Comparative evaluation of the depletion‐red cell exchange program with the Spectra Optia and the isovolemic hemodilution‐red cell exchange method with the <scp>COBE</scp> Spectra in sickle cell disease patients

Poullin, Pascale; Sanderson, F.; Bernit, Emmanuelle; Brun, Marion; Berdah, Yael; Badens, Catherine

doi:10.1002/jca.21422

Cited by 21 publications

(37 citation statements)

References 23 publications

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“…Several studies have described the performances of the SO device when using the RBCX technique associated (SO/DE) or not (SO) with the depletion step for patients with SCA . These studies showed similar performance of SO compared to CSP both associated and not associated with DE.…”

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confidence: 99%

Automatic depletion with Spectra Optia allows a safe 16% reduction of red blood cell pack consumption in exchanged sickle cell anemia patients

et al. 2019

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BACKGROUND Chronic red blood cell exchanges (RBCXs) are frequently used to prevent complications in patients with sickle cell anemia, but the scarcity of matched red blood cell packs (RBCPs) is a serious concern. The main goal of this study was to compare the number of RBCPs used during RBCXs between the Spectra Optia (SO) device (with the automatic depletion step) and the former Cobe Spectra (CSP) device. STUDY DESIGN AND METHODS The performances and safety of 300 SO sessions using the automatic depletion step (SO/DE) in 50 patients with sickle cell anemia under a chronic transfusion program over a 1‐year period were prospectively analyzed. The numbers of RBCPs saved using this protocol compared to the SO device without depletion and to the CSP device were determined. RESULTS The SO/DE protocol appeared to be safe, as only 5% and 17% of the sessions were characterized by a significant decrease in blood pressure and increase in heart rate (grade 2 adverse events), respectively. Postapheresis hematocrit and fraction of cells remaining reached expected values. The SO/DE protocol required 16% fewer RBCPs compared to SO without depletion, allowing a mean saving of 12 RBCPs per patient and per year and 13% fewer compared to CSP device. Interestingly, the saving was more important for patients with high total blood volume and/or high preapheresis hematocrit. CONCLUSION The SO/DE protocol is an efficient, safe and cost‐effective procedure for patients with sickle cell anemia under a chronic transfusion program.

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confidence: 99%

Automatic depletion with Spectra Optia allows a safe 16% reduction of red blood cell pack consumption in exchanged sickle cell anemia patients

et al. 2019

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“…RCE can be modified to include an initial phase of isovolemic hemodilution (or “depletion”—removing RBCs to a specified Hct while instilling saline [or 5% albumin], which is then followed by RCE) . This procedure can reduce the volume of RBCs needed for the exchange and thus reduce donor exposure—that is, for the same volume of RBCs used, the efficiency of HbS removal is improved because fewer RBCs need to be removed . However, this is not an option for all patients, as the preprocedure Hct must be taken into account.…”

Section: Resultsmentioning

confidence: 99%

“…However, this is not an option for all patients, as the preprocedure Hct must be taken into account. One study selected only patients with preprocedure Hct levels of more than 26% and stable hemodynamic status . A second study required a preprocedure Hct level of 23% or more and decreased the patient's Hct up to 6% during the isovolemic hemodilution phase (if baseline Hct level was 23%‐31%) or 8% (if baseline Hct level was ≥32%) .…”

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confidence: 99%

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Red blood cell exchange in patients with sickle cell disease—indications and management: a review and consensus report by the therapeutic apheresis subsection of the AABB

et al. 2018

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Although a consensus as to protocol details may not be possible, there are areas of agreement in the management of these patients, for example, that it is optimal to avoid hyperviscosity and iron overload, that a target Hb S level in the range of 30% is generally desirable, and that RCE as an acute treatment for pain crisis in the absence of other acute or chronic conditions is ordinarily discouraged.

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“…21,22 Complications of acute hemoreduction may be seen in both the automated and manual setting and include hypovolemia (dizziness, syncope, headache, weakness) and a possible risk of acute neurologic complications caused by acute anemia. Symptoms of hypovolemia maybe reduced by administration of a normal saline bolus before the hemoreduction.…”

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confidence: 99%

Sickle cell disease: when and how to transfuse

2016

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Blood transfusion remains an important therapeutic intervention in patients with sickle cell disease (SCD), aiming to both increase the oxygen carrying capacity of blood and to reduce the complications of vaso-occlusion. Simple, manual exchange and automated exchange can be effective in reducing the acute and chronic complications of SCD, and the advantages and disadvantages of each methodology mean they all have a role in different situations. Evidence for the role of emergency transfusion in the management of the acute complications of SCD, including acute pain and acute chest syndrome, comes from observational data. Several important randomized controlled trials have shown the efficacy of transfusion in primary and secondary stroke prevention in patients with SCD but, outside these areas, clinical practice lacks a clear evidence base. Evidence for the role of long-term transfusion in the prevention of the non-neurologic chronic complications of SCD comes from analysis of secondary outcomes of these randomized trials and from observational data. In view of the paucity of data, the risks and benefits of transfusion should be fully discussed with patients/families before a long-term transfusion program is commenced. Evidence is only available for the role of preoperative transfusion or for prophylactic transfusion through pregnancy in certain situations, and the role of transfusions outside these situations is discussed. Questions about when and how to transfuse in SCD remain and will need further randomized trials to provide answers. Learning Objectives• To describe the advantages and disadvantages of simple, manual exchange and automated exchange transfusion • To discuss when transfusion should be used to treat the acute and chronic complications of sickle cell disease • To discuss the role of preoperative transfusion and of transfusion during pregnancy in decreasing sickle-related complications

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Comparative evaluation of the depletion‐red cell exchange program with the Spectra Optia and the isovolemic hemodilution‐red cell exchange method with the COBE Spectra in sickle cell disease patients

Cited by 21 publications

References 23 publications

Automatic depletion with Spectra Optia allows a safe 16% reduction of red blood cell pack consumption in exchanged sickle cell anemia patients

Automatic depletion with Spectra Optia allows a safe 16% reduction of red blood cell pack consumption in exchanged sickle cell anemia patients

Red blood cell exchange in patients with sickle cell disease—indications and management: a review and consensus report by the therapeutic apheresis subsection of the AABB

Sickle cell disease: when and how to transfuse

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