A comparison of chronic manual and automated red blood cell exchange transfusion in sickle cell disease patients

Guidelines on red cell transfusion in sickle cell disease. Part I: principles and laboratory aspects

“…In both settings, transfusion may be administered by simple (top up) transfusion or by exchange transfusion (where patient red cells are removed and replaced with donor red cells). Exchange transfusion can be performed manually (Porter & Huehns, 1987) or with an automated cell separator (Janes et al, 1997;Lawson et al, 1999;Kuo et al, 2015;Tsitsikas et al, 2016) (see section Exchange transfusion techniques).…”

“…The volume of blood exchanged and the target final Hb can be adjusted. The ability of these two methods to achieve pre-defined haematological targets, rate of complications, blood usage and clinical outcome over a 1-year period were compared in a retrospective observational cohort study (Kuo et al, 2015).…”

Sickle cell disease: when and how to transfuse

“…Other indications for long-term transfusion include recurrent acute chest syndrome (ACS), priapism, pulmonary hypertension, renal dysfunction, and sickle hepatopathy. 1,8,9 This variation was confirmed among physicians in the US by a mail survey of transfusion practice. 10 Although there is a paucity of randomized trials of transfusion outside the treatment of neurologic complications of SCD, we can use the secondary outcomes of the RCTs outlined here before to provide evidence for the efficacy (or not) of chronic transfusion therapy in the treatment of other chronic complications of SCD.…”

“…Suggested methodologies for manual exchange in adults and children are available. 13,15 Retrospective comparison of automated and manual exchange procedures in both adults and children have shown that automated procedures were more likely to achieve HbS% targets 8,16 and required half the time of manual procedures (P , .0001), 8 but alternative methodologies of manual exchange can achieve improved adherence with HbS% targets. 17,18 Control of iron loading with manual exchanges is intermediate between simple transfusions and automated exchanges.…”

“…Automated exchanges do require more blood than manual exchange or simple transfusion but are not associated with increased rates of alloimmunization. 8,19 The National Institute of Clinical Excellence has recently reviewed data on automated and manual exchange procedures and recommended automated RCE should be considered for patients who need regular transfusion, and it is cost-effective (www.nice.org.uk). Despite British recommendations that all patients with SCD should have access to automated RCE, recent peer review data in the UK (2015)(2016) showed that several large sickle centers could not provide automated RCE.…”