Prophylactic vs therapeutic blood transfusions impact on pregnant sickle cell patients.

Objective: To observe the fetomaternal outcome of therapeutic versus prophylactic blood transfusions in patients with sickle cell disease (SCD) during pregnancy.

Method: This single-center retrospective observational study was conducted on consecutive pregnant women with SCD between January 2018 and December 2020. All the pregnant women with SCD were included in this study. Sickler women carrying sickle cell traits (HbAS, HbAC), multiple pregnancy, or other medical diseases were excluded from the study. We used non-random, convenience sampling and collected their demographic details, medical history, course of SCD before & during pregnancy, maternal/fetal outcome, laboratory parameters, and other information using the questionnaire. Patients were sub-grouped into three according to blood transfusion categories (therapeutic, prophylactic, or not transfused) during the pregnancy. Descriptive data were represented as numbers and mean ± SD values. The medical and obstetrical complications and fetomaternal outcomes among the three groups were analyzed by Chi-square/Fisher's Extract test.

Results: The study included 62 patients, 37 were in the therapeutic group, 11 were in the prophylactic group, and 14 were in the non-transfusion group. Hemolytic crises, painful crises, acute chest syndrome, pregnancy-induced hypertension (PIH), preeclampsia, preterm births, intrauterine growth retardation (IUGR), and neonatal ICU admission were significantly lower among the prophylactic group (P = 0.000, p = 0.000, p = 0.001, p = 0.002, p = 0.009, p = 0.007, p =0.001 & p= 0.016 respectively) compared with other two groups.

Conclusions: Our study demonstrates that prophylactic blood transfusion in SCD positively alters the course of pregnancy by reducing fetomaternal complications.