“…Figure 2 shows marked improvement post-TPE, except in Patient 3, in relevant laboratory markers of organ damage and vaso-occlusive severity. 58 Given that mean 6 SD duration of hospitalization in adults can be 8 6 7 days for pain crisis 59 and 10 days (range, 6-19 days) for acute chest syndrome with RCE, 60 discharge of these three severely ill patients 10 to 15 days after presentation is notable. Patient 3 who died was the most severely ill, presenting with pain crisis, 1 to 2 days of altered mental status and shortness of breath, and hypotension, and developed acidosis, gastrointestinal bleeding, shock liver (alanine aminotransferase [ALT] > 10,000 U/L), and hyperkalemia requiring hemodialysis.…”