Canadian Journal of Anesthesia

, Volume 52, Issue 10, pp 1058–1063 | Cite as

Preoperative screening for sickle cell disease in children: clinical implications

  • Mark W. Crawford
  • Seth Galton
  • Mohamed Abdelhaleem
Obstetrical and Pediatric Anesthesia



Preoperative screening of at-risk patients for sickle cell disease (SCD) is recommended as a method to decrease perioperative morbidity. However, the effectiveness of preoperative screening in accomplishing this goal has never been demonstrated. We undertook a retrospective study to determine the prevalence of positive test results among those screened preoperatively at our institution and to determine whether amendments to present screening guidelines can be recommended.


The hematology laboratory database of a university teaching hospital was searched to identify all patients who underwent preoperative screening for SCD from October 1999 to October 2003. The medical records of those patients testing positive were reviewed.


Of 1,906 children screened preoperatively, 79 (4.1%) were diagnosed as having sickle cell trait and three (0.16%) as having some form of SCD: one had homozygous hemoglobin S and two had sickle-hemoglobin C disease. Tw o of the three had a family history for SCD and none had a preoperative hemoglobin concentration < 10 g·dL-1. No patient developed perioperative sickle-related complications.


Preoperative screening of 1,906 children identified only one asymptomatic child with undiagnosed SCD and a negative family history, suggesting that routine preoperative screening for SCD is rarely of significant clinical value in our population. Had preoperative screening not been performed, no child requiring preoperative transfusion would have been missed, representing a long-run probability of at least 99.84% that no at-risk child would require transfusion. We recommend that preoperative screening for SCD be undertaken selectively, giving consideration to the risks and benefits of screening to the individual patient.


Sickle Cell Disease Sickle Cell Newborn Screening African Ancestry Sickle Cell Trait 
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Dépistage préopératoire de la drépanocytose chez les enfants : implications cliniques



Le dépistage préopératoire des patients à risque de drépanocytose est recommandé pour réduire la morbidité périopératoire. Ľefficacité de ce dépistage n’a pourtant jamais été démontrée. Notre étude rétrospective voulait déterminer la prévalence de résultats positifs aux tests préopératoires à notre institution et pour déterminer si nous pouvons recommander des modifications aux présentes normes de dépistage.


La base de données du laboratoire ďhématologie ďun hôpital universitaire a été revue à la recherche des patients soumis à un dépistage préopératoire de la drépanocytose entre octobre 1999 et octobre 2003. Ľexamen des dossiers médicaux présentant des tests positifs a été fait.


Des 1 906 enfants vus en dépistage préopératoire, 79 (4,1 %) présentaient un trait drépanocytaire et 3 (0,16 %) une forme de drépanocytose : un avait une hémoglobinose S homozygote et 2 avec falciformation-hémoglobine C. Deux des trois avaient des antécédents familiaux de drépanocytose et aucun n’avait une concentration préopératoire ďhémoglobine < 10 g·dL-1 . Aucune complication de falciformation ne s’est manifestée chez ces patients.


Du dépistage préopératoire de 1 906 enfants, il y avait un enfant asymptomatique atteint de drépanocytose non diagnostiquée et sans antécédents familiaux. Donc, le dépistage préopératoire de routine de la drépanocytose n’a que rarement une valeur clinique significative dans notre population. Même sans le dépistage préopératoire, aucun enfant nécessitant une transfusion préopératoire n’aurait été oublié, ce qui représente une probabilité à long terme ďau moins 99,84 % qu’aucun enfant à risque aurait eu besoin de transfusion. Le dépistage préopératoire sélectif de la drépanocytose est recommandé, tenant compte des risques et des avantages du dépistage ďun patient en particulier.


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Copyright information

© Canadian Anesthesiologists 2005

Authors and Affiliations

  • Mark W. Crawford
    • 1
  • Seth Galton
    • 1
  • Mohamed Abdelhaleem
    • 1
  1. 1.Department of AnesthesiaThe Hospital for Sick ChildrenTorontoCanada

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