Review Article

Evidence for Prophylactic Transfusion during Pregnancy for Women with Sickle Cell Disease

Authors: Julie R. Whittington, MD, Everett F. Magann, MD, Songthip T. Ounpraseuth, PhD, Jon N. Chang, Dayna D. Whitcombe, MD, John C. Morrison, MD


The objective of this study was to examine prior studies on maternal and neonatal outcomes with prophylactic compared with emergent blood transfusion in pregnant women with sickle cell disease. A review of the literature was performed. Twenty-one articles were identified and included in the analysis. A generalized linear mixed-effects model was used to analyze the outcomes. Pregnancy outcomes assessed were preeclampsia, pneumonia, pyelonephritis, pain crises, intrauterine growth restriction, neonatal death, perinatal death, and maternal mortality. Women who underwent emergent transfusion were more likely than women who underwent prophylactic transfusion to have the following adverse perinatal outcomes: preterm delivery (adjusted odds ratio [aOR 2.04], 95% confidence interval [CI] 1.14–3.63), pneumonia (aOR 2.98, 95% CI 1.44–6.15), pain crises (aOR 1.67, 95% CI 1.18–2.38), and perinatal death (aOR 1.84, 95% CI 1.06–3.07). Prophylactic transfusion should be reexamined as a potentially beneficial approach to the management of sickle cell disease in pregnancy.

Posted in: Pregnancy16

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1. ACOG Committee on Obstetrics. ACOG Practice Bulletin no. 78: hemoglobinopathies in pregnancy. Obstet Gynecol 2007;109:229–237.   2. Malowany JI, Butany J. Pathology of sickle cell disease. Semin Diagn Pathol 2012;29:49–55.   3. Hassell KL. Population estimates of sickle cell disease in the U.S. Am J Prev Med 2010;38(4 suppl):S512–S521.   4. Marti-Carvajal AJ, Pena-Marti GE, Comunián-Carrasco G, et al. Interventions for treating painful sickle cell crisis during pregnancy. Cochrane Database Syst Rev 2009;1:CD006786.   5. Villers MS, Jamison MG, De Castro LM, et al. Morbidity associated with sickle cell disease in pregnancy. Am J Obstet Gynecol 2008;199:125.e1–125.e5.   6. Chou ST. Transfusion therapy for sickle cell disease: a balancing act. Hematol Am Soc Hematol Educ Program 2013;2013:439–446.   7. Okusanya BO, Oladapo OT. Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy. Cochrane Database Syst Rev 2016;12: CD010378.   8. Malinowski AK, Shehata N, Souza R, et al. Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and metaanalysis. Blood 2015;126:2424–2435.   9. Chang JN, Magann EF, Novotny SA, et al. Maternal/perinatal outcome in women with sickle cell disease: a comparison of two time periods. South Med J 2018;111:742–745.   10. Koshy M, Burd L, Wallace D, et al. Prophylactic red cell transfusions in pregnant patients with sickle cell disease: a randomized cooperative study. N Engl J Med 1988;319:1447–1452.   11. Morrison JC, Morrison FS, Floyd RC, et al. Use of continuous flow erythocytapheresis in pregnant patients with sickle cell disease. J Clin Apher 1991;6:224–229.   12. Milner PF, Jones BR, Döbler J. Outcome of pregnancy in sickle cell anemia and sickle cell-hemoglobin C: an analysis of 181 pregnancies in 98 patients, and a review of the literature. Am J Obstet Gynecol 1980;138:239–245.   13. Howard RC, Tuck SM, Pearson TC. Pregnancy in sickle cell disease in the UK: results of a multicenter survey of the effect of prophylactic blood transfusion on maternal and fetal outcome. Br J Obstet Gynaecol 1995;102:947–951.   14. Koshy M, Chisum D, Burd L, et al. Management of sickle cell anemia and pregnancy. J Clin Apher 1991;6:230–233.   15. Miller JM, Horger EO, Key TC, et al. Management of sickle hemoglobinopathies in pregnant patients. Am J Obstet Gynecol 1981;141:237–241.   16. Morrison JC, Wiser WL. The use of prophylactic partial exchange transfusion in pregnancies associated with sickle cell hemoglobinopathies. Obstet Gynecol 1976;5:516–520.   17. Cunningham FG, Pritchard JA, Mason R. Pregnancy and sickle cell hemoglobinopathies: results with and without prophylactic transfusions. Obstet Gynecol 1983;62:419–424.   18. Al Kahtani MA, AlQahtani M, Alshebaily MM, et al. Morbidity and pregnancy outcomes associated with sickle cell anemia among Saudi women. Int J Gynaecol Obstet 2012;119:224–226.   19. Asma S, Kozanoglu I, Tarim E, et al. Prophylactic red blood cell exchange may be beneficial in the management of sickle cell disease in pregnancy. Transfusion 2015;55:36–44.   20. El-Shafei AM, Dhaliwal JK, Sandhu AK, et al. Indications for blood transfusion in pregnancy with sickle cell disease. Aust NZ Obstet Gynaecol 1995;35:405–408.   21. Gilli SC, DePaula EV, Biscaro EP, et al. Third-trimester erythrocytapheresis in pregnant patients with sickle cell disease. Int J Gynaecol Obstet 2007;96:8–11.   22. Silva-Pinto AC, de Oliveira Domingues Ladeira S, Brunetta DM, et al. Sickle cell disease and pregnancy: analysis of 34 patients followed at the Regional Blood Center of Ribeirão Preto, Brazil. Rev Bras Hematol Hemoter 2014;36:329–333.   23. Serjeant GR, Loy LL, Crowther M, et al. Outcome of pregnancy in homozygous sickle cell disease. Obstet Gynecol 2004;103:278–285.   24. Sun PM, Wilburn W, Raynor D, et al. Sickle cell disease in pregnancy: twenty years of experience at Grady Memorial Hospital, Atlanta, Georgia. Am J Obstet Gynecol 2001;184:1127–1130.   25. Cunningham FG, Pritchard JA. Prophylactic transfusion of normal red blood cells during pregnancies complicated by sickle cell hemoglobinopathies. Am J Obstet Gynecol 1979;135:994–1003.   26. Grossetti E, Carles G, Guindi WE, et al. Selective prophylactic transfusion in sickle cell disease. Acta Obset Gynecol 2009;88:1090–1094.   27. Morrison JC, Schneider JM, Whybrew WD, et al. Prophylactic transfusion in pregnant patients with sickle hemoglobinopathies: benefit vs risk. Obstet Gynecol 1980;56:274–280.   28. Moussaoui L, Chouhou K, Guelzim J, et al. Drepanocytose majeure et grossesse transfusions prophylactiques systematiques, A propos De 16 case. Med Trop 2002;62:603–606.   29. Ngo C, Kayem G, Habibi A, et al. Pregnancy in sickle cell disease: maternal and fetal outcomes in a population receiving prophylactic partial exchange transfusions. Eur J Obstet Gynecol Reprod Biol 2018;152:138–142.   30. Tuck SM, James CE, Brewster EM, et al. Prophylactic blood transfusion in maternal sickle cell syndromes. Br J Obstet Gynaecol 1987;94:121–125.   31. Howard J, Malfroy M, Llewelyn C, et al. The transfusion alternatives preoperatively in sickle cell disease (TAPS) study: a randomized, controlled, multicenter clinical trial. Lancet 2013;381:930–998.   32. Ware RE, Helms RW, for the SWiTCH Investigators. Stroke with transfusion changing to hydroxyurea (SWITCH). Blood 2012;119:3925–3932.   33. Okusanya BO, Oladapo OT. Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy. Cochrane Database Syst Rev. 2013;12:CD010378.   34. Morrison JC, Blake PG, Reed CD. Therapy for the pregnant patient with sickle cell hemoglobinopathies: a national focus. Am J Obstet Gynecol 1982;144:268–269.