Prophylactic versus on-demand transfusion in pregnant women with sickle cell disease: A systematic review and meta-analysis of randomised controlled trials

IntroductionSickle cell disease (SCD) poses significant risks during pregnancy. Transfusions are the only recommended treatment, but there is no strong evidence of its efficacy. The aim of this study was to evaluate prophylactic transfusion on pregnancy outcomes.MethodsWe performed a systematic review and meta-analysis (PROSPERO-CRD42024510511), using MEDLINE, EMBASE, Cochrane, Web of Science, and Maternity and Infant Care. No date or language restrictions were applied. Inclusion criteria comprised randomised-controlled trials (RCTs) involving SCD pregnancy, comparing maternal and foetal outcomes for prophylactic versus on-demand transfusions. Two independent reviewers performed screening, selection, and data extraction, following PRISMA. Two authors independently assessed certainty and risk-of-bias. Data were pooled using random-effects model. Primary outcomes included mortality, vaso-occlusive crisis (VOC), acute chest syndrome, venous thromboembolism and preterm delivery. The measure of the effect was the unadjusted odds ratio (OR), calculated from numbers of events.ResultsNinety-one studies were identified and two RCTs (106 patients) were included, with uncertain and low risk of bias. Prophylactic transfusions reduced VOC, OR of 0.197 (95% CI 0.08-0.49). However, due to the small number of patients, this meta-analysis was underpowered to evaluate other outcomes.ConclusionA larger RCT is needed to comprehensively assess the impact of prophylactic transfusion in SCD pregnancy.