To transfuse or not to transfuse? A pilot study evaluating preoperative transfusion practices for pediatric sickle cell patients undergoing central venous access procedures

Abstract

IntroductionPerioperative transfusion guidelines for pediatric sickle cell disease (SCD) patients are underdeveloped. The American Society of Hematology (ASH) provides transfusion recommendations for procedures requiring general anesthesia and lasting >1 hour. However, many pediatric SCD patients require long term central venous access and these short procedures do not fall within these guidelines. The objective of this study is to investigate our institutional preoperative transfusion practices in central venous access procedures. MethodsA retrospective chart review was performed from 2018 to 2022 of SCD patients who underwent a line placement or removal at a stand-alone quaternary care children's hospital. Clinical information including demographics, Hgb levels, number of transfusions, and postoperative complications were collected. Statistical analysis was performed using Fisher exact and Wilcoxon rank sum tests. ResultsA total of 30 patients underwent 34 venous access procedures (76 % line placement, 36 % line removal). Half of the patients (15) had an initial Hgb <9 g/dL. There were no significant differences in the demographics, complications, or readmission rates between patients with an initial Hgb <9 or >9 g/dL. Significantly more patients received a preoperative blood transfusion in patients with a Hgb <9 g/dL compared to those with a Hgb >9 g/dL (73% vs 20 %, p = 0.01) Length of stay, postoperative complications, intraoperative transfusion, and readmission rates were not significantly different in patients who received a preoperative transfusion. ConclusionWe encountered variability in the preoperative transfusion threshold; however, outcomes remained similar with no significant differences based on preoperative Hgb. Future studies focused on quality, safety, and resource allocation are needed for development of practice recommendations.