Researchers examined outcomes with preoperative transfusion (PT) in patients with sickle cell disease (SCD) prior to cholecystectomy, and they found that a targeted transfusion-sparing strategy may limit certain transfusion-related complications. They reported their findings in the Journal of Clinical Medicine.
A consequence of SCD many patients face is the development of cholelithiasis, which can lead to acute biliary complications, enhancing the risk of vaso-occlusive events (VOEs). Cholecystectomy is frequently recommended for patients with SCD, but this procedure is also associated with VOE risks. Some patients may be offered PT based on their hemoglobin status to potentially reduce the risk of postoperative VOE. This approach is, however, associated with risks including alloimmunization and delayed hemolytic transfusion reactions (DHTR).
In this study conducted at European Georges Pompidou University Hospital in Paris, France, the researchers aimed to identify patterns of outcomes and patient characteristics with use of PT prior to cholecystectomy in adult patients with SCD. The primary study endpoint was the occurrence of a significant VOE or death during the month after surgery. A significant VOE could include a painful vaso-occlusive crisis (VOC) or acute chest syndrome, necessitating a longer hospital stay or readmission.
The study included 79 patients with SCD who underwent laparoscopic cholecystecomy. Most (81.0%) patients had an S/S or S/b0-thalassemia genotype. Patients overall had a median length of hospital stay lasting 4 days (interquartile range, 3-9.5).
PT had been used with 52 patients (66%) prior to cholecystectomy, while 27 patients had no PT. An S/S or S/b0 genotype was present in 88.5% of patients receiving PT, compared with 66.7% of patients without PT (P =.04). Hydroxyurea treatment showed a nonsignificant trend of being more common among patients with PT (42.6%) than in those without PT (23.8%; P =.13)
Hemoglobin levels prior to cholecystectomy were similar between patients receiving PT and those not receiving it (P =0.59). However, patients with PT showed a trend of having more preoperative VOCs during the month before surgery (39.2%) than patients without PT did (14.8%; P =.05), with a similar pattern observed in the 6-month preoperative period.
Operations performed in an emergency setting also showed a trend of being more common in patients who had PT (38.5%) than in those without PT (14.8%; P =.06). Median lengths of stay were considered similar between the 2 groups (P =.11), as were rates of postoperative VOEs, occurring in 19.2% of patients with PT and in 29.6% of patients without PT (P =.45).
Post-PT alloimmunization occurred in 4 patients, representing 8.5% of evaluable patients receiving PT, and 2 of these cases resulted in DHTR. Overall, the researchers considered the rates of all severe complications during the month after surgery to be similar between transfused (26.9%) and nontransfused (29.6%) patients.
“Transfusion sparing before a planned cholecystectomy seems to be a safe option in properly selected stable SCD patients, with no history of hospitalization for VOC within the 6 previous months, and in the context of planned surgery,” the researchers concluded in their report.
Rambaud E, Ranque B, Tsiakyroudi S, et al. Risks and benefits of prophylactic transfusion before cholecystectomy in sickle cell disease. J Clin Med. 2022;11(14):3986. doi:10.3390/jcm11143986