Summary of management and transfusion protocols
| Author, year, journal . | Prophylactic transfusion . | ODT . | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Type of transfusion . | Timing of initiation, weeks GA . | MUT . | Proportion requiring ODT, n (%) . | Initial targets subsequent triggers . | Reason for transfusion . | Timing of initiation, weeks GA . | MUT . | Proportion requiring ODT, % . | |
| Cohort studies | |||||||||
| Morrison 197627 Obstet Gynecol* | Partial exchange transfusion from 28 wks (routine admission) | 28 | 3-6 per transfusion | 2/36 (5.6%) | Target | Severe anemia (Hct <15%) with crisis &/or infection | NR | 1 | 38% |
| Hct 35% | |||||||||
| HbA 40% | |||||||||
| Trigger | |||||||||
| a) Hct <25% & HbA <20% | |||||||||
| b) 36-38 wks | |||||||||
| c) with crisis | |||||||||
| d) in labor | |||||||||
| Miller 198126 Am J Obstet Gynecol | Initially partial exchange transfusion, subsequently EA | 22.3 ± 8.4 | 13 | NR | Target | Hb <70 g/L or anemia-related symptoms | NR | 3.7 | NR |
| NR | |||||||||
| Trigger | |||||||||
| Hct or HbA <25% | |||||||||
| Cunningham 198319 Obstet Gynecol | Simple transfusion or partial exchange transfusion depending on degree of anemia | ∼20 | HbSS - 13 | NR | Target | Hb <70 g/L or Hct < 20% or infection, hypoxia, excessive blood loss | NR | NR | NR |
| HbSC - 15 | HbA 50% | ||||||||
| HbS/B-Thal – NR | HbS 50% | ||||||||
| Trigger | |||||||||
| Hct <25% HbA <40% | |||||||||
| Tuck 198730 BJOG | Simple or partial exchange transfusion depending on degree of anemia | <20 or | 12 (4-28) | NR | Target | NR | NR | NR | NR |
| Dulwich: PT for all SCD types | >20 in HbSS | Hb 110 g/L & | |||||||
| St. Thomas: PT for HbSS | depending on time of presentation | HbS 25% | |||||||
| Trigger | |||||||||
| NR | |||||||||
| Koshy 199115 J Clin Apher | Simple or partial exchange transfusion | “Early pregnancy” | 12 | NR | Target | Prior to C/S, ACS, PET, severe anemia | NR | 4 | 74% |
| Hb 100-110 g/L | |||||||||
| HbS <35% | |||||||||
| Trigger | |||||||||
| NR | |||||||||
| Morrison 199127 J Clin Apher | Partial exchange transfusion or EA if severe crisis or morbidity | 19.4 | NR | NR | Target | Severe and symptomatic anemia, or crisis un-responsive to treatment | NR | NR | 58% |
| HbA >50% | |||||||||
| Trigger | |||||||||
| HbA <20% or “significant crisis, severe morbidity” | |||||||||
| Howard 199510 BJOG | Simple or partial exchange transfusion depending on severity of anemia | “First or second trimester” | NR | NR | Target | Sickling complications | NR | NR | 26% |
| NR | |||||||||
| Trigger | |||||||||
| NR | |||||||||
| El-Shafei 199518 Aust NZ J Obstet Gynaecol | PT for anemia (Hb <100 g/L) | NR | NR | 148 (60.7%) | Target | Hb <60 g/L, ongoing crisis, Hb <80 g/L prior to C/S, or PPH | NR | NR | 29.4% |
| NR | |||||||||
| Trigger | |||||||||
| NR | |||||||||
| Moussaoui 200229 Trop Med | Simple transfusion | 16 | 12 | 2/10 (for PPH) | Target | Severe anemia in pregnancy, severe anemia peripartum, or to treat PPH | NR | 7.83 | NR |
| Hb >100 g/L | |||||||||
| HbS <40% | |||||||||
| Trigger | |||||||||
| NR | |||||||||
| Gilli 200717 Int J Gyn Ob | Erythro-cytapheresis | 28 | 8.14 ± 4.31 | NR | Target | Acute SCD complications | NR | 3.76 ± 2.70 | NR |
| NR | |||||||||
| Trigger | |||||||||
| NR | |||||||||
| Asma 201514 Transfusion | Continuous flow apheresis; 60-70% RBCs exchanged | Variable | 6.2 ± 0.6 | 4/24 (16.7%) | Target | Simple transfusion - Hb <70g/L leukocytosis in absence of infection, and underlying pulmonary or cardiac disease | One in first & one in third trimester | NR | 15% |
| HbS <30% | |||||||||
| Trigger | |||||||||
| Clinical deterioration, Hb <70g/L, leukocytosis with no infection, and underlying pulmonary or cardiac disease - hyper-transfusion with target Hct of 27% | |||||||||
| RCT | |||||||||
| Koshy 198816 NEJM† | Simple or partial exchange transfusion | 8-14 wks | 12 | NR | Hb 100-110 g/L or | Hematologic or obstetric indications | NR | 6.5 | 44% |
| (78%) | Hct near 33% and | Hematologic | |||||||
| 20-26 wks | HbS <35% | Hb <60g/L | |||||||
| (22%) | Hct <18% | ||||||||
| Retics <3% | |||||||||
| Author, year, journal . | Prophylactic transfusion . | ODT . | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Type of transfusion . | Timing of initiation, weeks GA . | MUT . | Proportion requiring ODT, n (%) . | Initial targets subsequent triggers . | Reason for transfusion . | Timing of initiation, weeks GA . | MUT . | Proportion requiring ODT, % . | |
| Cohort studies | |||||||||
| Morrison 197627 Obstet Gynecol* | Partial exchange transfusion from 28 wks (routine admission) | 28 | 3-6 per transfusion | 2/36 (5.6%) | Target | Severe anemia (Hct <15%) with crisis &/or infection | NR | 1 | 38% |
| Hct 35% | |||||||||
| HbA 40% | |||||||||
| Trigger | |||||||||
| a) Hct <25% & HbA <20% | |||||||||
| b) 36-38 wks | |||||||||
| c) with crisis | |||||||||
| d) in labor | |||||||||
| Miller 198126 Am J Obstet Gynecol | Initially partial exchange transfusion, subsequently EA | 22.3 ± 8.4 | 13 | NR | Target | Hb <70 g/L or anemia-related symptoms | NR | 3.7 | NR |
| NR | |||||||||
| Trigger | |||||||||
| Hct or HbA <25% | |||||||||
| Cunningham 198319 Obstet Gynecol | Simple transfusion or partial exchange transfusion depending on degree of anemia | ∼20 | HbSS - 13 | NR | Target | Hb <70 g/L or Hct < 20% or infection, hypoxia, excessive blood loss | NR | NR | NR |
| HbSC - 15 | HbA 50% | ||||||||
| HbS/B-Thal – NR | HbS 50% | ||||||||
| Trigger | |||||||||
| Hct <25% HbA <40% | |||||||||
| Tuck 198730 BJOG | Simple or partial exchange transfusion depending on degree of anemia | <20 or | 12 (4-28) | NR | Target | NR | NR | NR | NR |
| Dulwich: PT for all SCD types | >20 in HbSS | Hb 110 g/L & | |||||||
| St. Thomas: PT for HbSS | depending on time of presentation | HbS 25% | |||||||
| Trigger | |||||||||
| NR | |||||||||
| Koshy 199115 J Clin Apher | Simple or partial exchange transfusion | “Early pregnancy” | 12 | NR | Target | Prior to C/S, ACS, PET, severe anemia | NR | 4 | 74% |
| Hb 100-110 g/L | |||||||||
| HbS <35% | |||||||||
| Trigger | |||||||||
| NR | |||||||||
| Morrison 199127 J Clin Apher | Partial exchange transfusion or EA if severe crisis or morbidity | 19.4 | NR | NR | Target | Severe and symptomatic anemia, or crisis un-responsive to treatment | NR | NR | 58% |
| HbA >50% | |||||||||
| Trigger | |||||||||
| HbA <20% or “significant crisis, severe morbidity” | |||||||||
| Howard 199510 BJOG | Simple or partial exchange transfusion depending on severity of anemia | “First or second trimester” | NR | NR | Target | Sickling complications | NR | NR | 26% |
| NR | |||||||||
| Trigger | |||||||||
| NR | |||||||||
| El-Shafei 199518 Aust NZ J Obstet Gynaecol | PT for anemia (Hb <100 g/L) | NR | NR | 148 (60.7%) | Target | Hb <60 g/L, ongoing crisis, Hb <80 g/L prior to C/S, or PPH | NR | NR | 29.4% |
| NR | |||||||||
| Trigger | |||||||||
| NR | |||||||||
| Moussaoui 200229 Trop Med | Simple transfusion | 16 | 12 | 2/10 (for PPH) | Target | Severe anemia in pregnancy, severe anemia peripartum, or to treat PPH | NR | 7.83 | NR |
| Hb >100 g/L | |||||||||
| HbS <40% | |||||||||
| Trigger | |||||||||
| NR | |||||||||
| Gilli 200717 Int J Gyn Ob | Erythro-cytapheresis | 28 | 8.14 ± 4.31 | NR | Target | Acute SCD complications | NR | 3.76 ± 2.70 | NR |
| NR | |||||||||
| Trigger | |||||||||
| NR | |||||||||
| Asma 201514 Transfusion | Continuous flow apheresis; 60-70% RBCs exchanged | Variable | 6.2 ± 0.6 | 4/24 (16.7%) | Target | Simple transfusion - Hb <70g/L leukocytosis in absence of infection, and underlying pulmonary or cardiac disease | One in first & one in third trimester | NR | 15% |
| HbS <30% | |||||||||
| Trigger | |||||||||
| Clinical deterioration, Hb <70g/L, leukocytosis with no infection, and underlying pulmonary or cardiac disease - hyper-transfusion with target Hct of 27% | |||||||||
| RCT | |||||||||
| Koshy 198816 NEJM† | Simple or partial exchange transfusion | 8-14 wks | 12 | NR | Hb 100-110 g/L or | Hematologic or obstetric indications | NR | 6.5 | 44% |
| (78%) | Hct near 33% and | Hematologic | |||||||
| 20-26 wks | HbS <35% | Hb <60g/L | |||||||
| (22%) | Hct <18% | ||||||||
| Retics <3% | |||||||||
ACS, acute chest syndrome; C/S, Caesarean section; EA, erythrocytapheresis; Hb, hemoglobin, MUT, mean units transfused; NR, not reported; ODT, on-demand transfusion; PET, preeclampsia; PPH, postpartum hemorrhage; PT, prophylactic transfusion; Retics, reticulocyte count; RBCs, red blood cells.
Data include Morrison (1976) J Pediatr.
Data for patients in the prophylactic transfusion arm also previously reported as part of RCT (Koshy 1988).