Sickle cell disease patients receive questionable surgical transfusion care

Susan Claster, MD, and colleagues at Children’s Hospital in Los Angeles report that over half of the sickle cell disease (SCD) patients in the state of California do not receive transfusions in association with surgical procedures. 

The investigators conducted a retrospective cohort study using 2005-2008 public data from the California Office of Statewide Health Planning and Development. They found that in the period, 468 visits to California hospitals by patients with SCD were associated with one of six targeted surgical procedures. And 222 of these surgical cases (47.4%) were associated with a transfusion.

The timing of transfusion was available for 179 cases: 145 patients (81%) had a preoperative transfusion and 34 (19%) of patients had a transfusion following surgery. 

Clinicians documented acute chest syndrome (ACS) in 59 (12.6%) of surgical patients. Forty- three cases of a ACS appeared among the transfused patients (19%), and 16 cases (6.5%) appeared among the non-transfused group.  

The researchers concluded, “Although we were unable to determine if preoperative transfusions were administered prior to hospital admission, the data suggests that many patients are not being given what many sickle cell providers in the US consider standard preoperative treatment.  Finally, the frequency of ACS in transfused patients was nearly twice that of the study performed in academic sickle cell centers in 1995. This finding is consistent with the notion that many California patients do not receive care at a sickle cell center and thus may have poorer outcomes.”