Review Article

Tourniquet Use and Sickle Cell Hemoglobinopathy: How Should We Proceed?

Authors: Brent Fisher, MD, Craig S. Roberts, MD, MBA

Abstract

The use of tourniquets for upper and lower extremity operative procedures is controversial in patients with sickle cell hemoglobinopathies. The authors used Ovid and MEDLINE®, PubMed, and CINAHL® to detect English-language reports of any surgical procedure where a tourniquet was used on a patient with sickle cell disease or trait. Four papers met the search criteria and were reviewed. These studies included 96 patients with hemoglobin SS, SC, and sickle cell trait (AS). The investigations differed in tourniquet type, perioperative care, operative procedure, and patient genotype distribution. Twelve of 96 sickle cell patients (12.5%) experienced postoperative complications (8 SS/SC and 4 AS) detailed in two of the four studies. Nonetheless, the available limited evidence suggests that with proper perioperative management and necessary precautions, tourniquets can be used with relative safety in most patients with sickle cell disease.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Marchant WA, Walker I. Anaesthetic management of the child with sickle cell disease. Paediatr Anaesth 2003;13:473–489.
 
2. Tobin JR, Butterworth J. Sickle cell disease: dogma, science, and clinical care. Anesth Analg 2004;98:283–284.
 
3. Buck J, Davies SC. Surgery in sickle cell disease. Hematol Oncol Clin North Am 2005;19:897–902, vii.
 
 
4. Roizen MF, Fleisher LA. Anesthetic implications of concurrent diseases, in Miller RD, Eriksson LI, Fleisher LA, Winer-Kronish JP, Young WL (eds): Miller's Anesthesia. Philadelphia, Churchill Livingstone, 2009, pp 1127–1128.
 
 
5. Gilbertson AA. Anaesthesia in West African patients with sickle-cell anaemia, haemoglobin SC disease, and sickle-cell trait. Br J Anaesth 1965;37:614–622.
 
6. Santavirta S, Höckerstedt K, Niinikoski J. Effect of pneumatic tourniquet on muscle oxygen tension. Acta Orthop Scand 1978;49:451–459.
 
7. Wilgis EF. Observations on the effects of tourniquet ischemia. J Bone Joint Surg Am 1971;53:1343–1346.
 
8. Bunn HF. Pathogenesis and treatment of sickle cell disease. N Engl J Med 1997;337:762–769.
 
9. Adu-Gyamfi Y, Sankarankutty M, Marwa S. Use of a tourniquet in patients with sickle-cell disease. Can J Anaesth 1993;40:24–27.
 
10. Martin WJ, Green DR, Dougherty N, et al. Tourniquet use in sickle cell disease patients. J Am Podiatry Assoc 1984;74:291–294.
 
11. Oginni LM, Rufai MB. How safe is tourniquet use in sickle-cell disease? Afr J Med Med Sci 1996;25:3–6.
 
12. Stein RE, Urbaniak J. Use of the tourniquet during surgery in patients with sickle cell hemoglobinopathies. Clin Orthop Relat Res 1980:231–233.
 
 
13. Saunthararajah Y, Vichinsky EP. Sickle cell disease—clinical features and management, in Hoffman R, Benz EJ Jr, Shattil SJ, et al (eds): Hematology: Basic Principles and Practice. Philadelphia, Churchill Livingstone, 2008, pp 581–599.
 
 
14. Janerich DT, Kelly JH, Ziegler FD, et al. Age trends in the prevalence of the sickle cell trait. Health Serv Rep 1973;88:804-807.
 
15. Sears DA. The morbidity of sickle cell trait: a review of the literature. Am J Med 1978;64:1021–1036.
 
16. National Heart Lung and Blood Institute, National Institute of Health. Sickle cell anemia: Who is at risk? 2009. Available at: www.nhlbi.nih.gov/health/dci/Diseases/Sca/SCA_WhoIsAtRisk.html. Accessed May 9, 2009.
 
 
17. Lange RD, Minnich V, Moore CV. Effect of oxygen tension and of pH on the sickling and mechanical fragility of erythrocytes from patients with sickle cell anemia and the sickle cell trait. J Lab Clin Med 1951;37:789–802.
 
18. Willinsky JS, Lepow R. Sickle cell trait and use of the pneumatic tourniquet. A case report. J Am Podiatry Assoc 1984;74:38–41.
 
19. Abdulla Al-Ghamdi A. Bilateral total knee replacement with tourniquets in a homozygous sickle cell patient. Anesth Analg 2004;98:543–544.
 
 
20. Fanning R, O'Donnell B, Lynch B, et al. Anesthesia for sickle cell disease and congenital myopathy in combination. Paediatr Anaesth 2006;16:880–883.
 
21. Blond L, Madsen JL. Exsanguination of the upper limb in healthy young volunteers. J Bone Joint Surg Br 2002;84:489–491.
 
22. Greenberg MS, Kass EH, Castle WB. Studies on the destruction of red blood cells. XII. Factors influencing the role of S hemoglobin in the pathologic physiology of sickle cell anemia and related disorders. J Clin Invest 1957;36(6 Pt 1):833–843.
 
23. Charache S, Terrin ML, Moore RD, et al. Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia. Investigators of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia. N Engl J Med 1995;332:1317–1322.