Preventive Exchange Blood Transfusion in Pregnant Women with Sickle Cell Disease: Maternal and Perinatal Prognosis in a Country with Limited Resources, Burkina Faso

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.