Prophylactic red blood cell transfusion may have independent protective effects on maternal and perinatal outcomes among pregnant women with sickle cell disease (SCD), according to a study published in the European Journal of Obstetrics & Gynecology and Reproductive Biology.
Pregnancy in SCD can be dangerous, especially if it coincides with vaso-occlusive crises or acute chest syndrome. Women with SCD are also at a higher risk of experiencing adverse pregnancy outcomes such as pre-eclampsia, eclampsia, thromboembolic events, intrauterine fetal death, and prematurity.
Prophylactic red blood cell transfusion is aimed at reducing these negative outcomes. It replaces SCD blood with donor red cells to increase the proportion of normal hemoglobin in each patient. However, there is no general consensus regarding target hemoglobin concentrations, and evidence is lacking for its universal use in pregnant women with SCD.
The authors of the study sought to assess the protective merits of prophylactic red blood cell transfusion in pregnant women with SCD. They conducted a retrospective study based on medical records of all pregnancies among women with SCD who received prenatal care and gave birth at a tertiary care center in France between January 2004 and December 2017. Prophylactic red blood cell transfusion was proposed at 22 weeks gestation and was advanced if patients experienced vaso-occlusive complications or became symptomatic after hydroxycarbamide was discontinued.
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The researchers were then able to compare pregnancy and childbirth outcomes between individuals who were treated with prophylactic red blood cell transfusion and those who were not. In particular, researchers took note of episodes of preeclampsia, delayed hemolytic transfusion reaction, as well as hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome. In addition, the research team collected information regarding infant size for gestational age, the occurrence of intrauterine fetal death/neonatal death, and/or maternal death.
This study included 224 pregnancies. Among them, 148 (66%) received prophylactic red blood cell transfusion, whereas 76 (34%) did not. There were 4 maternal deaths in the prophylactic red blood cell transfusion group. The rates of preterm birth at 37 and 34 gestational weeks were significantly more common in the nonprophylactic red blood cell transfusion group compared with the group who received transfusion. Rates of vaso-occlusive crises and acute chest syndrome were also more common among patients who did not receive prophylactic red blood cell transfusion. There was no statistically significant difference between the two groups in terms of rates of preeclampsia, eclampsia, HELLP syndrome, and cesarean section delivery.
“In this retrospective study of 224 pregnancies, propensity score-weighted analysis showed a potential independent protective effect of [prophylactic red blood cell transfusion] against composite obstetric adverse outcomes,” the authors concluded.
Sobcyzk O, Gottardi E, Lefebvre M, et al. Evaluation of a prophylactic transfusion programme on obstetric outcomes in pregnant women with sickle cell disease: a single centre retrospective cohort study. Eur J Obstet Gynecol Reprod Biol. Published online September 6, 2023. doi:10.1016/j.ejogrb.2023.08.390