Preoperative Transfusion in Sickle Cell Disease Children Undergoing Adenotonsillectomy

Jammu, India Department of ENT, Government Medical College. GRID: grid.413224.2. ISNI: 0000 0004 1800 4333 Winston-Salem, USA Department of Anesthesiology, Wake Forest Baptist Hospital. GRID: grid.412860.9. ISNI: 0000 0004 0459 1231 Iowa City, IA USA Department of Pathology, University of Iowa Hospitals and Clinics. GRID: grid.412584.e. ISNI: 0000 0004 0434 9816 New Orleans, USA Department of Pediatrics, Division of Hematology/ Oncology, Children's Hospital New Orleans. GRID: grid.413979.1. ISNI: 0000 0004 0438 4435 Iowa City, IA USA Department of Otolaryngology, University of Iowa Hospitals and Clinics. GRID: grid.412584.e. ISNI: 0000 0004 0434 9816 200 Hawkins Drive, 52245 Iowa City, IA USA Department of Otolaryngology Head and Neck Surgery, University of Iowa Hospitals and Clinics. GRID: grid.412584.e. ISNI: 0000 0004 0434 9816

Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India. 2023;75(2):227-235

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OBJECTIVE To perform a systematic review and meta-analysis comparing two pre-operative transfusion regimens (conservative versus aggressive) in children with sickle cell disease(SCD) undergoing adenotonsillectomy in terms of post-operative complications, complications related to SCD and transfusion related complications. DATA SOURCES AND REVIEW METHODS A literature review was performed through PubMed, EMBASE, Cochrane, and Ovid databases using the following phrases: (Adenotonsillectomy OR Tonsillectomy) AND (Sickle Cell Disease OR Sickle Cell Trait). Using predetermined inclusion and exclusion criteria, seven articles were selected for systemic review and two control trials were included in meta-analysis. RESULTS Out of a total of 3,146 results, seven articles were selected for review and two controlled trials were included in the meta-analysis. There was no statistically significant difference in the rate of primary and secondary hemorrhage between the aggressive and conservative transfusion regimens (RR = 3.1, CI = 0.84-11.4, p-value = 0.089). The rate of sickle cell disease related complications including vaso-occlusive crisis and acute chest syndrome was also not statistically significant between the two transfusion groups (RR = 1.4, CI = 0.7-2.8, p-value = 0.339). Even though, the transfusion related complications did not reach statistical significance, there was a higher complication rate in the group receiving aggressive blood transfusion. CONCLUSION In SCD children undergoing adenotonsillectomy, an aggressive transfusion regimen that focuses on reducing the Hemoglobin S ratio to below 30% has not been shown to be more effective in reducing post-operative complications when compared to a conservative transfusion regimen. Therefore, it is reasonable to utilize a conservative transfusion regimen, thereby reducing the transfusion-associated risks.
Study details
Study Design : Systematic Review
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine