A Comparison of Conservative and Aggressive Transfusion Regimens in the Perioperative Management of Sickle Cell Disease

Perioperative complications in patients with sickle cell anemia are common. 1 – 9 Early reviews reported perioperative mortality rates as high as 10 percent, and the rate of postoperative complications reached 50 percent. 8 , 10 – 17 These problems may arise from perioperative hypoxia, hypoperfusion, and acidosis, which cause erythrocytes to sickle, thus precipitating vaso-occlusion and organ dysfunction. To prevent these complications, transfusions of red cells are given to reduce the proportion of sickle erythrocytes and correct the anemia. Various regimens, ranging from conservative (correcting the anemia) to aggressive (lowering the level of hemoglobin S to less than 30 percent), have been used. 2 , . . .