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A comparison of conservative and aggressive transfusion regimens in the perioperative management of sickle cell disease

Elliot P. Vichinsky, MD, et al and the Preoperative Transfusion in Sickle Cell Disease Study Group

This multi-center study was designed to evaluate the comparative rates of perioperative complications among sickle cell patients who were randomly assigned to an aggressive (group 1) or conservative (group 2) transfusion regimen. Aggressive transfusion meant that the patient was transfused in order to decrease hgb S to < 30% and conservative transfusion was designed to increase hgb to 10 mg%. The preop hgb was 11 gm% in group 1 patients and 10.6 gm% in the group 2 patients. The demographics and types of surgical procedures were similar in the two groups. In the five-year period of the study, data was collected on 692 surgical procedures.

Acute chest syndrome occurred in 10% of patients in both groups. The two deaths that occurred as a result of ACS were both in group 1. There were significantly more transfusion related complications in group 1 compared to group 2, with these occurring in 14% of group 1 patients and 7% of group 2 patients. Transfusion-related complications included development of a new alloantibody, hemolysis, allergic or anaphylactic reactions, fever, fluid overload and other minor reactions. The authors point out the two-fold increase in transfusion-related complications in the aggressive transfusion group but do not actually endorse this practice.

Table of Contents

• Editor's Corner
• President's Message
• Society for Pediatric Anesthesia Policy Statment on Provision of Pediatric Anesthesia Care
• Williams Syndrome, Supravalvar Aortic Stenosis and Cardiac Arrest During Anesthesia
• Book Corner
• Out of Africa
• Peds Passport
• MHAUS Research Opportunities
• For Patients: Frequently Asked Questions


• Reviews & Commentary
  • Bariatric surgery for severely overweight adolescents: concerns and recommendations.
    Inge T, et al. Pediatrics 2004;114;217-223
  • Conscious sedation of children with propofol is anything but conscious
    Reeves ST, Havidich JE, and Tobin DP. Pediatrics 2004;114:e74-e76. URL http://www.pediatrics.org/cgi/content/ full/114/1/e74
  • A factorial trial of six interventions for the prevention of postoperative nausea and vomiting.
    Apfel CC, et al. N Engl J Med 2004; 50:2441-2451
  • The effect of dexrazoxane of myocardial injury in dozorubicin-treated children with acute lymphoblastic leukemia
    Lipshultz SE, et al. N Engl J Med 2004; 351:145-153
  • Unilateral negative-pressure pulmonary edema in an infant during bronchoscopy
    Shai Hannania, MD, et al. Pediatrics 2004;113:e501-e503. URL: http://www.pediatrics.org/cgi/content/full/113/5/e501
  • Does pediatric surgical specialty training affect outcome after Ramstedt Pyloromyotomy? A population-based study.
    Langer J, To T. Pediatrics 2004;113:1342-1347
  • Overweight children and adolescents; A risk group for iron deficiency
    Nead KG, et al. Pediatrics 2004;114:104-108
  • A comparison of conservative and aggressive transfusion regimens in the perioperative management of sickle cell disease
    Elliot P. Vichinsky, MD, et al and the Preoperative Transfusion in Sickle Cell Disease Study Group
  • Cholecystectomy in sickle cell anemia patients: Perioperative outcome of 364 cases from the National Preoperative Transfusion Study
    Charles M. Haberkern, et al, and the Preoperative Transfusion in Sickle Cell Disease Study Group
  • Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia
    Samuel Charache, MD, et al
  • Epidural Analgesia in the Management of Severe Vaso-Occlusive Sickle-Cell Crisis.
    Yaster M, et al. Pediatrics 1994;93:310-315


• Literature Reviews
  • A case of propofol toxicity: further evidence for a causal mechanism
    Davinia E Withington, Mary K. Decell, Tareq Al Ayed. Pediatric Anesthesia 2004;14:505
    Death after re-exposure to propofol in a 3-year-old child: a case report
    Josef Holzki, Christoph Aring, Alex Gillor. Paediatric Anaesthesia 2004;14:265
  • Does anaesthesia harm the developing brain - evidence or speculation?
    Andrew Davidson and Sulpicio Soriano. Paediatric Anaesthesia 2004; 14: 199-20.
  • An evaluation of pediatric in-hospital advanced life support interventions using the pediatric Utstein guidelines: a review of 203 cardiorespiratory arrests.
    J. Guay, L. Lortie.Can J Anesth 2004:51:4:373-378
  • A factorial trial of six interventions for the prevention of postoperative nausea and vomiting
    Christian C. Apfel, MD, et al. IMPACT Investigators. N Engl J Med 2004;350:2441-51
  • Interactive Music Therapy as a Treatment for Preoperative Anxiety in Children: A Randomized Controlled Trial
    Kain Z, Caldwell-Andrews A, Krivutza D, Weinberg M, Gaal D, Wang SM, Mayes L. Anesthesia & Analgesia 2004;98:1260-1266.
  • Trends in the practice of parental presence during induction of anesthesia and the use of preoperative sedative premedication in the United States, 1995-2002: results of a follow-up national survey.
    Kain, Z.N. et al. Anesth Analg 2004; 98:1252-9.
  • Anesthetic Complications of Tympanostomy Tube Placement in Children.
    Hoffmann KK, Thompson GK, Burke BL et al. Arch Otolaryngol Head Neck Surg. 128:1040-1043, 2002
  • Neurobehavioral Implications of Habitual Snoring in Children.
    O'Brien CM, et al. Pediatrics 2004; 116:44-50

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