TAPS supports preoperative transfusion

By Lynda Williams, Senior medwireNews Reporter

Preoperative transfusion may protect sickle cell patients from surgical complications, suggest findings published in The Lancet.

The Transfusion Alternatives Preoperatively in Sickle Cell Disease (TAPS) study showed that transfusion in the 10 days before low- or medium-risk elective surgery significantly reduced the risk for clinically significant complications in patients with hemoglobin SS subtype or Sβ thalassaemia sickle-cell-disease subtypes compared with no transfusion (15 vs 39%).

This gave an odds ratio of 3.4 for the likelihood for clinically significant complications in patients not given preoperative transfusion, after adjustment for baseline factors.

The rate of serious adverse events (SAEs) was also significantly reduced with preoperative transfusion (3 vs 30%), say Jo Howard (Guy's and St Thomas' Hospital, London, UK) and co-authors.

Of note, 12 of the 15 sickle cell disease-associated complications occurred in patients not given a preoperative transfusion.

Acute chest syndrome accounted for 10 of the 11 SAEs, with two patients admitted to intensive care and eight requiring intra- or postoperative transfusions. One patient had severe intraoperative bleeding and acute chest syndrome.

Patients given preoperative transfusions did not have a significantly longer hospital stay than those who were not (mean 5.4 vs 4.8 days), but there was a trend towards a lower rate of readmission, although it did not reach significance.

Noting mixed results for previous investigations into the benefits of preoperative transfusion in this population, the researchers emphasize: "Further evidence from randomised trials would, therefore, be required to fully clarify the extent of benefit of preoperative transfusion in patients who undergo low-risk surgery."

Nevertheless, they add: "Most cases of acute chest syndrome were seen in patients who underwent medium-risk surgery without preoperative transfusion, which suggests that this subgroup would gain the most benefit."

The randomized, controlled TAPS study reports on the outcome of 33 patients with no preoperative transfusion and 34 patients given a transfusion with intent to increase their hemoglobin concentration to 100 g/L by either top-up transfusion or partial exchange transfusion. The patients underwent low- or medium-risk procedures (19 and 81%, respectively).

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