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Blood. 2015 Nov 19;126(21):2424-35; quiz 2437. doi: 10.1182/blood-2015-06-649319. Epub 2015 Aug 24.

Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and meta-analysis.

Author information

1
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Canada; Department of Medicine and.
2
Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Division of Haematology, Department of Medicine, Mount Sinai Hospital, Toronto, Canada; Division of Medical Oncology and Haematology, Department of Medicine, University Health Network, Toronto, Canada; and Department of Laboratory Medicine and Pathobiology, and.
3
Department of Medicine and Division of Medical Oncology and Haematology, Department of Medicine, University Health Network, Toronto, Canada; and.
4
Department of Medicine and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada.

Abstract

Pregnancy in women with sickle cell disease is associated with adverse maternal and neonatal outcomes. Studies assessing the effects of prophylactic red blood cell transfusions on these outcomes have drawn inconsistent conclusions. The objective of this systematic review was to assess the effect of prophylactic compared with on-demand red blood cell transfusions on maternal and neonatal outcomes in women with sickle cell disease. A systematic search of several medical literature databases was conducted. Twelve studies involving 1291 participants met inclusion criteria. The studies had moderate to high risk of bias. Meta-analysis demonstrated that prophylactic transfusion was associated with a reduction in maternal mortality (7 studies, 955 participants; odds ratio [OR], 0.23; 95% confidence interval [CI], 0.06-0.91), vaso-occlusive pain episodes (11 studies, 1219 participants; OR, 0.26; 95% CI, 0.09-0.76), pulmonary complications (9 studies, 1019 participants; OR, 0.25; 95% CI, 0.09-0.72), pulmonary embolism (3 studies, 237 participants; OR, 0.07; 95% CI, 0.01-0.41), pyelonephritis (6 studies, 455 participants; OR, 0.19; 95% CI, 0.07-0.51), perinatal mortality (8 studies, 1140 participants; OR, 0.43; 95% CI, 0.19-0.99), neonatal death (5 studies, 374 participants; OR, 0.26; 95% CI, 0.07-0.93), and preterm birth (9 studies, 1123 participants; OR, 0.59; 95% CI, 0.37-0.96). Event rates for most of the results were low. Prophylactic transfusions may positively impact several adverse maternal and neonatal outcomes in women with sickle cell disease; however, the evidence stems from a relatively small number of studies with methodologic limitations. A prospective, multicenter, randomized trial is needed to determine whether the potential benefits balance the risks of prophylactic transfusions.

PMID:
26302758
DOI:
10.1182/blood-2015-06-649319
[Indexed for MEDLINE]
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