Ananthaneni Anil, Jones Sarah, Ghoweba Mohamed, Grant Vishwa, Leethy Kenna, Benzar Taras, Master Samip, Mansour Richard, Ramadas Poornima
Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA.
Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA.
Hematol Transfus Cell Ther. 2024 Nov;46 Suppl 5(Suppl 5):S109-S114. doi: 10.1016/j.htct.2024.07.001. Epub 2024 Sep 7.
The incidence of feto-maternal complications is high in women with sickle cell disease. The paucity of high-quality evidence has led to conditional recommendations for transfusional support in pregnant patients. This study aimed to assess if scheduled partial red cell exchanges impact pregnancy outcomes in sickle cell disease patients.
Forty-seven pregnancies were divided into two groups based on whether patients received scheduled partial red cell exchanges. Collected data included demographics, laboratory values, number of hospital visits, and prenatal/perinatal/postnatal outcomes. Data were analyzed using descriptive statistics, t-test, Chi-square and Fisher's exact tests, and binary regression.
The mean age was 25.09 ± 4.39 years. Of 47 patients, 14 (29.8%) received scheduled red cell exchanges with 78.6% compliance with no evidence of alloimmunization. This procedure during pregnancy was associated with fewer admissions for pain crises (p=0.032), higher gestational age at delivery (p=0.007), and a lower incidence of neonatal intensive care admissions (p=0.011; odds ratio: 0.071; 95% confidence interval: 0.008-0.632). Logistic regression did not show any significant associations.
Sickle cell disease patients with complications in previous pregnancies, including high hospitalization/admission rates and preterm deliveries, could benefit from scheduled partial red cell exchanges or simple transfusions. Further research is needed to guide clinical practice pertaining to transfusional support in pregnant patients with sickle cell disease.
镰状细胞病女性患者发生母胎并发症的几率很高。高质量证据的匮乏导致针对妊娠患者输血支持的建议存在一定条件性。本研究旨在评估计划性部分红细胞置换是否会影响镰状细胞病患者的妊娠结局。
根据患者是否接受计划性部分红细胞置换，将47例妊娠分为两组。收集的数据包括人口统计学信息、实验室检查值、住院次数以及产前/围产期/产后结局。使用描述性统计、t检验、卡方检验和费舍尔精确检验以及二元回归分析数据。
平均年龄为25.09±4.39岁。47例患者中，14例（29.8%）接受了计划性红细胞置换，依从率为78.6%，且无同种免疫证据。孕期进行该操作与疼痛危象住院次数减少（p = 0.032）、分娩时孕周增加（p = 0.007）以及新生儿重症监护病房收治率降低相关（p = 0.011；比值比：0.071；95%置信区间：0.008 - 0.632）。逻辑回归未显示任何显著关联。
既往妊娠有并发症（包括高住院率/入院率和早产）的镰状细胞病患者可能会从计划性部分红细胞置换或简单输血中获益。需要进一步研究以指导镰状细胞病妊娠患者输血支持的临床实践。
