1 Warren Alpert Medical School, Brown University, United States.
2 Case Western Reserve University, University Hospitals Cleveland Medical Center, United States.
3 Yale University School of Medicine, Yale New Haven Health, Bridgeport Hospital, United States.
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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-occlusive (painful) crisis, acute chest syndrome, post-operative
infections, congestive heart failure, cerebrovascular accident and
acute kidney injury. Pre-operative assessment must include a
careful review of the patient's known crisis triggers, baseline
hematologic profile, usual transfusion requirements, pre-existing organ
dysfunction and opioid 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.
|Table 1. Common surgical procedures in sickle cell disease.|
Genetics of Sickle Cell Disease
|Table 2. Percent Hb S concentration in selected major Sickle Cell genotypes.|
Pre-Operative Assessment and Interventions
|Table 3. Cardiac and Pulmonary Complications in Sickle Cell disease.|
|Table 4. Randomized control trials.|
|Table 5. Observational studies|
Take Home Points