Patients with sickle cell disease may benefit from blood transfusion therapy. However, transfusion may cause more harm than good due to complications such as iron overload, infection or alloimmunization.
General guidelines:
(1) acute simple transfusion: when increased oxygen carrying capacity is desired but no significant decrease in hemoglobin S concentration is required.
(2) chronic simple transfusion: limited by long term complications to a few conditions
(3) exchange transfusions: management or prevention of organ or life threatening events.
|
Condition |
Acute Simple |
Chronic Simple |
Exchange |
|
symptomatic anemia |
X |
|
|
|
sequestration crisis |
X |
|
|
|
aplastic crisis |
X |
|
|
|
accelerated hemolysis |
X |
|
|
|
blood loss |
X |
|
|
|
preoperative preparation |
investigational |
investigational |
investigational |
|
cerebrovascular disease |
|
X |
X |
|
priapism |
|
selected patients |
selected patients |
|
painful crisis |
|
selected patients |
|
|
leg ulcers |
|
selected patients |
|
|
acute chest syndrome or chronic lung disease |
|
selected patients |
selected patients |
|
cardiac disease |
|
selected patients |
|
|
complicated pregnancy |
|
selected patients |
possible benefit |
|
arterial hypoxemia syndrome |
|
|
X |
|
eye surgery |
|
|
X |
|
retinal vaso-occlusion |
|
|
possible benefit |
|
hepatic failure |
|
|
possible benefit |
|
septic shock |
|
|
possible benefit |
from Wayne et al (1993), Table pages 1111-1112 and text
where:
• Cardiac disease includes symptomatic congestive heart failure or coronary artery disease.
• Complicated pregnancy: (1) severe, (2) multiple gestation, (3) history of recurrent fetal loss.
Specialty: Clinical Laboratory, Hematology Oncology, Genetics
