PERIOPERATIVE MANAGEMENT OF SICKLE CELL DISEASE: A NARRATIVE REVIEW

Kwame Ofori Adjepong, Folashade Otegbeye, Yaw Amoateng ADJEPONG
  • Kwame Ofori Adjepong
    Warren Alpert Medical School, Brown University, United States
  • Folashade Otegbeye
    Case Western Reserve University, University Hospitals Cleveland Medical Center, United States
  • Yaw Amoateng ADJEPONG
    Yale University School of Medicine, United States | pyamoa@bpthosp.org

Abstract

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. 

Keywords

Sickle cell disease, perioperative, transfusion

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