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Cochrane Database of Systematic Reviews

Transfusión sanguínea profiláctica versus selectiva para la anemia falciforme del embarazo

Información

DOI:
https://doi.org/10.1002/14651858.CD010378.pub3Copiar DOI
Base de datos:
  1. Cochrane Database of Systematic Reviews
Versión publicada:
  1. 22 diciembre 2016see what's new
Tipo:
  1. Intervention
Etapa:
  1. Review
Grupo Editorial Cochrane:

  1. Grupo Cochrane de Embarazo y parto

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Autores

  • Babasola O Okusanya

    Correspondencia a: Experimental and Maternal Medicine Unit, Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Idi‐Araba, Lagos, Nigeria

    [email protected]

  • Olufemi T Oladapo

    UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland

Contributions of authors

BO Okusanya and OT Oladapo independently assessed trials for inclusion and extracted data from the included study. BO Okusanya prepared the first draft of the review and has overall responsibility for maintaining the review. OT Oladapo revised and contributed to the final draft of the review.

Sources of support

Internal sources

  • UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.

External sources

  • No sources of support supplied

Declarations of interest

Babasola O Okusanya: none known.

Olufemi T Oladapo: none known.

Acknowledgements

The contact author acknowledges the assistance of Reviews for Africa Programme (RAP) Nigeria run by the Nigerian Branch of the South African Cochrane Centre towards the completion of the first version of this review (Okusanya 2013b). RAP‐Nigeria was funded by a grant from the Department for International Development (DFID) through the Research Programme Consortium at the Liverpool School of Tropical Medicine.

This project was supported by the National Institute for Health Research, via Cochrane Infrastructure funding to Cochrane Pregnancy and Childbirth. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health.

The World Health Organization and BO Okusanya retain copyright and all other rights in their respective contributions to the manuscript of this review as submitted for publication.

Version history

Published

Title

Stage

Authors

Version

2016 Dec 22

Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy

Review

Babasola O Okusanya, Olufemi T Oladapo

https://doi.org/10.1002/14651858.CD010378.pub3

2013 Dec 03

Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy

Review

Babasola O Okusanya, Olufemi T Oladapo

https://doi.org/10.1002/14651858.CD010378.pub2

2013 Feb 28

Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy

Protocol

Babasola O Okusanya, Olufemi T Oladapo

https://doi.org/10.1002/14651858.CD010378

Differences between protocol and review

The frequency of sickle cell crises (vaso‐occlusive, sequestration or haemolytic) listed as a secondary outcome in the protocol was amended to the number of women experiencing the individual types of sickle cell crisis in the review. This is because the included trial (Koshy 1988) separately reported the number of women experiencing pain, sequestration and haemolytic crises and it was impossible to derive the number of women experiencing 'any sickle cell crisis' from the reported data. In future updates when sufficient data become available, both the frequency of sickle cell crises and the number of women experiencing each of them will be reported in the review.

The last published version of this review (Okusanya 2013b) included two studies (Koshy 1987; Koshy 1988). However, after careful scrutiny, it appears that these two studies are in fact reporting on a single trial (Koshy 1988) and so the current update now only includes one trial (Koshy 1988).

Keywords

MeSH

Medical Subject Headings (MeSH) Keywords

Medical Subject Headings Check Words

Female; Humans; Pregnancy;

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

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'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Figuras y tablas -
Figure 2

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
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Figure 3

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Comparison 1 Prophylactic versus selective blood transfusion, Outcome 1 Maternal death.
Figuras y tablas -
Analysis 1.1

Comparison 1 Prophylactic versus selective blood transfusion, Outcome 1 Maternal death.

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Comparison 1 Prophylactic versus selective blood transfusion, Outcome 2 Severe maternal morbidity (pulmonary embolism).
Figuras y tablas -
Analysis 1.2

Comparison 1 Prophylactic versus selective blood transfusion, Outcome 2 Severe maternal morbidity (pulmonary embolism).

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Comparison 1 Prophylactic versus selective blood transfusion, Outcome 3 Severe maternal morbidity (congestive cardiac failure).
Figuras y tablas -
Analysis 1.3

Comparison 1 Prophylactic versus selective blood transfusion, Outcome 3 Severe maternal morbidity (congestive cardiac failure).

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Comparison 1 Prophylactic versus selective blood transfusion, Outcome 4 Severe maternal morbidity (acute chest syndrome).
Figuras y tablas -
Analysis 1.4

Comparison 1 Prophylactic versus selective blood transfusion, Outcome 4 Severe maternal morbidity (acute chest syndrome).

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Comparison 1 Prophylactic versus selective blood transfusion, Outcome 5 Perinatal death.
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Analysis 1.5

Comparison 1 Prophylactic versus selective blood transfusion, Outcome 5 Perinatal death.

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Comparison 1 Prophylactic versus selective blood transfusion, Outcome 6 Sickle cell crisis (pain crisis).
Figuras y tablas -
Analysis 1.6

Comparison 1 Prophylactic versus selective blood transfusion, Outcome 6 Sickle cell crisis (pain crisis).

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Comparison 1 Prophylactic versus selective blood transfusion, Outcome 7 Sickle cell crises (acute splenic sequestration).
Figuras y tablas -
Analysis 1.7

Comparison 1 Prophylactic versus selective blood transfusion, Outcome 7 Sickle cell crises (acute splenic sequestration).

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Comparison 1 Prophylactic versus selective blood transfusion, Outcome 8 Sickle cell crisis (haemolysis).
Figuras y tablas -
Analysis 1.8

Comparison 1 Prophylactic versus selective blood transfusion, Outcome 8 Sickle cell crisis (haemolysis).

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Comparison 1 Prophylactic versus selective blood transfusion, Outcome 9 Blood transfusion reaction.
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Analysis 1.9

Comparison 1 Prophylactic versus selective blood transfusion, Outcome 9 Blood transfusion reaction.

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Summary of findings for the main comparison. Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy

Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy

Patient or population: patients with sickle cell disease in pregnancy
Settings: secondary and tertiary hospital in USA
Intervention: prophylactic

Control: selective blood transfusion

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Control

Prophylactic versus selective blood transfusion

Maternal death

See comment

See comment

Not estimable

72
(1 study)

⊕⊝⊝⊝
very low1,2,3

No woman in this study died.

Severe maternal morbidity (pulmonary embolism)

See comment

See comment

Not estimable

72
(1 study)

⊕⊝⊝⊝
very low1,2

No woman in this study experienced pulmonary embolism.

Severe maternal morbidity (congestive cardiac failure)

28 per 1000

28 per 1000
(2 to 427)

RR 1.00
(0.07 to 15.38)

72
(1 study)

⊕⊝⊝⊝
very low1,4

Perinatal death

54 per 1000

154 per 1000
(33 to 715)

RR 2.85
(0.61 to 13.22)

76
(1 study)

⊕⊝⊝⊝
very low1,4

Sickle cell crisis (pain crisis)

500 per 1000

140 per 1000
(60 to 335)

RR 0.28
(0.12 to 0.67)

72
(1 study)

⊕⊕⊝⊝
low1,5

Sickle cell crises (acute splenic sequestration)

28 per 1000

9 per 1000
(0 to 220)

RR 0.33
(0.01 to 7.92)

72
(1 study)

⊕⊕⊝⊝
low1,5

Blood transfusion reaction

83 per 1000

167 per 1000
(45 to 616)

RR 2.00
(0.54 to 7.39)

72
(1 study)

⊕⊝⊝⊝
very low1,4

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 The only study was at uncertain risk of bias due to unclear methods of random sequence generation and allocation concealment, and lack of blinding.
2 No events and few study participants. Confidence interval expected to be very wide.
3 Reporting bias likely. Maternal death was not a pre‐specified study outcome but was reported in the result.
4 Very few events, small total number of participants, and wide confidence interval.
5 Few events and small total number of participants.

Figuras y tablas -
Summary of findings for the main comparison. Prophylactic versus selective blood transfusion for sickle cell disease in pregnancy
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Comparison 1. Prophylactic versus selective blood transfusion

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Maternal death Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Severe maternal morbidity (pulmonary embolism) Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

0.0 [0.0, 0.0]

3 Severe maternal morbidity (congestive cardiac failure) Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

1.0 [0.07, 15.38]

4 Severe maternal morbidity (acute chest syndrome) Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

0.67 [0.12, 3.75]

5 Perinatal death Show forest plot

1

76

Risk Ratio (M‐H, Fixed, 95% CI)

2.85 [0.61, 13.22]

6 Sickle cell crisis (pain crisis) Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

0.28 [0.12, 0.67]

7 Sickle cell crises (acute splenic sequestration) Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.01, 7.92]

8 Sickle cell crisis (haemolysis) Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

0.33 [0.04, 3.06]

9 Blood transfusion reaction Show forest plot

1

72

Risk Ratio (M‐H, Fixed, 95% CI)

2.0 [0.54, 7.39]
Figuras y tablas -
Comparison 1. Prophylactic versus selective blood transfusion
Ir a la tabla de la revisión