TAPS: Preoperative Transfusion in Sickle Cell Disease

Simple preop transfusion to Hb 10 cut serious complications by 60% in moderate-risk surgery.

Population

67 patients with HbSS or HbSβ⁰ thalassemia undergoing low-/medium-risk surgery (cholecystectomy, ortho, ENT) at 17 UK + Netherlands centers.

Intervention

Simple preop transfusion to Hb ≥10 g/dL within 10 days of surgery.

Comparison

No transfusion.

Outcome

Composite of clinically important complications (acute chest, vaso-occlusive crisis, stroke, transfusion reaction) within 30 days.

Open-label RCT. Trial halted early at scheduled interim analysis for clear benefit. Stratified by surgery risk + center.

• Composite complications: 39% no-transfusion vs 15% transfusion (OR 3.81, 95% CI 1.24-11.7, P=0.013) — trial stopped.
• Acute chest syndrome: 27% vs 3%.
• Total transfusion-related complications were similar — preop transfusion did not cause excess delayed hemolytic reactions in the modest sample.

Pre-op simple transfusion to Hb 10 g/dL reduces sickle cell complications in low-/medium-risk surgery — now standard of care in major centers. Reserve EXCHANGE transfusion to HbS <30% for high-risk surgery (cardiac, cranial, major vascular) per ASH 2020. For low-risk same-day procedures (myringotomy, dental), no transfusion is reasonable. Always continue hydroxyurea, maintain normothermia + euvolemia + normoxia + adequate analgesia regardless of transfusion strategy. Watch for acute chest post-op (#1 cause of perioperative death).

• Small (67 patients) — early stopping makes effect size estimate uncertain.
• Excluded high-risk surgery — generalizability to cardiac/cranial/major vascular is limited.
• UK + Dutch population — different baseline alloimmunization rates than US sickle cell populations.
• Pre-hydroxyurea-era practice may understate baseline VOC rate.

1. Is your sickle cell preop pathway: simple-to-10 for low/medium, exchange-to-30% for high-risk? Or institutional variation?
2. How do you handle the alloimmunized patient where transfusion carries delayed hemolytic reaction risk?
3. Should ALL sickle cell patients have hematology preop consult, or only those needing transfusion decision?