Perioperative Management for Orthopaedic Patients with Sickle Cell Anaemia

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anemia, sickle cell, blood component transfusion, blood transfusion, orthopedics, preoperative care

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Purpose: To compare outcomes of 2 types of perioperative optimisation for patients with sickle cell anaemia (SCA) undergoing various orthopaedic surgeries.

Methods: 12 female and 11 male patients aged 13 to 40 (mean, 18) years with SCA underwent 31 separate orthopaedic procedures for osteonecrosis of the femoral head. They were referred to a haematologist for 2 types of perioperative optimisation, based on the choice of the attending paediatrician. In the aggressive management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to 9 to 11 g/dl and to lower the haemoglobin S level to

Results: No patient in the aggressive management group received supplemental oxygen or had an estimated intra-operative blood loss of >400 ml. Three patients in the conservative management group received multiple intra- and post-operative transfusions and supplemental oxygen.

Conclusion: Both aggressive and conservative protocols may be safely used in SCA patients. The more aggressive protocol resulted in lower rates for postoperative complications, transfusions, and resorting to supplemental oxygen.

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Citation / Publisher Attribution

Journal of Orthopaedic Surgery, v. 17, issue 3, p. 346-350