Partial Red Cell Exchange Is an Effective Tool for Adequately Reducing Hemoglobin S Levels in Patients with Sickle Cell Disease and Improving Patient Outcomes Including Reduction in Acute Care Utilization

Introduction: Red cell exchange (RCE) is a therapeutic procedure that aims to reduce the number of sickle-shaped red blood cells in circulation and replace them with healthy donor cells. The use of red cell exchange in sickle cell disease (SCD) is primarily aimed at preventing or treating acute comp...

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Bibliographic Details
Published in:Blood 2023-11, Vol.142 (Supplement 1), p.5288-5288
Main Authors: Sheinei, Alan, Zik, Chad, Fusisi, Rania, Ershler, William B
Format: Article
Language:English
Online Access:Get full text
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Summary:Introduction: Red cell exchange (RCE) is a therapeutic procedure that aims to reduce the number of sickle-shaped red blood cells in circulation and replace them with healthy donor cells. The use of red cell exchange in sickle cell disease (SCD) is primarily aimed at preventing or treating acute complications such as acute chest syndrome, stroke or priapism. However, in patients with inadequate disease control and associated frequent hospitalizations requiring parenteral opioids, we have proposed that prophylactic partial RCE (pRCE) be incorporated into the treatment plan. Implementation of pRCE with resulting limitation of parenteral opioid use may potentially reduce hospitalizations and achieve overall better disease control. Use of pRCE for disease control remains limited as it is labor intensive and requires copious amounts of blood which can be challenging especially in this era of COVID19 pandemic blood shortage. For this reason, we have utilized pRCE at our institution. Here we demonstrate that pRCE with four to five units of packed red blood cells (pRBCs) is equally effective in reducing hemoglobin S to levels below 40% and SCD related complications including VOCs and hospitalizations. Methods and Results: In our center, we identified six individuals with frequent hospitalizations and significant daily oral morphine equivalent requirements. These patients were then placed on a monthly pRCE protocol. Patients with variable genotypes were enrolled including HbSS, HbSC and HbSβthal +. Each patient underwent pRCE initially utilizing four units. Hemoglobin S level was closely monitored and if the target level of
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2023-189044