TY - JOUR
T1 - Elective surgery in children with sickle cell disease without preoperative blood transfusion
AU - Griffin, Timothy C.
AU - Buchanan, George R.
N1 - Funding Information:
From the Department qf Pediatrics, The University of Texas Southwestern Medical Center at D&as. and Children’s Medical Center, Dallas. TX Date accepted: April 14, 1992. Supported in part by the Sickle Cell Research Fund, Children’s Medical Center of Dallas, and by National Institutes of Heahh Research Training Grants CA09640 and HDO73OX. Presented in part at the Society for Pediattic Research meeting, Washington, DC, May 4, 1989 (abstract published in Pediatr Res 25:15lA. 1989). Address reprint requests to George R. Buchanan, MD, Depanment of Pediatrics, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd. Dallas, TX 75235-906.3. Copyright o I993 by W B. Saunders Company 0022-3468/9312805-0011$03.0010
PY - 1993/5
Y1 - 1993/5
N2 - It is generally recommended that patients with sickle cell disease receive red blood cell (RBC) transfusions before undergoing general anesthesia and surgery. Since RBC transfusions are costly, inconvenient, and may cause serious complications, it might be useful to identify groups of patients for whom they are not absolutely necessary. We report our experience with 54 pediatric patients undergoing 66 elective surgical procedures without preoperative transfusion preparation. All patients were felt to be clinically and hematologically stable in the immediate preoperative period. For the majority of procedures ( 57 66, 86%) no transfusions were administered at any time during the perioperative course. There were no intraoperative complications or postoperative deaths. Overall, some type of postoperative complication was encountered after 17 procedures (26%). Complications were usually minor and were more likely to occur after procedures involving thoracotomy or laparotomy ( 10 20, 50%) and tonsillectomy/adenoidectomy (T&A) ( 5 9, 56%) than other procedures ( 2 37, 5%; P < .001). Pulmonary complications were especially more prevalent in the group undergoing thoracotomy, laparotomy, or T&A ( 9 29 v 0 37 for all other procedures, P < .001). We conclude that preoperative transfusions might be avoided in children with sickle cell disease who undergo most minor surgical procedures on an elective basis. Patients undergoing thoracotomy, laparotomy, or T&A are at a relatively higher risk of developing postoperative complications and would comprise ideal groups for evaluation of preoperative transfusion regimens in prospective carefully controlled, randomized studies.
AB - It is generally recommended that patients with sickle cell disease receive red blood cell (RBC) transfusions before undergoing general anesthesia and surgery. Since RBC transfusions are costly, inconvenient, and may cause serious complications, it might be useful to identify groups of patients for whom they are not absolutely necessary. We report our experience with 54 pediatric patients undergoing 66 elective surgical procedures without preoperative transfusion preparation. All patients were felt to be clinically and hematologically stable in the immediate preoperative period. For the majority of procedures ( 57 66, 86%) no transfusions were administered at any time during the perioperative course. There were no intraoperative complications or postoperative deaths. Overall, some type of postoperative complication was encountered after 17 procedures (26%). Complications were usually minor and were more likely to occur after procedures involving thoracotomy or laparotomy ( 10 20, 50%) and tonsillectomy/adenoidectomy (T&A) ( 5 9, 56%) than other procedures ( 2 37, 5%; P < .001). Pulmonary complications were especially more prevalent in the group undergoing thoracotomy, laparotomy, or T&A ( 9 29 v 0 37 for all other procedures, P < .001). We conclude that preoperative transfusions might be avoided in children with sickle cell disease who undergo most minor surgical procedures on an elective basis. Patients undergoing thoracotomy, laparotomy, or T&A are at a relatively higher risk of developing postoperative complications and would comprise ideal groups for evaluation of preoperative transfusion regimens in prospective carefully controlled, randomized studies.
KW - Sickle cell disease
KW - elective surgery
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U2 - 10.1016/0022-3468(93)90031-F
DO - 10.1016/0022-3468(93)90031-F
M3 - Article
C2 - 8340858
AN - SCOPUS:0027176957
SN - 0022-3468
VL - 28
SP - 681
EP - 685
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
IS - 5
ER -