Efficacy of exchange blood transfusion in the management of priapism in patients with sickle cell disease in northeast Nigeria

Abstract

Background: Thirteen cases of priapism seen in adult patients with sickle cell disease (SCD) were treated by exchange blood transfusion (EBT) at the University of Maiduguri Teaching Hospital during a five-year period (1996-2000). Each patient was scheduled to receive a total of 12-unit exchange, but due to voluntary donor blood scarcity and differences in affordability of commercial donors only 1 (7.7%) patient could receive 10 units, 3 (23.1%) patients had 8 units each, and 9 (69.2%) patients received 7 units each.


Method: EBT was carried out manually in all cases and the mean number of units exchanged, the mean levels of Hb S and the mean levels of haematocrit were determined before the start of EBT (pre-EBT) and at the time of achieving complete detumescence.


Result: The exchange procedures were started with mean pre- EBT levels of 95% of Hb S and 0.24L/L of haematocrit; complete detumescence was achieved in all cases after an average of 6 units were exchanged by which time the mean Hb S level had fallen to 50.3% and the haematocrit had risen to a mean level of 0.28L/L.


Conclusion: EBT was successful in achieving complete detumescence and at much higher Hb S level (50.3%) than was earlier recommended. EBT is therefore effective in treating priapism in SCD and should be offered to such patients in order to avoid surgery, the risks of general anaesthesia in SCD and the possibility of postoperative impotence.


Keywords: Sickle cell disease, Priapism, Exchange blood transfusion.


Nig. J. of Surgical Research Vol.4(1-2) 2002: 22-27