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 | ||||||
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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.