Prophylactic transfusion for pregnant women with sickle cell disease: A systematic review and meta-analysis

Abstract

Pregnancy in women with sickle cell disease is associated with adverse maternal and neonatal outcomes. Studies assessing the effects of prophylactic red blood cell transfusions on these outcomes have drawn inconsistent conclusions. The objective of this systematic review was to assess the effect of prophylactic compared with on-demand red blood cell transfusions on maternal and neonatal outcomes in women with sickle cell disease. A systematic search of several medical literature databases was conducted. Twelve studies involving 1291 participants met inclusion criteria. The studies had moderate to high risk of bias. Meta-analysis demonstrated that prophylactic transfusion was associated with a reduction in maternal mortality (7 studies, 955 participants; odds ratio [OR], 0.23; 95% confidence interval [CI], 0.06-0.91), vaso-occlusive pain episodes (11 studies, 1219 participants; OR, 0.26; 95% CI, 0.09-0.76), pulmonary complications (9 studies, 1019 participants; OR, 0.25; 95% CI, 0.09-0.72), pulmonary embolism (3 studies, 237 participants; OR, 0.07;95%CI,0.01-0.41),pyelonephritis (6studies,455participants;OR,0.19;95%CI, 0.07-0.51), perinatal mortality (8 studies, 1140 participants; OR, 0.43; 95% CI, 0.19-0.99), neonatal death (5 studies, 374 participants; OR, 0.26; 95% CI, 0.07-0.93), and preterm birth (9 studies, 1123participants;OR, 0.59;95%CI, 0.37-0.96).Event rates formostof the resultswere low.Prophylactic transfusionsmaypositivelyimpact several adversematernal and neonatal outcomes in women with sickle cell disease; however, the evidence stems from a relatively small number of studieswithmethodologic limitations.Aprospective,multicenter, randomizedtrial isneededtodeterminewhether thepotential benefits balance the risks of prophylactic transfusions.