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Am J Hematol. 2018 Jun;93(6):794-802. doi: 10.1002/ajh.25097. Epub 2018 Apr 17.

Transfusion-related adverse events are decreased in pregnant women with sickle cell disease by a change in policy from systematic transfusion to prophylactic oxygen therapy at home: A retrospective survey by the international sickle cell disease observatory.

Author information

1
Biotherapy Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
2
Biotherapy CIC, West University Hospital Group, Assistance Publique-Hôpitaux de Paris, INSERM, Paris, France.
3
Clinical Hematology and Cellular Therapy Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, France - INSERM UMRs 938, Pierre et Marie Curie University (UPMC, Paris VI), Paris, France.
4
Department of Obstetrics and Fetal Medicine, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
5
Reference Center for Sickle Cell Disease, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris, Créteil, France.
6
Necker Children's Hospital, French Blood Establishment - Ile de France, Paris, France.
7
Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Necker Pasteur Center for Infectious Diseases and Tropical Medicine, Paris, France.
8
Imagine Institute, Paris, France.
9
Paris Descartes University, Paris, France.
10
Reference Centre for Sickle Cell Disease, Pediatric Department, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
11
Unit of Pediatric Immunology and Hematology, Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France.
12
Necker Children's Hospital, Assistance Publique-Hôpitaux de Paris, Clinical Research Unit/Clinical Investigation Centre, Paris, France.
13
Saint-Louis Hospital, Paris, France and Monaco Scientific Center, Eurocord Monacord International Observatory on Sickle Cell Disease, Monaco.
14
Department of Obstetrics and Gynecology and Reproductive Medicine, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Clamart, France.

Abstract

Sickle cell disease (SCD) in pregnancy can be associated with adverse maternal and perinatal outcomes. Furthermore, complications of SCD can be aggravated by pregnancy. Optimal prenatal care aims to decrease the occurrence of maternal and fetal complications. A retrospective, French, two-center study compared two care strategies for pregnant women with SCD over two time periods. In the first study period (2005-2010), the women were systematically offered prophylactic transfusions. In the second study period (2011-2014), a targeted transfusion strategy was applied whenever possible, and home-based prophylactic nocturnal oxygen therapy was offered to all the pregnant women. The two periods did not differ significantly in terms of the incidence of vaso-occlusive events. Maternal mortality, perinatal mortality, and obstetric complication rates were also similar in the two periods, as was the incidence of post-transfusion complications (6.1% in 2005-2010 and 1.3% in 2011-2014, P = .15), although no de novo alloimmunizations or delayed hemolysis transfusion reactions were observed in the second period. The results of this preliminary, retrospective study indicate that targeted transfusion plus home-based prophylactic nocturnal oxygen therapy is safe and may decrease transfusion requirements and transfusion-associated complications.

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