Automated red cell exchange in sickle cell disease

Abstract

Summary.Red cell exchange is important in the care of acutely ill sickle-cell patients, and may be life-saving. An automated red cell exchange technique has been developed using a Baxter blood cell separator, enabling an isovolaemic exchange to be performed within 2·5 h. A total of 20 procedures have been performed in 15 patients, including one woman in the third trimester of pregnancy, with a mean decrease of 72% in the circulating sickle haemoglobin (HbS) level. This method enables almost all adult patients with sickle cell anaemia to have their HbS reduced to safe levels by only one procedure. The procedure was well tolerated by all patients, including those who were acutely ill. This technique provides an effective procedure for reducing the percentage of circulating HbS rapidly in acutely ill patients with complications of sickle cell anaemia.

Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects

“…It reduces %HbS faster than manual exchange because plasma, platelets and white cells are returned to the patient (Lawson et al, 1999). The procedure takes around 2 h with good venous access (Kim et al, 1994;Janes et al, 1997;Lawson et al, 1999) and is well tolerated (Lawson et al, 1999). Additionally, its effectiveness in reducing %HbS allows up to 6-weekly transfusion intervals (Kalff et al, 2010).…”

“…Both manual and automated exchange transfusions are suitable in the emergency setting for inpatients with acute sickle complications (Janes et al, 1997;Vichinsky et al, 2000;Velasquez et al, 2009) as well in the outpatient setting for elective indications Adams et al, 1998;Singer et al, 1999;Raj et al, 2005;Billard et al, 2013). The volume of blood exchanged and the target final Hb can be adjusted.…”

“…It also limits or eliminates iron accumulation (Kim et al, 1994). Automated red cell exchange is suitable for both children (Singer et al, 1999;Velasquez et al, 2009;Billard et al, 2013) and adults (Janes et al, 1997;Lawson et al, 1999;Kozanoglu et al, 2007;Kalff et al, 2010).…”

“…In both settings, transfusion may be administered by simple (top up) transfusion or by exchange transfusion (where patient red cells are removed and replaced with donor red cells). Exchange transfusion can be performed manually (Porter & Huehns, 1987) or with an automated cell separator (Janes et al, 1997;Lawson et al, 1999;Kuo et al, 2015;Tsitsikas et al, 2016) (see section Exchange transfusion techniques).…”

Safety and efficacy of blood exchange transfusion for priapism complicating sickle cell disease

“…The patient's plasma was returned with donor RBC. Red cell exchange protocol has been described previously [18]. For both types of exchange, sicklenegative donor RBC were phenotyped for ABO, D, c, C, e, E and Kell antigens.…”