Preoperative Transfusion in Sickle Cell Disease Children Undergoing Adenotonsillectomy

Sonika Kanotra; Samuel H Muller; Jhanvi Kanotra; Renee Gardner; Sohit Paul Kanotra

doi:10.1007/s12070-022-03137-7

Preoperative Transfusion in Sickle Cell Disease Children Undergoing Adenotonsillectomy

Indian J Otolaryngol Head Neck Surg. 2023 Jun;75(2):227-235. doi: 10.1007/s12070-022-03137-7. Epub 2022 Sep 9.

Authors

Sonika Kanotra¹, Samuel H Muller², Jhanvi Kanotra³, Renee Gardner⁴, Sohit Paul Kanotra^{5

6}

Affiliations

¹ Department of ENT, Government Medical College, Jammu, India.
² Department of Anesthesiology, Wake Forest Baptist Hospital, Winston-Salem, USA.
³ Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA USA.
⁴ Department of Pediatrics, Division of Hematology/ Oncology, Children's Hospital New Orleans, New Orleans, USA.
⁵ Department of Otolaryngology, University of Iowa Hospitals and Clinics, Iowa City, IA USA.
⁶ Department of Otolaryngology Head and Neck Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, 52245 Iowa City, IA USA.

PMID: 37275080
PMCID: PMC10235364 (available on 2024-06-01)
DOI: 10.1007/s12070-022-03137-7

Abstract

Objective: To perform a systematic review and meta-analysis comparing two pre-operative transfusion regimens (conservative versus aggressive) in children with sickle cell disease(SCD) undergoing adenotonsillectomy in terms of post-operative complications, complications related to SCD and transfusion related complications.

Data sources and review methods: A literature review was performed through PubMed, EMBASE, Cochrane, and Ovid databases using the following phrases: (Adenotonsillectomy OR Tonsillectomy) AND (Sickle Cell Disease OR Sickle Cell Trait). Using predetermined inclusion and exclusion criteria, seven articles were selected for systemic review and two control trials were included in meta-analysis.

Results: Out of a total of 3,146 results, seven articles were selected for review and two controlled trials were included in the meta-analysis. There was no statistically significant difference in the rate of primary and secondary hemorrhage between the aggressive and conservative transfusion regimens (RR = 3.1, CI = 0.84-11.4, p-value = 0.089). The rate of sickle cell disease related complications including vaso-occlusive crisis and acute chest syndrome was also not statistically significant between the two transfusion groups (RR = 1.4, CI = 0.7-2.8, p-value = 0.339). Even though, the transfusion related complications did not reach statistical significance, there was a higher complication rate in the group receiving aggressive blood transfusion.

Conclusion: In SCD children undergoing adenotonsillectomy, an aggressive transfusion regimen that focuses on reducing the Hemoglobin S ratio to below 30% has not been shown to be more effective in reducing post-operative complications when compared to a conservative transfusion regimen. Therefore, it is reasonable to utilize a conservative transfusion regimen, thereby reducing the transfusion-associated risks.

Keywords: Adenoidectomy; Adenotonsillectomy; Bleeding; Children; Pediatric; Sickle cell disease; Systematic review; Tonsil; Tonsillectomy; Transfusion.

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