed their pregnancy (58.3%) without requiring transfusion. Providing pregnant SCD patients with relevant medical care based on simple cost-effective approaches can have a positive impact on SCD-associated morbidity and mortality in an otherwise difficult setting in Africa.
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Bourantas K, Makrydimas G, Georgiou J, Tsiara S, Lolis D. Preliminary results with administration of recombinant human erythropoietin in sickle cell/beta-thalassemia patients during pregnancy. Eur J Haematol Suppl 1996; 56:326-8. [PMID: 8641410 DOI: 10.1111/j.1600-0609.1996.tb00725.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Howard RJ, Tuck SM, Pearson TC. Pregnancy in sickle cell disease in the UK: results of a multicentre survey of the effect of prophylactic blood transfusion on maternal and fetal outcome. BRITISH JOURNAL OF OBSTETRICS AND GYNAECOLOGY 1995; 102:947-51. [PMID: 8652484 DOI: 10.1111/j.1471-0528.1995.tb10900.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine the outcome of pregnancies complicated by sickle cell disease in the UK during 1991-1993 and the effect of prophylactic blood transfusion programmes on maternal and fetal outcome. DESIGN A multicentre study. SUBJECTS Eighty-one pregnancies complicated by sickle cell disease and 100 pregnancies from women of black African descent without haemoglobinopathies to act as a comparative group. Pregnancies complicated by sickle cell disease were divided by the type of haemoglobinopathy and also by transfusion regimen. MAIN OUTCOME MEASURES Antenatal and postnatal complications of sickle cell disease, proteinuric hypertension, preterm delivery, emergency delivery by caesarean section, fetal distress, birthweight, perinatal and maternal mortality. RESULTS There were two maternal deaths in the 81 pregnancies and the perinatal mortality rate was 60/1000. Antenatal sickling complications occurred in 46.2% of pregnancies and postnatal sickling complications occurred in 7.7% of pregnancies. Pregnancies complicated by sickle cell disease were significantly more likely to be associated with anaemia, preterm delivery, proteinuric hypertension, birthweight below the 10th centile and caesarean section as an emergency procedure than the comparative group. Severe sickling complications occurred more commonly in the third trimester and there was some evidence that a prophylactic transfusion programme reduced the risk of this. Prophylactic transfusion did not improve obstetric outcome when compared with those pregnancies that were untransfused. CONCLUSIONS Sickle cell disease remains a severe complicating factor to pregnancy and perinatal mortality and maternal mortality rates in the UK have increased since last reported. A policy of exchange transfusing all women with homozygous sickle cell disease (HbSS) from 28 weeks gestation is recommended to reduce the risk of maternal complications in the third trimester and puerperium. There remains a role for earlier prophylactic blood transfusion programmes in women with poor obstetric and haematological histories.
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Affiliation(s)
- R J Howard
- University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK
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El-Shafei AM, Kaur Dhaliwal J, Kaur Sandhu A, Rashid Al-Sharqi M. Indications for blood transfusion in pregnancy with sickle cell disease. Aust N Z J Obstet Gynaecol 1995; 35:405-8. [PMID: 8717565 DOI: 10.1111/j.1479-828x.1995.tb02153.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
In order to assess the value of prophylactic blood transfusion in the management of pregnant patients with sickle cell disease, a study was conducted on 571 sickle cell disease pregnancies. These patients were divided into 2 groups, one with prophylactic transfusion and the other with restricted transfusion. In spite of the reduction in the incidence of blood transfusion the rate of preterm labour, intrauterine growth retardation, perinatal mortality and maternal mortality were similar in both groups. A restricted blood transfusion policy can be safely followed without compromising fetal or maternal well-being with an additional benefit of reducing the incidence of transfusion related crises and other complications.
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Affiliation(s)
- A M El-Shafei
- Salmaniya Medical Centre, Arabian Gulf University, State of Bahrain
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