PERIOPERATIVE MANAGEMENT OF SICKLE CELL DISEASE: A NARRATIVE REVIEW

• Main Authors: Kwame Ofori Adjepong, Folashade Otegbeye, Yaw Amoateng ADJEPONG
• Format: Article
• Language: English
• Published: PAGEPress Publications 2018-05-01
• Series: Mediterranean Journal of Hematology and Infectious Diseases
• Subjects: Sickle cell disease, perioperative, transfusion
• Online Access: https://www.mjhid.org/index.php/mjhid/article/view/3228

An estimated 30 million people worldwide have sickle cell disease (SCD).  Emergent and non-emergent surgical procedures in SCD have been associated with relatively increased risks of peri-operative mortality, vaso-occlussive (painful) crisis, acute chest syndrome, post-operative infections, congestive heart failure, cerebrovascular accident and acute kidney injury.  Pre-operative assessment must include careful review of the patient’s known crisis triggers, baseline hematologic profile, usual transfusion requirements, pre-existing organ dysfunction and narcotic use. Use of preoperative blood transfusions should be selective and decisions individualized based on the baseline hemoglobin, surgical procedure and anticipated volume of blood loss.  Intra- and post-operative management should focus on minimizing hypoxia, hypothermia, acidosis, and intravascular volume depletion. Pre- and post-operative incentive spirometry use should be encouraged.