Comprehensive guide to managing a chronic automated red cell exchange program in sickle cell disease

Abstract

Sickle cell disease (SCD) is associated with significant morbidity and mortality, and limits both the quality and quantity of life. Transfusion therapy, specifically automated red cell exchange (aRCE), plays a key role in management of SCD and is beneficial for certain indications in the chronic, outpatient setting. The approach to maintain a successful chronic aRCE program for SCD is multifaceted. This review will highlight important considerations including indications for aRCE, patient selection, transfusion medicine pearls, vascular access needs, complications of therapy, aRCE prescription, and therapy optimization.Moreover, the importance of a multidisciplinary approach with frequent communication between the services involved cannot be overstated. Ultimately, the underlying goal of a chronic RCE program is to improve the quality of life and longevity of patients with SCD.

Optimization of single‐needle red cell exchange in patients with sickle cell disease

“…Red cell exchange (RCE), an essential treatment for sickle cell disease (SCD), 1,2 usually requires two vascular access for concurrent blood withdrawal and return, which can be difficult to obtain in pediatric patients. [3][4][5][6] A single-needle RCE (SN-RCE) program that alternates blood withdrawal and return have been recently developed. 7 With high inlet rates, SN-RCE has only slightly longer procedure time than double-needle RCE (DN-RCE).…”