Perioperative management for orthopaedic patients with sickle cell anaemia.

Published

Journal Article

PURPOSE: To compare outcomes of 2 types of perioperative optimisation for patients with sickle cell anaemia (SCA) undergoing various orthopaedic surgeries. METHODS: 12 female and 11 male patients aged 13 to 40 (mean, 18) years with SCA underwent 31 separate orthopaedic procedures for osteonecrosis of the femoral head. They were referred to a haematologist for 2 types of perioperative optimisation, based on the choice of the attending paediatrician. In the aggressive management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to 9 to 11 g/dl and to lower the haemoglobin S level to <30%. Fresh frozen plasma was given when their Factor VII level was <30%. In the conservative management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to a minimum of 10 g/dl. Fresh frozen plasma or packed red blood cells were given intra-operatively only when excessive bleeding occurred. The length of hospital stay, the number of perioperative complications, the number of transfusions, and episodes of alloimmunisation and/or vaso-occlusive crises in the two groups were compared. RESULTS: No patient in the aggressive management group received supplemental oxygen or had an estimated intra-operative blood loss of >400 ml. Three patients in the conservative management group received multiple intra- and post-operative transfusions and supplemental oxygen. CONCLUSION: Both aggressive and conservative protocols may be safely used in SCA patients. The more aggressive protocol resulted in lower rates for postoperative complications, transfusions, and resorting to supplemental oxygen.

Full Text

Duke Authors

Cited Authors

  • Marulanda, GA; Minniti, CP; Ulrich, SD; Seyler, TM; Mont, MA

Published Date

  • December 2009

Published In

Volume / Issue

  • 17 / 3

Start / End Page

  • 346 - 350

PubMed ID

  • 20065378

Pubmed Central ID

  • 20065378

Electronic International Standard Serial Number (EISSN)

  • 2309-4990

Digital Object Identifier (DOI)

  • 10.1177/230949900901700321

Language

  • eng

Conference Location

  • England