Sickle Cell Pre-Op Transfusion Strategy — FRCA Final MCQ

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ModeratePaediatric AnaesthesiaSickle Cell Pre-Op Transfusion StrategyFRCA Final

A 10-year-old child (35 kg) with sickle cell disease (HbSS) requires a tonsillectomy. His last haemoglobin crisis was 3 months ago. Pre-operative Hb is 78 g/L and HbS is 65%. According to SCAN guidelines, what pre-operative transfusion strategy should be used?

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Correct answer: A — Exchange transfusion to reduce HbS to <50%

For children with sickle cell disease undergoing intermediate-risk surgery (tonsillectomy), the SCAN (Sickle Cell and Anaesthesia Network) guidelines recommend pre-operative simple transfusion to achieve Hb ≥100 g/L. The TAPS trial (2013) showed that simple transfusion (targeting Hb 100 g/L) was non-inferior to aggressive exchange transfusion (targeting HbS <30%) for reducing perioperative complications, with fewer transfusion-related adverse events. This patient with Hb 78 requires a top-up transfusion of approximately 1-2 units to reach Hb 100 g/L. HbS percentage decreases proportionally with simple transfusion.

Reference: Howard J et al – 2013 – TAPS trial; SCAN – 2020 – Sickle cell perioperative guidelines