Red blood cell exchange in patients with sickle cell disease—indications and management: a review and consensus report by the therapeutic apheresis subsection of the AABB

Abstract

Although a consensus as to protocol details may not be possible, there are areas of agreement in the management of these patients, for example, that it is optimal to avoid hyperviscosity and iron overload, that a target Hb S level in the range of 30% is generally desirable, and that RCE as an acute treatment for pain crisis in the absence of other acute or chronic conditions is ordinarily discouraged.

Red blood cell exchange for SARS-CoV-2: A Gemini of therapeutic opportunities

“…Finally, simple transfusion is traditionally recommended for the treatment of symptomatic anemia with hemoglobin (Hb) levels less than 9 g/dL [27] , [30] . On the other hand, red cell exchange is indicated to prevent or treat complications arising from the presence of abnormal hemoglobin proteins, such as hemoglobin S (HbS) in sickle cell disease [30] . And the goal of exchange is to lower HbS level to less than 30% [30] .…”

“…On the other hand, red cell exchange is indicated to prevent or treat complications arising from the presence of abnormal hemoglobin proteins, such as hemoglobin S (HbS) in sickle cell disease [30] . And the goal of exchange is to lower HbS level to less than 30% [30] . In this setting, with such significant Hb protein and lipid structural damages, the use of RBC exchange would likely be more beneficial than that of simple transfusion.…”

Patologías del niño inmigrante en la Unidad de Cuidados Intensivos

“…Cálculo de masa eritrocitaria a recambiar: 1-1,25 x (Hto x volumen sanguíneo total). Volumen sanguíneo total: 70 ml/kg en >20 kg y 85 ml/kg en < 20 kg El niño inmigrante -P. Carrasco T. et al de alta resolución 15 , o en su defecto se han propuesto fórmulas para su estimación 18 .…”

“…La exanguinotransfusión tiene el objetivo de disminuir el porcentaje de HbS a < 30% y se debe considerar en ACV, STA, shock séptico, previo a procedimientos invasivos y/o quirúrgicos 15 . Respecto a esta última indicación, tanto la anestesia como la cirugía incrementan el riesgo de complicaciones, particularmente el STA 15 .…”

“…La exanguinotransfusión tiene el objetivo de disminuir el porcentaje de HbS a < 30% y se debe considerar en ACV, STA, shock séptico, previo a procedimientos invasivos y/o quirúrgicos 15 . Respecto a esta última indicación, tanto la anestesia como la cirugía incrementan el riesgo de complicaciones, particularmente el STA 15 . Como medida preoperatoria es trascendente la hiperhidratación; durante la cirugía es importante evitar la hipotermia y en el postoperatorio debe lograrse una correcta analgesia, promover la deambulación precoz y realizar manejo kinésico respiratorio para prevenir el desarrollo de atelectasias (precipitan crisis vaso-oclusivas) 12 .…”