Sickle cell anemia is a condition that is often underrecognized before surgery. As it stands, sickle cell disease already affects certain groups of people disproportionately. Affected patients should be monitored for pain control during procedures
Sickle cell disease (SCD) is a genetic disorder of the red blood cells (RBC). It is caused by a mutation that alters the shape of red blood cells, impairing their ability to deliver oxygen to tissues. Importantly, SCD is not distributed equally and is more common in people of African ancestry (1 in 365 live Black births in the United States).
The femoral canal is an anatomic space that contains fat and lymph nodes. Patients with SCD often have fat buildup in the bone marrow, which can lead to sclerosis and a narrowing of the femoral canal. Therefore, osteonecrosis of the femoral head occurs in 10 to 40% of SCD patients. These patients often need total hip arthroplasty, making them a large group requiring special care before surgery.
Red blood cells break apart and die easily in SCD, resulting in anemia. For patients with sickle cell anemia, admission to the hospital one day prior to surgery is advisable in order to facilitate consultations with appropriate specialists to optimize care and prevent intraoperative complications, including intraoperative hypoxia, hypothermia, acidosis, dehydration, and anemia. To dilute sickle cells, patients should get 1.25-fold maintenance fluids and RBC transfusions the night before surgery. The goal is to have a hemoglobin level greater than 10 g/dL.
Another critical optimization is pain control. The pain of sickle cell crisis occurs when sickled red blood cells block small blood vessels that carry blood to the bones. SCD patents often receive inadequate pain management due to provider bias. After surgery, patients should always receive non-steroidal anti-inflammatory drugs along with analgesics to optimize effects. Before surgery, it’s best to have a well-thought-out written plan for pain relief and postoperative infection.
To summarize, it is advised that SCD patients consult with hematology, anesthesia, infectious disease, and cardiology prior to surgery to ensure the best possible outcome.
Source:
Huff, T., Gibson, D., & O’Connor, M. I. (2022). Movement Is Life: Optimizing Patient Access to Total Joint Arthroplasty: Anemia and Sickle Cell Disease Disparities. Journal of the American Academy of Orthopaedic Surgeons. https://doi.org/10.5435/jaaos-d-21-00911
