Perioperative management for orthopaedic patients with sickle cell anaemia.

German A. Marulanda, Caterina P. Minniti, Slif D. Ulrich, Thorsten M. Seyler, Michael A. Mont

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

PURPOSE: To compare outcomes of 2 types of perioperative optimisation for patients with sickle cell anaemia (SCA) undergoing various orthopaedic surgeries. METHODS: 12 female and 11 male patients aged 13 to 40 (mean, 18) years with SCA underwent 31 separate orthopaedic procedures for osteonecrosis of the femoral head. They were referred to a haematologist for 2 types of perioperative optimisation, based on the choice of the attending paediatrician. In the aggressive management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to 9 to 11 g/dl and to lower the haemoglobin S level to <30%. Fresh frozen plasma was given when their Factor VII level was <30%. In the conservative management group, patients received packed red blood cells preoperatively to increase the haemoglobin level to a minimum of 10 g/dl. Fresh frozen plasma or packed red blood cells were given intra-operatively only when excessive bleeding occurred. The length of hospital stay, the number of perioperative complications, the number of transfusions, and episodes of alloimmunisation and/or vaso-occlusive crises in the two groups were compared. RESULTS: No patient in the aggressive management group received supplemental oxygen or had an estimated intra-operative blood loss of >400 ml. Three patients in the conservative management group received multiple intra- and post-operative transfusions and supplemental oxygen. CONCLUSION: Both aggressive and conservative protocols may be safely used in SCA patients. The more aggressive protocol resulted in lower rates for postoperative complications, transfusions, and resorting to supplemental oxygen.

Original languageEnglish (US)
Pages (from-to)346-350
Number of pages5
JournalJournal of Orthopaedic Surgery
Volume17
Issue number3
StatePublished - Dec 2009
Externally publishedYes

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Sickle Cell Anemia
Orthopedics
Oxygen
Orthopedic Procedures
Sickle Hemoglobin
Osteonecrosis
Thigh
Hemoglobins
Erythrocytes

ASJC Scopus subject areas

  • Surgery

Cite this

Marulanda, G. A., Minniti, C. P., Ulrich, S. D., Seyler, T. M., & Mont, M. A. (2009). Perioperative management for orthopaedic patients with sickle cell anaemia. Journal of Orthopaedic Surgery, 17(3), 346-350.

Perioperative management for orthopaedic patients with sickle cell anaemia. / Marulanda, German A.; Minniti, Caterina P.; Ulrich, Slif D.; Seyler, Thorsten M.; Mont, Michael A.

In: Journal of Orthopaedic Surgery, Vol. 17, No. 3, 12.2009, p. 346-350.

Research output: Contribution to journalArticle

Marulanda, GA, Minniti, CP, Ulrich, SD, Seyler, TM & Mont, MA 2009, 'Perioperative management for orthopaedic patients with sickle cell anaemia.', Journal of Orthopaedic Surgery, vol. 17, no. 3, pp. 346-350.
Marulanda, German A. ; Minniti, Caterina P. ; Ulrich, Slif D. ; Seyler, Thorsten M. ; Mont, Michael A. / Perioperative management for orthopaedic patients with sickle cell anaemia. In: Journal of Orthopaedic Surgery. 2009 ; Vol. 17, No. 3. pp. 346-350.
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