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REPLY

The Hospital for Sick Children, University of Toronto, Toronto, Canada E-mail: mark.crawford{at}sickkids.ca

We would like to thank Dr. Eipe et al. for their interest and comments on our article on preoperative screening for sickle cell disease. As they correctly point out, in areas where access to medical facilities is limited and sickle cell disease is prevalent, the preoperative period may be a useful time to screen for this hemoglobinopathy. This may be helpful for long-term health care and counselling, but the benefit of such screening with regard to perioperative outcome has yet to be established. For the reasons cited in our study,¹ the potential benefit of universal preoperative screening in terms of perioperative outcome is questionable in our population. We agree with Dr. Eipe et al. that preoperative screening should be performed in selected at-risk patients, including those with known or suspected anemia or a family history of sickle cell disease, and those undergoing high-risk surgery, as stated in our study. We do not question the role of screening in public health. However, to have the greatest impact on public health, screening should be performed in the newborn period. Early identification of sickle cell disease through newborn screening, together with comprehensive follow-up health care and education, has significantly reduced sickle-related morbidity and mortality in children.² Consequently, legislation mandating universal screening of all newborns for sickle cell disease has been enacted in many parts of North America. Universal screening of all newborns should be a societal goal in populations where sickle cell disease is prevalent.

References

1 Crawford MW, Galton S, Abdelhaleem M. Preoperative screening for sickle cell disease in children: clinical implications. Can J Anesth 2005; 52: 1058–63.[Abstract/Free Full Text]

2 Vichinsky E, Hurst D, Earles A, Earles A, Kleman K, Lubin B. Newborn screening for sickle cell disease: effect on mortality. Pediatrics 1988; 81: 749–55.[Abstract/Free Full Text]

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