Table 2.
Consensus results of the Delphi panel for transfusion for pregnant patients with SCD
| Statement | Agreement % (n/N) |
|---|---|
| 1.1. Start of transfusion therapy | |
| Regular transfusion therapy should be started straight after hydroxyurea therapy is stopped‡ | 50.0 (6/12) |
| Prophylactic transfusion therapy should be started if >2 hospitalizations for acute pain during 1 month in the pregnancy† | 83.3 (10/12) |
| Prophylactic transfusion therapy should be started if the patient had poor fetal outcomes or fetal loss during (a) previous pregnancy/pregnancies‡ | 66.7 (8/12) |
| Prophylactic transfusion therapy should be started if the patient has a history of poor maternal outcomes during (a) previous pregnancy/pregnancies (eg, a serious complication, several hospitalizations, or severe pain)∗ | 91.7 (11/12) |
| Prophylactic transfusion therapy should be started if the patient developed end-organ injury unrelated to stroke during pregnancy† | 75.0 (9/12) |
| Prophylactic transfusion therapy should not be started for all pregnant individuals with SCD‡ | 58.3 (7/12) |
| Prophylactic transfusion therapy should not be started for all pregnant individuals with HbSS genotype‡ | 58.3 (7/12) |
| The only absolute indication for prophylactic transfusion therapy for pregnant individuals with SCD is primary and secondary stroke prophylaxis‡ | 50.0 (6/12) |
| The only absolute contraindication for prophylactic transfusion therapy during the pregnancy of a patient with SCD is safety concerns related to their transfusion history (eg, a history of serious transfusion complications or reactions, or multiple alloantibodies)∗ | 91.7 (11/12) |
| Start prophylactic transfusion therapy as soon as possible after the decision is made‡ | 58.3 (7/12) |
| 1.2. Targets and transfusion modalities | |
| The frequency of prophylactic transfusions cannot be established upfront because this depends on the patient’s Hb and HbS levels‡ | 66.7 (8/12) |
| I would not recommend aRBCx throughout pregnancy for patients presenting with a baseline Hb of ≥7.0 g/dL† | 75.0 (9/12) |
| I would recommend STs throughout pregnancy for patients presenting with a baseline Hb of <7.0 g/dL‡ | 50.0 (6/12) |
| In case of iron overload, I would recommend aRBCx over ST, throughout pregnancy† | 75.0 (9/12) |
| Target Hb levels for prophylactic transfusion therapy should be 10 g/dL, and the target Hct should be 30% ± 3%‡ | 66.7 (8/12) |
| Pretransfusion target HbS should be <30%† | 75.0 (9/12) |
| RBC matching for Rh and Kell antigens is recommended to prevent alloimmunization from transfusions‡ | 58.3 (7/12) |
| RBC genotyping, or more extended phenotyping, is recommended to prevent alloimmunization from transfusions‡ | 66.7 (8/12) |
| aRBCx is not preferred over ST and mRBCx (modified/partial) to prevent alloimmunization (presuming the same method of RBC phenotyping/genotyping) ‡ | 66.7 (8/12) |
| In the absence of resource constraints and if I had free choice, I would recommend leukocyte-reduced (prestorage) blood products† | 75.0 (9/12) |
| In the absence of resource constraints and if I had free choice, I would recommend sickle trait–negative blood products† | 83.3 (10/12) |
| In the absence of resource constraints and if I had free choice, I would recommend CMV-negative blood products‡ | 41.7 (5/12) |
| If the patient is already on regular transfusions for secondary stroke prophylaxis, the mere fact of pregnancy would not influence the decision regarding transfusion† | 75.0 (9/12) |
| 1.3. Transfusion access | |
| If prophylactic transfusions were initiated, I would recommend peripheral venous access whenever possible (pending vascular access/venous assessment)† | 83.3 (10/12) |
| Even with difficult venous access, I would recommend the same transfusion modality, using different access† | 75.0 (9/12) |
| I would not adapt transfusion modality to the type of access† | 83.3 (10/12) |
CMV, cytomegalovirus; Hct, hematocrit; n/N, number of agreeing panelists/total number of panelists.
∗
Strong consensus.
†
Consensus.
‡
No consensus.