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Prophylactic red blood cell exchange may be beneficial in the management of sickle cell disease in pregnancy
Author(s) -
Asma Suheyl,
Kozanoglu Ilknur,
Tarım Ebru,
Sarıturk Cagla,
Gereklioglu Cigdem,
Akdeniz Aydan,
Kasar Mutlu,
Turgut Nurhilal H.,
Yeral Mahmut,
Kandemir Fatih,
Boga Can,
Ozdogu Hakan
Publication year - 2015
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12780
Subject(s) - medicine , pregnancy , preeclampsia , obstetrics , intrauterine growth restriction , eclampsia , anemia , disease , incidence (geometry) , fetus , pediatrics , genetics , physics , optics , biology
Background Sickle cell disease ( SCD ) is associated with chronic hemolysis and painful episodes. Pregnancy accelerates sickle cell complications, including prepartum and postpartum vasoocclusive crisis, pulmonary complications, and preeclampsia or eclampsia. Fetal complications include preterm birth and its associated risks, intrauterine growth restriction, and a high rate of perinatal mortality. The purpose of this study was to evaluate pregnancy outcomes in patients with SCD who underwent planned preventive red blood cell exchange ( RBCX ). Study Design and Methods We retrospectively evaluated the complications of SCD in 37 pregnant patients. Patients with SCD who had undergone prophylactic RBCX were compared with a control group who had not undergone RBCX during pregnancy. Results Forty‐three exchange procedures were performed in 24 patients. The control group comprised 13 patients with a mean age of 27.4 ± 3.3 years who had not undergone RBCX during pregnancy. Four of the five patients who developed a vasoocclusive crisis died. There was a significant difference in maternal mortality between the study and control groups (p = 0.011). There was also a significant difference in the incidence of vasoocclusive crisis between the study and control groups. One fetal death occurred in the 20th gestational week in a patient in the control group, although there were no postpartum complications in either the babies or the mothers in the control group. Conclusion This study has demonstrated that prophylactic RBCX during pregnancy is a feasible and safe procedure for prevention of complications. Given the decrease in the risks of transfusion, RBCX warrants further study.