Effect of automated red cell exchanges on oxygen saturation on-air, blood parameters and length of hospitalization in sickle cell disease patients with acute chest syndrome

Abstract

Background:Red cell exchanges (RCEs) lead to improvement in tissue oxygenation and reduction in inflammatory markers in sickle cell disease (SCD) patients who present with acute chest syndrome (ACS). The aim of this study is to evaluate the effects of automated-RCE (auto-RCE) on oxygen saturation (SpO2) on-air, blood counts, the time to correct the parameters and length of hospitalization after the exchange in SCD patients presenting with ACS.Subjects and Methods:This was 2 years study involving five SCD patients; the time for SpO2 on air to increase to ≥95% and chest symptoms to resolve, postprocedure, as well as the length of in-patient hospitalization was recorded. All data were entered into Statistical Package for Social Sciences Version 20.0 (SPSS Inc., Chicago, IL, USA) computer software for analyses.Results:The study involved 4 (80%) hemoglobin (Hb) SS and 1 (20%) HbSC patients. The median time of SpO2 recovery was 24 h, ranging from 6 to 96 h. About 60% (3/5) of patients achieved optimal SpO2 within 24 h post-RCE, while discharge from intensive care unit was 24 h after auto-RCE in one patient. The Hb concentration was significantly higher, while the total white cell and absolute neutrophil counts were significantly lower at the time of resolution of symptoms, compared to before auto-RCE (P < 0.05). The average post auto-red cell transfusion symptoms duration was 105.6 (24–240) h while mean inpatient stay was 244.8 (144–456) h.Conclusion:Auto-RCE could reverse hypoxia in ACS within 24 h.

Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence‐Based Approach from the Writing Committee of the American Society for Apheresis: The Ninth Special Issue

“…A retrospective review of 81 pediatric patients with ACS found that RBC exchange in the children with worse pulmonary function equalized them to achieve a similar hospital course to those children with less severe pulmonary function at the start of the admission (Saylors, 2013). A small study of 5 patients with SCD showed that the median time to oxygen saturation recovery on room air was 24 hours after RBC exchange (Aneke, 2016). Side effects of RBC exchange in acute SCD manifestations include central venous catheter thrombosis and hemorrhage, which can be mitigated with placement in internal jugular site compared to the femoral vein location.…”

Role of Emergency Automated Red Cell Exchange in Sickle Cell Crisis: A Case Report

“… 13 Aneke et al, reported that after RCEx in acute chest syndrome SPO 2 recovery time on room air was shorter ranging from 6 to 96 hours. 14 RCEx is relatively safe procedure still the patient is at risk for transfusion-associated adverse events, in addition to apheresis risks. Risk may include but not limited to central venous catheter thrombosis, haemorrhage, mitigation of catheter at internal jugular site, etc.…”

Case series supporting heme detoxification via therapeutic plasma exchange in acute multiorgan failure syndrome resistant to red blood cell exchange in sickle cell disease

“…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.…”