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Blood cell exchange in sickle cell disease: A single center experience

Background and Objectives: Red cell exchange (RCE) is a type of therapeutic apheresis procedure aimed at removing the deformed red blood cells of a patient and replacing them with those obtained from healthy donors. It is a commonly used but yet underutilized procedure for the treatment of hemoglobinopathies such as sickle cell disease (SCD) (acute or chronic), and other diseases and conditions such as ABO-incompatible hematopoietic stem cell transplantation, severe erythrocytosis, hereditary hemochromatosis, severe infection with intra-erythrocytic parasites such as malaria, babesiosis or cases of a drug overdose, poisoning and to perform envenomation. The objective of the study is to study and understand the efficacy of RCE in the management of patients in various clinical scenarios. Methods: This is a retrospective study carried out at a tertiary care hospital in North India over a period of 4 years (2016–2020). All the RCE were performed on Spectra Optia apheresis (System 1 P0 4552 (Terumo BCT, Lakewood, CO, USA) which comes with a built-in software (Version 11) for performing RCE. Results: A total of 8 exchanges were performed in five patients. Three of these patients had undergone the procedure twice. Two out of the five patients were found to be antibody screen positive. Corresponding antigen-negative units of packed red cells were issued for these patients. The targeted and final fraction of red cell remaining values which were kept at ≤30% was achieved in all cases. Conclusion: RCE is a safe and effective therapeutic treatment modality for patients of SCD. It is a simple and relatively safe treatment modality that provides immediate relief in acute complications and also prevents the risk of long-term complications such as iron overload and iron-induced organ damage.