Automated<scp>RBC</scp>exchange compared to manual exchange transfusion for children with sickle cell disease is cost‐effective and reduces iron overload

Dedeken, Laurence; Lê, Phu Quoc; Rozen, Laurence; Kenz, Hanane El; Huybrechts, Sophie; Devalck, Christine; Diallo, S; Heijmans, Cathérine; Ferster, Alina

doi:10.1111/trf.14575

Cited by 24 publications

(39 citation statements)

References 52 publications

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“…Automated exchange was associated with a lower increase in ferritin than manual exchange as automatic exchange transfusion is an isovolumetric process that can accomplish a larger, more efficient exchange of RBCs. 8,9 Our results are distinctly different from prior single center studies that have demonstrated automatic exchange transfusion limits excessive iron stores [10][11][12][13][14][15] because our primary results did not have to adjust for treatment with or adherence to chelation therapy and intra-individual differences in absorption of chelation. Even when we included those that received some chelation therapy in the first year, there was no significant difference in the primary finding that automated RBC exchange transfusion is associated with a lower rise of ferritin levels when compared to manual exchange or simple blood transfusion therapy.…”

Section: Discussioncontrasting

confidence: 76%

Automated exchange compared to manual and simple blood transfusion attenuates rise in ferritin level after 1 year of regular blood transfusion therapy in chronically transfused children with sickle cell disease

Kelly

Rodeghier²,

DeBaun

2020

Transfusion

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Background: Optimal strategies for regular blood transfusion therapy are not well defined in sickle cell disease (SCD). This analysis tested the hypothesis that in the first of year of regular transfusions, when chelation therapy use is minimal, automated exchange transfusion would be the superior method for attenuating the rise in ferritin levels compared to simple and manual exchange transfusions. Study design and methods: The Silent Cerebral Infarct Multi-Center Clinical Trial randomly allocated children with SCD and silent cerebral infarcts to receive standard care or regular transfusions with a target pre-transfusion HbS concentration ≤ 30% and minimum hemoglobin level > 9.0 g/dL. Participants with at least nine transfusions and sufficient ferritin testing in the first year of the trial were included in a planned secondary analysis. Ferritin levels by the end of the first study year were compared between participants receiving automatic exchange transfusion, manual exchange transfusion, and simple transfusion. Results: A total of 83 participants were analyzed. During the first year of the study, 75.9% of the participants had >80% of transfusions via one transfusion method. At baseline no significant differences in ferritin levels were observed in the three transfusion groups (p = 0.1). After 1 year of transfusions the median (interquartile range) ferritin levels in the simple transfusion (n = 40), manual exchange transfusion (n = 34) and automatic exchange transfusion (n = 9) groups were 1800 ng/mL (1426-2204 ng/mL), 1530 ng/mL (1205-1805 ng/mL), and 355 ng/mL (179-579 ng/mL), respectively (p < 0.001). Conclusion: Automated exchange transfusion, when compared to other transfusion methods, is the optimal transfusion strategy for attenuating increase in ferritin levels in children with SCD.

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Section: Discussioncontrasting

confidence: 76%

Automated exchange compared to manual and simple blood transfusion attenuates rise in ferritin level after 1 year of regular blood transfusion therapy in chronically transfused children with sickle cell disease

Kelly

Rodeghier²,

DeBaun

2020

Transfusion

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“…Nine studies compared automated RCE with simple transfusion (average patient ages in the studies, 7.3-20 years), [85][86][87][88][89][90][91][92][93] and 6 studies compared automated RCE with manual RCE (average patient ages in the studies, 5.9-27 years). 87,[94][95][96][97][98] Most patients were of the SS genotype.…”

Section: Remarks: Cmentioning

confidence: 99%

American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support

et al. 2020

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Background: Red cell transfusions remain a mainstay of therapy for patients with sickle cell disease (SCD), but pose significant clinical challenges. Guidance for specific indications and administration of transfusion, as well as screening, prevention, and management of alloimmunization, delayed hemolytic transfusion reactions (DHTRs), and iron overload may improve outcomes. Objective: Our objective was to develop evidence-based guidelines to support patients, clinicians, and other healthcare professionals in their decisions about transfusion support for SCD and the management of transfusion-related complications. Methods: The American Society of Hematology formed a multidisciplinary panel that was balanced to minimize bias from conflicts of interest and that included a patient representative. The panel prioritized clinical questions and outcomes. The Mayo Clinic Evidence-Based Practice Research Program supported the guideline development process. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to form recommendations, which were subject to public comment. Results: The panel developed 10 recommendations focused on red cell antigen typing and matching, indications, and mode of administration (simple vs red cell exchange), as well as screening, prevention, and management of alloimmunization, DHTRs, and iron overload. Conclusions: The majority of panel recommendations were conditional due to the paucity of direct, high-certainty evidence for outcomes of interest. Research priorities were identified, including prospective studies to understand the role of serologic vs genotypic red cell matching, the mechanism of HTRs resulting from specific alloantigens to inform therapy, the role and timing of regular transfusions during pregnancy for women, and the optimal treatment of transfusional iron overload in SCD.

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“…Acute and chronic transfusions are sometimes needed in SCA to improve the clinical status of the patients . The replacement of abnormal hemoglobin and sickled RBCs was originally achieved by prophylactic transfusions associated with manual bloodletting, but this methodology did not prevent iron overload . Conversely, RBC exchange (RBCX) using an apheresis device can replace a larger number of RBCs without inducing iron overload .…”

mentioning

confidence: 99%

“…The replacement of abnormal hemoglobin and sickled RBCs was originally achieved by prophylactic transfusions associated with manual bloodletting, but this methodology did not prevent iron overload . Conversely, RBC exchange (RBCX) using an apheresis device can replace a larger number of RBCs without inducing iron overload . Several studies showed its safety and efficiency in preventing the occurrence of SCA complications when regularly performed .…”

mentioning

confidence: 99%

“…6 Conversely, RBC exchange (RBCX) using an apheresis device can replace a larger number of RBCs without inducing iron overload. [6][7][8] Several studies showed its safety and efficiency in preventing the occurrence of SCA complications when regularly performed. [7][8][9] However, the increasing use of prophylactic RBCX requires blood transfusion centers to get a large variability and high number of blood group phenotypes for blood matching between patients and donors.…”

mentioning

confidence: 99%

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Automatic depletion with Spectra Optia allows a safe 16% reduction of red blood cell pack consumption in exchanged sickle cell anemia patients

et al. 2019

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BACKGROUND Chronic red blood cell exchanges (RBCXs) are frequently used to prevent complications in patients with sickle cell anemia, but the scarcity of matched red blood cell packs (RBCPs) is a serious concern. The main goal of this study was to compare the number of RBCPs used during RBCXs between the Spectra Optia (SO) device (with the automatic depletion step) and the former Cobe Spectra (CSP) device. STUDY DESIGN AND METHODS The performances and safety of 300 SO sessions using the automatic depletion step (SO/DE) in 50 patients with sickle cell anemia under a chronic transfusion program over a 1‐year period were prospectively analyzed. The numbers of RBCPs saved using this protocol compared to the SO device without depletion and to the CSP device were determined. RESULTS The SO/DE protocol appeared to be safe, as only 5% and 17% of the sessions were characterized by a significant decrease in blood pressure and increase in heart rate (grade 2 adverse events), respectively. Postapheresis hematocrit and fraction of cells remaining reached expected values. The SO/DE protocol required 16% fewer RBCPs compared to SO without depletion, allowing a mean saving of 12 RBCPs per patient and per year and 13% fewer compared to CSP device. Interestingly, the saving was more important for patients with high total blood volume and/or high preapheresis hematocrit. CONCLUSION The SO/DE protocol is an efficient, safe and cost‐effective procedure for patients with sickle cell anemia under a chronic transfusion program.

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AutomatedRBCexchange compared to manual exchange transfusion for children with sickle cell disease is cost‐effective and reduces iron overload

Abstract: Erythrocytapheresis reduces iron overload and allows a longer interval between procedures without a higher RBC requirement from the second year on aRBX. The cost did not increase as estimated in our Belgian Health Care System.

Cited by 24 publications

References 52 publications

Automated exchange compared to manual and simple blood transfusion attenuates rise in ferritin level after 1 year of regular blood transfusion therapy in chronically transfused children with sickle cell disease

Automated exchange compared to manual and simple blood transfusion attenuates rise in ferritin level after 1 year of regular blood transfusion therapy in chronically transfused children with sickle cell disease

American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support

Automatic depletion with Spectra Optia allows a safe 16% reduction of red blood cell pack consumption in exchanged sickle cell anemia patients

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