The role of preoperative transfusion in sickle cell disease, a systematic review and meta-analysis

IF 6.9 2区 医学 Q1 HEMATOLOGY Blood Reviews Pub Date : 2024-02-18 DOI:10.1016/j.blre.2024.101183
Yasamin Abdu , Alaa Rahhal , Khalid Ahmed , Nada Adli , Mariam Abdou , Elrazi Awadelkarim Hamid Ali , Salam Al-Kindi , Mona Al Rasheed , Jaffer Altooq , Iheb Bougmiza , Mohamed A Yassin
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Abstract

This systematic review and meta-analysis aimed to provide guidance on preoperative blood transfusion strategies for patients with sickle cell disease (SCD). We included all randomized controlled and observational studies exploring the clinical outcomes of preoperative blood transfusion among patients with SCD compared to the conservative transfusion strategy until 14/09/2022.

Sixteen studies involving 3486 participants were analysed. The findings revealed a significantly higher bleeding rate in patients who received preoperative transfusion than those who followed a conservative strategy (RR = 4.32, 95% CI 1.75–10.68, P = 0.002, I2 = 0%). However, the two strategies had no significant differences in other clinical outcomes, such as acute chest syndrome, painful crisis, fever, neurological complications, thrombosis, ICU admission, and mortality. It is important to note that all the included studies had a moderate risk of bias. Preoperative transfusion in SCD was associated with a higher bleeding risk but a similar risk in other outcomes compared to conservative strategies. Notably, the increased bleeding risk observed seldom had clinical significance. We recommend individualizing management strategies, considering the overall positive impact of transfusions in reducing complications. Further high-quality studies are needed to refine recommendations.

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镰状细胞病术前输血的作用,系统回顾与荟萃分析
本系统综述和荟萃分析旨在为镰状细胞病(SCD)患者的术前输血策略提供指导。我们纳入了截至 2022 年 9 月 14 日所有探讨 SCD 患者术前输血与保守输血策略相比临床效果的随机对照研究和观察性研究。研究结果显示,术前输血患者的出血率明显高于采取保守输血策略的患者(RR = 4.32,95% CI 1.75-10.68,P = 0.002,I2 = 0%)。然而,这两种策略在其他临床结果上没有显著差异,如急性胸部综合征、疼痛危象、发热、神经系统并发症、血栓形成、入住重症监护室和死亡率。值得注意的是,所有纳入的研究都存在中度偏倚风险。与保守策略相比,SCD 患者术前输血与较高的出血风险相关,但其他结果的风险相似。值得注意的是,观察到的出血风险增加很少具有临床意义。考虑到输血对减少并发症的总体积极影响,我们建议采取个性化的管理策略。需要进一步开展高质量的研究来完善建议。
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来源期刊
Blood Reviews
Blood Reviews 医学-血液学
CiteScore
13.80
自引率
1.40%
发文量
78
期刊介绍: Blood Reviews, a highly regarded international journal, serves as a vital information hub, offering comprehensive evaluations of clinical practices and research insights from esteemed experts. Specially commissioned, peer-reviewed articles authored by leading researchers and practitioners ensure extensive global coverage across all sub-specialties of hematology.
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