Medical Science: Recent Advances and Applications Vol. 6

Abstract

Background: Sickle cell disease is one of the most common inherited haemoglobin disorders in the world. It is the most prevalent haemoglobin disorder in other parts of the world, including sub-Saharan Africa, the Middle East, the Mediterranean Basin, southern India and also South America.

Aim: A local hospital preoperative transfusion guideline was developed for sickle cell disease (SCD) patients to reduce perioperative and postoperative complications. This study was conducted to evaluate the outcome of clinical practice on SCD patients undergoing surgeries at King Fahd Hospital-Jeddah.

Methods: A retrospective review of 75 SCD patients undergoing surgery at King Fahd Hospital, Jeddah, Saudi Arabia, was conducted between April 2005 and May 2010. The medical records were reviewed to define the perioperative risks and the postoperative complications in relation to the type of transfusion modality selected. The data of patients’ details, transfusion type, risk factors and postoperative outcome were expressed in tables using SPSS v18.

Results: The median age of the patient was 24 years, and 34 of them were males and 41 were females. Preoperatively, 25.3% had complete exchange transfusion (CETX), 17.3% had partial exchange transfusion (PETX), 26.7% had simple top-up transfusion (STX), and 30.7% did not require transfusion (NTX). The postoperative complications included vaso-occlusive crises (VOC) in 20%, acute chest syndrome (ACS) in 2.7%, and fever in 16% of cases. In this study, 33.3% of patients required a prolonged period of hospital stay. In the patients of this study, postoperative fever, VOC, ACS, and the length of hospital stay did not show any difference regardless of the types of transfusion modalities. However, the correlation was highly significant between the pre-operative haemoglobin (Hb) level and postoperative fever (P<0.01) and VOC (P<0.01). Interestingly, SCD patients who received hydroxyurea had fewer postoperative complications such as fever (P<0.05) and vaso-occlusive crises (P<0.05), while those who received prophylactic heparin in the postoperative period had a reduced length of hospital stay (P<0.01) and vaso-occlusive crises (P<0.01).

Conclusion: The guidelines for preoperative transfusion in SCD patients were effective in reducing the postoperative morbidity and mortality. Moreover, this guideline emphasises the operative situations where preoperative transfusion is needed and the optimum regimen is required for different surgical operations subtypes. Further recommendations are extended to ensure patient safety by providing proper hydration, oxygenation, antibiotics and anticoagulation during and after surgery.