Sickle cell anaemia: aggressive transfusion was not better than conservative transfusion.

Clinical bottom line (level 1b-)

  1. Patients with sickle cell disease and having surgery who were given aggressive transfusion, had no clear difference in complications than those given conservative therapy.
  2. Patients given an aggressive transfusion regimen were more likely to have transfusion reactions (NNH = 15 at 30 days) .
Vichinsky et al: New England Journal of Medicine 1995; 333 (4): 206-213
Expires May 2003

The study

Unblinded concealed randomised trial without intention-to-treat
Setting: 36 hospitals, USA

551 patients (aged 40% aged 0-9; 35% aged 10-19 years, 51% male) sickle cell anaemia and undergoing elective surgery

Excluded if
  • transfusion within last three months before surgery


    • Note:
  • Patients were graded for anaesthetic risk and surgical risk.


    • Control Group: (n = 301, 301 analysed): 273 patients having 301 procedures; received conservative transfusion to maintain haemoglobin at 10 g/dl
    Experimental Group: (n = 303, 303 analysed): 278 patients having 303 procedures; received aggressive transfusion to maintain haemoglobin at 10 g/dl and HbS = 30%
    All patients had eight hours of pre-op hydration, and post-op oxygen, iv hydration and pulse oximetry.
    100% followed for 30 days
    Outcome notes:
    • serious/life-threatening complications : acute chest syndrome, painful crises, neurologic event, renal complication, fever or infection

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    serious/life-threatening complications 30 days 105
    (34.9%)    		 94
    (31.0%)    		 11%
    (-12% to 29%)    		 3.86%
    (-3.63% to 11.4%)    		 26
    (NNT = 28 to infinity;
    NNH = 9 to infinity)
    transfusion reactions 30 days 22
    (7.31%)    		 42
    (13.9%)    		 -90%
    (-210% to -16%)    		 -6.55%
    (-11.4% to -1.68%)    		 -15
    (-60 to -9)
    acute chest syndrome 30 days 30
    (9.97%)    		 30
    (9.90%)    		 1%
    (-61% to 39%)    		 0.07%
    (-4.71% to 4.84%)    		 1500
    (NNT = 21 to infinity;
    NNH = 21 to infinity)

  • 57% of the aggressive transfusion group required exchange transfusion, 30% required repeat transfusion.

    • Citation

    1. Vichinsky EP, Haberkern CM, Neumayr L, et al: A comparison of conservative and aggressive transfusion regimens in the perioperative management of sickle cell disease. New England Journal of Medicine 1995; 333 (4): 206-213
    Contributor: Chris Ball and Clare Wotton, May 2000
    Reviewer:

    Clinical Question.
    Patient sickle cell anaemia
    Intervention or Exposure aggressive transfusion
    Comparison conservative transfusion
    Outcome serious complications