General Updates | Managing sickle cell disease in pregnancy: utilizing prophylactic transfusions in this setting

Wonderful conversation and question that is really near and dear to my heart. We don’t have a very good approach that’s uniform in terms of managing patients, sickle cell patients, who are pregnant. As you know, we take them off of their disease-modifying therapy and now their placenta is growing an entire organ of its own, and the fetal development and the complications of pregnancy are quite profound. So one of the approaches we have had is really utilizing transfusion therapy to improve the hemoglobin in those patients, reduce the percentage of HbS. So the idea is, depending on resources, patients’ prior pregnancy or sickle cell phenotype, thinking about whether you can do simple transfusions versus exchange transfusions. But I think we have to do it more prophylactically rather than a reactive approach because by then it may be too late to have a positive impact on that pregnancy. 

So at my clinic, my approach is either simple or exchange transfusion, depending on patient preference and their prior pregnancy experience or their sickle cell disease phenotype. If I’ve had somebody who’s had a history of acute chest and frequent aggressive vaso-occlusive crisis or other major complications, who’s done well on hydroxyurea when they become pregnant, I tend to put those on more of an exchange protocol right in the beginning. I’ve had patients who’ve generally done well or who have not been on hydroxyurea before, which are very few because if you have an indication for hydroxyurea, you really do try to optimize those patients on it. Then we may discuss simple transfusions to keep up the hemoglobin and keep their S percentages down.

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