Title : Role of erythrocytapheresis in sickle cell anemia crisis management: A tertiary care centre experience from Chhattisgarh state of central India
Abstract:
Introduction: The current treatment of Sickle Cell Disease includes hydroxyurea and RBC transfusions or exchange transfusions. RBC exchange is the replacement of a patient’s RBC with donor RBC and can be performed either manually or automated. Automated RBC exchange is based on an apheresis procedure where RBC’s are selectively removed and replaced with donor RBC with rapid reduction of sickled RBC’s without increasing the hematocrit, fluid overload, and a reduced risk of iron accumulation. Costs, expertise & venous access are the main problems with automated RBC exchanges.
Aims:
- To Study the feasibility & efficacy of automated RBC exchange in the management of Sickle Cell crisis.
- To study the associated adverse events and patients compliance.
Materials and methods: This is an one year prospective observational study undertaken in our Centre at Raipur.
The study population included Sickle Cell Disease (homozygous) patients who had been underwent automated red cell exchange procedures during vaso-occlusive crisis.
Results: A total of 22 sickle crisis patients underwent 30 automated red cell exchanges during the study period.
The mean age of patient population was 17.6 years with three patients below six years of age.
Central venous access was needed in five patients, remaining all procedures were done through peripheral veins. The mean Red cell volume exchanged was 1.22 times the total red cell volume of the patient. ABO/Rh and cross match compatible RBC units were exchanged, keeping the volume:volume ratio 1:1. The exchange process took, on average, 153 minutes. Seven patients experienced the adverse reactions with Chills/rigors was the most common adverse event noted. On two occasions the procedures were abandoned due to the venous excess problem.
Conclusion: Automated RBC exchange is very well feasible and are efficient therapeutic modalities to treat acute sickle crisis. The benefits of automated RBC exchanges are prevention of iron overload and viscosity related complications. It may be suggested to conduct prospective clinical trials in future to establish the feasibility & efficacy of automated RBC exchanges.
Audience Takeaway:
- Feasibility & efficacy of automated RBC exchange in the management of Sickle Cell crisis.
- Associated adverse events and patients compliance about erythrocytapheresis
- Erythrocytapheresis procedure
