Tourniquet use in patients with sickle cell trait (SCT): Mediterranean or African ancestry influences complications, demonstrating a higher prevalence than control patients: matched study of nine hundred and forty SCT versus one thousand, two hundred and sixty three non-SCT patients.

PURPOSE

One ongoing debate in orthopaedic surgery concerns using tourniquets in sickle cell trait (SCT) patients. SCT, a heterozygous carrier state of sickle cell disease (SCD), affects an estimated 300 million individuals globally with various genetic ancestries.

METHODS

A retrospective cohort study was conducted on 940 SCT patients and 1263 matched non-SCT controls who underwent limb surgeries using tourniquets between 1978 and 2018. Patient data were gathered from hospital records, blood bank information, and postoperative haemoglobin electrophoresis. Outcomes assessed included the incidence of venous thromboembolism (VTE), pulmonary embolism (PE), phlebitis, peripheral nerve impairment, and superficial infection. Covariates included age, sex, ethnicity, and diabetes status.

RESULTS

Among SCT patients, 75% were unaware of their carrier status at surgery. VTE incidence was significantly higher in SCT patients (10%) than non-SCT controls (2%), especially after prolonged tourniquet use and in upper limb procedures without anticoagulation. PE occurred in 3% of SCT patients, versus 1% in controls. Diabetes, more prevalent in SCT individuals (9% vs. 6%), further increased the complication risk. Tourniquet inflation time did not differ significantly between groups; however, neurologic complications and phlebitis were more common in SCT patients, particularly those with Mediterranean ancestry. Notably, SCT carriers of African and Mediterranean descent experienced higher complication rates than non-carriers, though complications were not confined to any single ancestry.

CONCLUSION

SCT is associated with an increased risk of thrombotic and neurologic complications during tourniquet, particularly in patients with undiagnosed SCT or diabetes and in procedures with extended ischaemia time. These results confirm the perception of SCT as a benign condition, but call for further clinical guidelines regarding tourniquet use in SCT carriers.