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Cochrane Database of Systematic Reviews

Preoperative blood transfusions for sickle cell disease

Overview of attention for article published in Cochrane database of systematic reviews, April 2016
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  • In the top 25% of all research outputs scored by Altmetric
  • Good Attention Score compared to outputs of the same age (76th percentile)
  • Average Attention Score compared to outputs of the same age and source

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3 tweeters
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2 Facebook pages
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1 Wikipedia page

Citations

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32 Dimensions

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154 Mendeley
Title
Preoperative blood transfusions for sickle cell disease
Published in
Cochrane database of systematic reviews, April 2016
DOI 10.1002/14651858.cd003149.pub3
Pubmed ID
Authors

Lise J Estcourt, Patricia M Fortin, Marialena Trivella, Sally Hopewell

Abstract

Sickle cell disease is one of the commonest severe monogenic disorders in the world, due to the inheritance of two abnormal haemoglobin (beta globin) genes. Sickle cell disease can cause severe pain, significant end-organ damage, pulmonary complications, and premature death. Surgical interventions are more common in people with sickle cell disease, and occur at much younger ages than in the general population. Blood transfusions are frequently used prior to surgery and several regimens are used but there is no consensus over the best method or the necessity of transfusion in specific surgical cases. This is an update of a Cochrane review first published in 2001. To determine whether there is evidence that preoperative blood transfusion in people with sickle cell disease undergoing elective or emergency surgery reduces mortality and perioperative or sickle cell-related serious adverse events.To compare the effectiveness of different transfusion regimens (aggressive or conservative) if preoperative transfusions are indicated in people with sickle cell disease. We searched for relevant trials in The Cochrane Library, MEDLINE (from 1946), Embase (from 1974), the Transfusion Evidence Library (from 1980), and ongoing trial databases; all searches current to 23 March 2016.We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register: 18 January 2016. All randomised controlled trials and quasi-randomised controlled trials comparing preoperative blood transfusion regimens to different regimens or no transfusion in people with sickle cell disease undergoing elective or emergency surgery. There was no restriction by outcomes examined, language or publication status. Two authors independently assessed trial eligibility and the risk of bias and extracted data. Three trials with 990 participants were eligible for inclusion in the review. There were no ongoing trials identified. These trials were conducted between 1988 and 2011. The majority of people included had haemoglobin (Hb) SS SCD. The majority of surgical procedures were considered low or intermediate risk for developing sickle cell-related complications. Aggressive versus simple red blood cell transfusionsOne trial (551 participants) compared an aggressive transfusion regimen (decreasing sickle haemoglobin to less than 30%) to a simple transfusion regimen (increasing haemoglobin to 100 g/l). This trial re-randomised participants and therefore quantitative analysis was only possible on two subsets of data: participants undergoing cholecystectomy (230 participants); and participants undergoing tonsillectomy or adenoidectomy surgeries (107 participants). Data were not combined as we do not know if any participant received both surgeries. Overall, the quality of the evidence was very low across different outcomes according to GRADE methodology. This was due to the trial being at high risk of bias primarily due to lack of blinding, indirectness and the outcome estimates being imprecise. Cholecystectomy subgroup results are reported in the abstract. Results for both subgroups were similar.There was no difference in all-cause mortality between people receiving aggressive transfusions and those receiving conservative transfusions. No deaths occurred in either subgroup.There were no differences between the aggressive transfusion group and conservative transfusion group in the number of people developing:• an acute chest syndrome, risk ratio 0.84 (95% confidence interval 0.38 to 1.84) (one trial, 230 participants, very low quality evidence);• vaso-occlusive crisis, risk ratio 0.30 (95% confidence interval 0.09 to 1.04) (one trial, 230 participants, very low quality evidence);• serious infection, risk ratio 1.75 (95% confidence interval 0.59 to 5.18) (one trial, 230 participants, very low quality evidence);• any perioperative complications, risk ratio 0.75 (95% confidence interval 0.36 to 1.55) (one trial, 230 participants, very low quality evidence);• a transfusion-related complication, risk ratio 1.85 (95% confidence interval 0.89 to 3.88) (one trial, 230 participants, very low quality evidence). Preoperative transfusion versus no preoperative transfusionTwo trials (434 participants) compared a preoperative transfusion plus standard care to a group receiving standard care. Overall, the quality of the evidence was low to very low across different outcomes according to GRADE methodology. This was due to the trials being at high risk of bias due to lack of blinding, and outcome estimates being imprecise. One trial was stopped early because more people in the no transfusion arm developed an acute chest syndrome.There was no difference in all-cause mortality between people receiving preoperative transfusions and those receiving no preoperative transfusions (two trials, 434 participants, no deaths occurred).There was significant heterogeneity between the two trials in the number of people developing an acute chest syndrome, a meta-analysis was therefore not performed. One trial showed a reduced number of people developing acute chest syndrome between people receiving preoperative transfusions and those receiving no preoperative transfusions, risk ratio 0.11 (95% confidence interval 0.01 to 0.80) (65 participants), whereas the other trial did not, risk ratio 4.81 (95% confidence interval 0.23 to 99.61) (369 participants).There were no differences between the preoperative transfusion groups and the groups without preoperative transfusion in the number of people developing:• a vaso-occlusive crisis, Peto odds ratio 1.91 (95% confidence interval 0.61 to 6.04) (two trials, 434 participants, very low quality evidence).• a serious infection, Peto odds ratio 1.29 (95% confidence interval 0.29 to 5.71) (two trials, 434 participants, very low quality evidence);• any perioperative complications, risk ratio 0.24 (95% confidence interval 0.03 to 2.05) (one trial, 65 participants, low quality evidence).There was an increase in the number of people developing circulatory overload in those receiving preoperative transfusions compared to those not receiving preoperative transfusions in one of the two trials, and no events were seen in the other trial (no meta-analysis performed). There is insufficient evidence from randomised trials to determine whether conservative preoperative blood transfusion is as effective as aggressive preoperative blood transfusion in preventing sickle-related or surgery-related complications in people with HbSS disease. There is very low quality evidence that preoperative blood transfusion may prevent development of acute chest syndrome.Due to lack of evidence this review cannot comment on management for people with HbSC or HbSβ(+) disease or for those with high baseline haemoglobin concentrations.

Twitter Demographics

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Mendeley readers

The data shown below were compiled from readership statistics for 154 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United Kingdom 1 <1%
Canada 1 <1%
Brazil 1 <1%
Unknown 151 98%

Demographic breakdown

Readers by professional status Count As %
Student > Master 27 18%
Student > Bachelor 25 16%
Researcher 15 10%
Student > Doctoral Student 13 8%
Student > Ph. D. Student 12 8%
Other 38 25%
Unknown 24 16%
Readers by discipline Count As %
Medicine and Dentistry 68 44%
Nursing and Health Professions 21 14%
Biochemistry, Genetics and Molecular Biology 10 6%
Pharmacology, Toxicology and Pharmaceutical Science 4 3%
Social Sciences 4 3%
Other 14 9%
Unknown 33 21%

Attention Score in Context

This research output has an Altmetric Attention Score of 7. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 04 January 2019.
All research outputs
#2,569,349
of 14,116,115 outputs
Outputs from Cochrane database of systematic reviews
#5,414
of 10,854 outputs
Outputs of similar age
#60,806
of 263,699 outputs
Outputs of similar age from Cochrane database of systematic reviews
#106
of 185 outputs
Altmetric has tracked 14,116,115 research outputs across all sources so far. Compared to these this one has done well and is in the 81st percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 10,854 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 21.6. This one is in the 49th percentile – i.e., 49% of its peers scored the same or lower than it.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 263,699 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 76% of its contemporaries.
We're also able to compare this research output to 185 others from the same source and published within six weeks on either side of this one. This one is in the 42nd percentile – i.e., 42% of its contemporaries scored the same or lower than it.