Sir.—In the July 1988 issue of AJDC, Malone and Werlin1 reported the resuits of preoperative transfusion before elective cholecystectomy at the time of diagnosis of cholelithiasis in children with sickle cell anemia. Our own practice supports the conclusions of this study.
From 1976 to 1988, 240 children have been seen at the sickle cell clinic. Over the last 10 years, 24 children with sickle cell anemia (mean age, 10.5 years) underwent surgery for cholelithiasis in the Pediatric Surgery Unit at Centre Hospitalier Régional et Universitaire de la Guadeloupe. An annual ultrasonography study detected gallstones in 9 patients.
Fifteen children had a history of recurrent abdominal pain. Of these, 10 were admitted because of acute complications (4 patients with acute cholecystitis, 1 with biliary pancreatitis, and 5 with choledocal stones, with jaundice and cholangitis).
From 1979 to 1985, 13 children underwent surgery without preoperative transfusions. Seven of these children