Preventive exchange blood transfusion in pregnant women with sickle cell disease: maternal and perinatal prognosis in a country with limited resources, Burkina Faso

---

Résumé

Context: In pregnant women with sickle cell disease, the management with exchange transfusion
could be useful in improving the prognosis of mother and child by reducing the level of hemoglobin
S less than 40%. Objective: To analyze the maternal and perinatal outcome during the program
of the exchange transfusion in pregnant women with sickle cell disease. Patients and Methods:
We conducted a prospective study over a period of 18 months. Pregnant women with a major
form of sickle cell disease were included. A manual blood exchange transfusion was performed
monthly. We monitored the occurrence of maternal and perinatal morbidity during the follow-up.
Results: A total of 42 pregnant women with sickle cell disease were monitored. The frequency of
infectious episodes and vaso-occlusive crisis was significantly reduced, respectively from 47.6%
and 83.3% before the beginning of the blood exchanges transfusion to 11.9% and 16.7% during
blood exchanges transfusion program. All newborns were alive at birth with an Apgar score higher
or equal to 7 at the 5th minute. The rate of admission of the newborns at neonatal intensive care
unit was 9.3%. Maternal mortality was estimated at 7.1% and there was no early neonatal mortality.
Conclusion: Prophylactic exchange transfusion reduces infections and the reoccurrence of vaso-
occlusive crisis, which has an impact on perinatal prognosis.

Mots-clés

Sickle Cell Disease, Exchange Transfusion, Maternal and Perinatal Prognosis