Table 3.
Consensus results of the Delphi panel for treatment of SCD complications during pregnancy
| Statement | Agreement % (n/N) |
|---|---|
| 1.1. Transfusion as treatment of complications | |
| In a patient with progressively worsening asymptomatic anemia, recommend transfusion: | |
| if their Hb level dropped to ≥2 g/dL below baseline‡ | 41.7 (5/12) |
| if their Hb level dropped to <7 g/dL‡ | 50.0 (6/12) |
| if their Hb level dropped to <4 g/dL‡ | 66.7 (8/12) |
| based on clinical tolerance, regardless of Hb levels‡ | 41.7 (5/12) |
| if the patient becomes symptomatic‡ | 66.7 (8/12) |
| I would not perform transfusion for a single, uncomplicated acute pain episode‡ | 66.7 (8/12) |
| I would choose the transfusion modality depending on the Hb level‡ | 33.3 (4/12) |
| In a patient with ACS, the preferred transfusion modality would depend on the severity of their illness and their baseline Hb (aRBCx would be preferred in case of severe illness, ST would be indicated in case of Hb of <7 g/dL)∗ | 100 (12/12) |
| If transfusion is performed after ACS, I would recommend continuing prophylactic transfusions throughout pregnancy∗ | 91.7 (11/12) |
| Frequency of prophylactic transfusions after an ACS episode should be decided on a case-by-case basis‡ | 58.3 (7/12) |
| I may recommend a transfusion in the acute setting for life-threatening events, even in the presence of patient- or disease-specific factors that would make me recommend against prophylactic transfusions in the outpatient setting (eg, a history of serious transfusion reactions, or multiple alloantibodies)† | 83.3 (10/12) |
| Presence of intrauterine growth retardation would influence my decision regarding the recommendation for transfusion in the acute setting∗ | 91.7 (11/12) |
| Presence of fetal distress due to maternal complications (in the absence of indications for delivery) would influence my decision regarding the recommendation for transfusion in the acute setting† | 75.0 (9/12) |
| Presence of uteroplacental failure would influence my decision regarding the recommendation for transfusion in the acute setting‡ | 66.7 (8/12) |
| Presence of oligohydramnios would influence my decision regarding the recommendation for transfusion in the acute setting‡ | 41.7 (5/12) |
| 1.2 Daily opioid use | |
| If feasible, limit opiates or taper the opioid dose from conception until the patient is no longer breastfeeding, to reduce the risk of neonatal abstinence syndrome and harmful effects on the newborn∗ | 91.7 (11/12) |
| Start prophylactic RBCx to reduce the frequency of acute pain episodes, while limiting opioid exposure if the patient had frequent and severe serious pain crises∗ | 100 (12/12) |
n/N, number of agreeing panelists/total number of panelists.
∗
Strong consensus.
†
Consensus.
‡
No consensus.