Tourniquet use and sickle cell hemoglobinopathy: how should we proceed?

The use of tourniquets for upper and lower extremity operative procedures is controversial in patients with sickle cell hemoglobinopathies. The authors used Ovid and MEDLINE®, PubMed, and CINAHL® to detect English-language reports of any surgical procedure where a tourniquet was used on a patient with sickle cell disease or trait. Four papers met the search criteria and were reviewed. These studies included 96 patients with hemoglobin SS, SC, and sickle cell trait (AS). The investigations differed in tourniquet type, perioperative care, operative procedure, and patient genotype distribution. Twelve of 96 sickle cell patients (12.5%) experienced postoperative complications (8 SS/SC and 4 AS) detailed in two of the four studies. Nonetheless, the available limited evidence suggests that with proper perioperative management and necessary precautions, tourniquets can be used with relative safety in most patients with sickle cell disease.