Transfusion protocol for pregnant women with SCD
| Transfusion protocol . |
|---|
| Before transfusion |
| Establish indication (see below) |
| Select best method for transfusion—simple or exchange transfusion; exchange transfusion should be considered for acute stroke, severe ACS, or major surgery |
| Establish posttransfusion hemoglobin and hemoglobin S (sickle hemoglobin) goals—for most SCD-related complications, posttransfusion hemoglobin should be 10 g/dL but not above 12 g/dL in patients with SS; hemoglobin S for SCD-related complications should be <50% |
| Obtain red cell antigen genotype or phenotype before transfusion if not obtained previously |
| Consider quantitative hemoglobin S posttransfusion as well as pretransfusion—this may help with monitoring for delayed hemolytic transfusion reactions |
| Type and crossmatch; then, select E-, C-, K-matched units in addition to ABO, D matched; honor transient and present red cell antibodies; for patients with a history of severe delayed hemolytic transfusion reactions or multiple red cell antibodies, consider extended antigen matching for Kidd, Duffy, MNS, and other blood groups |
| Transfuse leuko-reduced irradiated units, because the patient may be a candidate for stem cell transplant |
| Cytomegalovirus-negative units are recommended during pregnancy (RCOG) |
| HbS-negative units are recommended to allow for best monitoring of posttransfusion HbS goals |
| Consider quantitative hemoglobin S posttransfusion as well as pretransfusion—this may help with monitoring for delayed hemolytic transfusion reactions |
| Indications for transfusion during pregnancy |
| Acute or simple transfusion |
| Acute complications of SCD, such as stroke, ACS, acute splenic sequestration |
| Acute exacerbation of anemia with illness—decrease in hemoglobin 2 g/dL; this may be owing to ACS, infection, acute splenic sequestration, or multiorgan system failure |
| Acute exacerbation of steady-state anemia—may be because of iron deficiency, renal disease, increase hemolysis |
| Chronic transfusions |
| Established chronic transfusion protocol at time of pregnancy |
| Twin pregnancy |
| Recurrent severe SCD-related complications during the pregnancy; for example, if exchange transfusion is required during pregnancy or >1 simple transfusion, then strongly consider continuing a chronic transfusion protocol for the remainder of the pregnancy |
| In particular circumstances—consider in patients for ACS prevention, acute recurrent pain prevention and past pregnancies with known severe complications |
| Transfusion protocol . |
|---|
| Before transfusion |
| Establish indication (see below) |
| Select best method for transfusion—simple or exchange transfusion; exchange transfusion should be considered for acute stroke, severe ACS, or major surgery |
| Establish posttransfusion hemoglobin and hemoglobin S (sickle hemoglobin) goals—for most SCD-related complications, posttransfusion hemoglobin should be 10 g/dL but not above 12 g/dL in patients with SS; hemoglobin S for SCD-related complications should be <50% |
| Obtain red cell antigen genotype or phenotype before transfusion if not obtained previously |
| Consider quantitative hemoglobin S posttransfusion as well as pretransfusion—this may help with monitoring for delayed hemolytic transfusion reactions |
| Type and crossmatch; then, select E-, C-, K-matched units in addition to ABO, D matched; honor transient and present red cell antibodies; for patients with a history of severe delayed hemolytic transfusion reactions or multiple red cell antibodies, consider extended antigen matching for Kidd, Duffy, MNS, and other blood groups |
| Transfuse leuko-reduced irradiated units, because the patient may be a candidate for stem cell transplant |
| Cytomegalovirus-negative units are recommended during pregnancy (RCOG) |
| HbS-negative units are recommended to allow for best monitoring of posttransfusion HbS goals |
| Consider quantitative hemoglobin S posttransfusion as well as pretransfusion—this may help with monitoring for delayed hemolytic transfusion reactions |
| Indications for transfusion during pregnancy |
| Acute or simple transfusion |
| Acute complications of SCD, such as stroke, ACS, acute splenic sequestration |
| Acute exacerbation of anemia with illness—decrease in hemoglobin 2 g/dL; this may be owing to ACS, infection, acute splenic sequestration, or multiorgan system failure |
| Acute exacerbation of steady-state anemia—may be because of iron deficiency, renal disease, increase hemolysis |
| Chronic transfusions |
| Established chronic transfusion protocol at time of pregnancy |
| Twin pregnancy |
| Recurrent severe SCD-related complications during the pregnancy; for example, if exchange transfusion is required during pregnancy or >1 simple transfusion, then strongly consider continuing a chronic transfusion protocol for the remainder of the pregnancy |
| In particular circumstances—consider in patients for ACS prevention, acute recurrent pain prevention and past pregnancies with known severe complications |