BOF: General (Haemoglobinopathy)
- Jun 25, 2016
- 1 min read
Transfusion should be used selectively in sickle cell disease to avoid the risk of transfusion reaction, allo-immunisation and iron overload.
Which of the following is NOT a reasonable indication for red cell transfusion in a pregnant woman with homozygous (HbSS) sickle cell disease?
a) Acute chest syndrome
b) Haemoglobin less than 7g/dl
c) Prior to elective Caesarean section
d) Recurrent veso-occlusive pain crises
e) Refractory pre-eclampsia
Answer:
Haemoglobin less than 7g/dl
Explanation:
Maternal mortality is around 1.8% in all patients with sickle cell anaemia: a low absolute risk but 1,000 times the risk in a woman without the condition. There is an increased tendency to pre-eclampsia, preterm labour and low birth weight babies. There is no correlation between level of anaemia and outcomes. A Cochrane review of two small trials comparing prophylactic and as-required regimes of antenatal transfusion found no benefit in a prophylactic approach. With the associated risks of transfusion, in particular allo-immunisation, red cell transfusion is only recommended for symptomatic anaemia, acute chest syndrome or other severe acute sickle-related episodes, refractory pre-eclampsia, and in preparation for Caesarean section.
Reference:
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