System Maintenance Notice

Please note that maintenance work is scheduled between 4 AM and 5 AM - CET. During this time, you may experience reduced performance. Thanks for your patience.

Publications

Journal Article Epublish 2 citations

PubMed: 40276327 DOI: 10.1002/jha2.1086

Prophylactic versus on-demand transfusion in pregnant women with sickle cell disease: A systematic review and meta-analysis of randomised controlled trials.

EJHaem 6(2):e21086

Authors: Denise Menezes Brunetta, Evangelia Vlachodimitropoulou, Nita Prasannan, Paul T Seed, Eugene Oteng-Ntim

Affiliations

  • Division of Women's Health Kings College London St Thomas' Hospital London UK.
  • Empresa Brasileira de Servicos Hospitalares - EBSERH Fortaleza Brazil.
  • Centro de Hematologia e Hemoterapia do Ceara - HEMOCE Fortaleza Brazil.
  • Universidade Federal do Ceara Fortaleza Brazil.
  • Guy's and St Thomas' NHS Foundation Trust London UK.
  • Department of Non-communicable Disease Epidemiology London School of Hygiene and Tropical Medicine London UK.

Abstract

Introduction

Sickle cell disease (SCD) poses significant risks during pregnancy. Transfusions are the only recommended treatment, but there is no strong evidence of its efficacy. The aim of this study was to evaluate prophylactic transfusion on pregnancy outcomes.

Methods

We performed a systematic review and meta-analysis (PROSPERO-CRD42024510511), using MEDLINE, EMBASE, Cochrane, Web of Science, and Maternity and Infant Care. No date or language restrictions were applied. Inclusion criteria comprised randomised-controlled trials (RCTs) involving SCD pregnancy, comparing maternal and foetal outcomes for prophylactic versus on-demand transfusions. Two independent reviewers performed screening, selection, and data extraction, following PRISMA. Two authors independently assessed certainty and risk-of-bias. Data were pooled using random-effects model. Primary outcomes included mortality, vaso-occlusive crisis (VOC), acute chest syndrome, venous thromboembolism and preterm delivery. The measure of the effect was the unadjusted odds ratio (OR), calculated from numbers of events.

Results

Ninety-one studies were identified and two RCTs (106 patients) were included, with uncertain and low risk of bias. Prophylactic transfusions reduced VOC, OR of 0.197 (95% CI 0.08-0.49). However, due to the small number of patients, this meta-analysis was underpowered to evaluate other outcomes.

Conclusion

A larger RCT is needed to comprehensively assess the impact of prophylactic transfusion in SCD pregnancy.

MeSH

Pregnant Women, Cells, Bias, Pregnancy, Anemia, Sickle Cell