Benites Bruno Deltreggia, Benevides Thais Celi Lopes, Valente Isabella Salvetti, Marques Jose Francisco, Gilli Simone Cristina Olenscki, Saad Sara Teresinha Olalla
Hematology and Hemotherapy Center-University of Campinas/Hemocentro-UNICAMP, Instituto Nacional de Ciência e Tecnologia do Sangue, University of Campinas, Campinas, São Paulo, Brazil.
Department of Obstetrics and Gynecology, University of Campinas, Campinas, São Paulo, Brazil.
Transfusion. 2016 Jan;56(1):119-24. doi: 10.1111/trf.13280. Epub 2015 Sep 3.
Pregnancy represents a challenge for women with sickle cell disease (SCD), with higher rates of both maternal and fetal complications. The aim of this study was to evaluate the impact of prophylactic transfusion support administered specifically to pregnant women with sickle hemoglobin C disease.
Patients were divided into two groups according to the type of transfusion support received: 10 women received prophylactic erythrocytapheresis or manual exchange transfusion at 28 weeks of gestation, and 14 received transfusions only on demand, due to acute complications, or received no transfusions at all.
Our results indicated higher frequencies of SCD-related complications in the group that did not receive prophylactic transfusion support (35.7% vs. only 10% in the erythrocytapheresis group). Furthermore, these complications were more severe in this group and included all cases of acute chest syndrome. A significant difference was observed concerning gestational age at birth (38.7 weeks in the transfusion group vs. 34.4 weeks, p = 0.037), with a higher frequency of preterm births in the nontransfused group (69.23% vs. 30% in the transfusion group).
We demonstrated a clear reduction of unfavorable outcomes in patients receiving prophylactic transfusions, probably reflecting better maternal and fetal conditions, which corroborated to the more satisfactory indices of vitality, observed in newborns. Considering that erythrocytapheresis or manual exchange transfusions both represent feasible and safe procedures, they could represent important tools for the optimal management of these patients.
怀孕对患有镰状细胞病（SCD）的女性来说是一项挑战，母婴并发症发生率更高。本研究的目的是评估专门给予镰状血红蛋白C病孕妇预防性输血支持的影响。
根据接受的输血支持类型将患者分为两组：10名女性在妊娠28周时接受预防性红细胞单采或手工换血输血，14名女性仅在出现急性并发症时按需输血，或根本未接受输血。
我们的结果表明，未接受预防性输血支持的组中SCD相关并发症的发生率更高（35.7%，而红细胞单采组仅为10%）。此外，该组的这些并发症更严重，包括所有急性胸综合征病例。在出生孕周方面观察到显著差异（输血组为38.7周，未输血组为34.4周，p = 0.037），未输血组早产频率更高（69.23%，而输血组为30%）。
我们证明接受预防性输血的患者不良结局明显减少，这可能反映了更好的母婴状况，这也证实了新生儿观察到的更令人满意的活力指标。考虑到红细胞单采或手工换血输血都是可行且安全的程序，它们可能是这些患者最佳管理的重要工具。
