Use of continuous flow erythrocytapheresis in pregnant patients with sickle cell disease

✍ Scribed by John C. Morrison; Francis S. Morrison; Randall C. Floyd; William E. Roberts; L. Wayne Hess; Winfred L. Wiser

• Publisher: John Wiley and Sons
• Year: 1991
• Tongue: English
• Weight: 612 KB
• Volume: 6
• Category: Article
• ISSN: 0733-2459
• DOI: 10.1002/jca.2920060411

✦ Synopsis

The role of partial prophylactic red cell exchange transfusion in the management of pregnant patients with major sickle hemoglobinopathies is unclear. Over a I0-year period, 13 1 pregnant patients with major hemoglobinopathies (HbS 101, HbS-C 30) were managed by the same group of physicians. Of these, 103 received partial prophylactic exchange transfusion early during prenatal care while 28 received blood only when serious complications developed (control group). Patients treated with exchange transfusion received continuous flow erythrocytapheresis on an outpatient basis. The results indicate that there were fewer crises (P = .0001), a reduction in other significant medical complications ( P = .002), and a decrease in maternal hospital days ( P = .05) in those receiving prophylactic transfusions compared to women in the control group. The number of preterm delivcries ( P = .004), the prevalence of low birthweight infants ( P = .01), and the perinatal death rate ( P = .01) were significantly lower among those who were routinely transfused. Two patients developed hepatitis, five had transfusion reactions, and I 1 were found to have alloantibodies among those receiving prophylactic transfusions versus one, two, and fivc patients, respectively, in the control group. The results indicate a benefit of this methodology in the treatment of pregnant sickle cell patients in our population. However, a national collaborative randomized study is needed to adequately address the controversy regarding the use of red cell exchange in the pregnant sickler.