Use of continuous flow erythrocytapheresis in pregnant patients with sickle cell disease

Abstract

The role of partial prophylactic red cell exchange transfusion in the management of pregnant patients with major sickle hemoglobinopathies is unclear. Over a 10-year period, 131 pregnant patients with major hemoglobinopathies (HbS 101, HbS-C 30) were managed by the same group of physicians. Of these, 103 received partial prophylactic exchange transfusion early during prenatal care while 28 received blood only when serious complications developed (control group). Patients treated with exchange transfusion received continuous flow erythrocytapheresis on an outpatient basis. The results indicate that there were fewer crises (P = .0001), a reduction in other significant medical complications (P = .002), and a decrease in maternal hospital days (P = .05) in those receiving prophylactic transfusions compared to women in the control group. The number of preterm deliveries (P = .004), the prevalence of low birthweight infants (P = .01), and the perinatal death rate (P = .01) were significantly lower among those who were routinely transfused. Two patients developed hepatitis, five had transfusion reactions, and 11 were found to have alloantibodies among those receiving prophylactic transfusions versus one, two, and five patients, respectively, in the control group. The results indicate a benefit of this methodology in the treatment of pregnant sickle cell patients in our population. However, a national collaborative randomized study is needed to adequately address the controversy regarding the use of red cell exchange in the pregnant sickler.

Prophylactic transfusion for pregnant women with sickle cell disease: a systematic review and meta-analysis

“…Studies to date have consistently supported the effectiveness of prophylactic transfusion in reducing the frequency of vaso-occlusive pain episodes, 14,15,17,19,[27][28][29][30] which tend to increase in pregnancy. 3 As this systematic review demonstrates, maternal mortality in a majority of women with SCD occurred in the setting of vaso-occlusive pain episodes, 14,18,28 with pulmonary embolism and acute chest syndrome accounting for 2 additional cases each.…”

“…Only 2 of the cohort studies were multicenter, 10,30 and all but 2 18,28 used a retrospective design with historical controls. 19,26,27 Historical controls from the 1950s and 1960s were included in 2 studies. 19,28 Seven studies specified outcomes based on b-globin genotype.…”

Red Cell Exchange in Sickle Cell Disease

“…22 Automated red cell exchange has been used with good results, but the study was not randomized and we cannot determine its true efficacy. 23 Red cell exchange may be useful in patients with a dramatic increase in pain episodes during pregnancy, or possibly in those with preeclampsia.…”

An Evidence-Based Approach to the Treatment of Adults with Sickle Cell Disease

“…35,37 In a non-randomized series, use of chronic erythrocytapheresis was associated with a significant reduction in pain events, ACS, low birth weight babies and perinatal death. 38 The use of transfusion was evaluated in an RCT of 72 women with Hb SS, prior to 28 weeks gestation, assigned to receive prophylactic transfusion or transfusion for acute events. 16 The prophylactic transfusion protocol called for a target Hb level of 10-11 g/dL and Hb S < 35%.…”