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Abstract：
BACKGROUND: The data to support chronic automated red cell exchange (RCE) in sickle cell disease (SCD) outside of stroke prevention, is limited, especially in adults.
METHODS: A retrospective analysis was conducted of patients with SCD who were referred for chronic RCE at our institution over a 10-year period. Data that were evaluated included patient demographics, referral indications, and procedural details (e.g., vascular access, adverse events, etc.). In a subanalysis, the number of annual acute care encounters during 3 years of chronic RCE was compared with that in the year preceding the first RCE.
RESULTS: A total of 164 patients were referred for chronic RCE: median age was 28 years (interquartile range [IQR] = 22-36) at referral and 60% were female. Seventy (42.6%) were naïve to chronic transfusion (simple or RCE) prior to referral. The leading indications for referral were refractory pain (73/164, 44.5%) and iron overload (57/164, 34.7%). A total of 5090 procedures occurred during the study period (median = 19, IQR = 5-45). Of the 138 patients who had central vascular access, 8 (6%) and 16 (12%) had ≥1 central-line-related thrombosis and/or infection, respectively. Of those who were not RBC alloimmunized at initiation of RCE, 12/105 (11.4%) developed new antibodies during chronic RCE. In those 30 patients who were adherent to therapy for 3 years, there was no significant difference in acute care encounters following initiation of RCE.
CONCLUSIONS: Prospective clinical trials are needed to determine which patients are most likely to benefit from chronic RCE and refine selection accordingly.
METHODS: A retrospective analysis was conducted of patients with SCD who were referred for chronic RCE at our institution over a 10-year period. Data that were evaluated included patient demographics, referral indications, and procedural details (e.g., vascular access, adverse events, etc.). In a subanalysis, the number of annual acute care encounters during 3 years of chronic RCE was compared with that in the year preceding the first RCE.
RESULTS: A total of 164 patients were referred for chronic RCE: median age was 28 years (interquartile range [IQR] = 22-36) at referral and 60% were female. Seventy (42.6%) were naïve to chronic transfusion (simple or RCE) prior to referral. The leading indications for referral were refractory pain (73/164, 44.5%) and iron overload (57/164, 34.7%). A total of 5090 procedures occurred during the study period (median = 19, IQR = 5-45). Of the 138 patients who had central vascular access, 8 (6%) and 16 (12%) had ≥1 central-line-related thrombosis and/or infection, respectively. Of those who were not RBC alloimmunized at initiation of RCE, 12/105 (11.4%) developed new antibodies during chronic RCE. In those 30 patients who were adherent to therapy for 3 years, there was no significant difference in acute care encounters following initiation of RCE.
CONCLUSIONS: Prospective clinical trials are needed to determine which patients are most likely to benefit from chronic RCE and refine selection accordingly.
摘要：
背景：支持预防中风以外的镰状细胞病（SCD）中慢性自动红细胞交换（RCE）的数据，是有限的，尤其是成年人。
方法：对我院接受慢性RCE转诊的SCD患者进行了10年的回顾性分析。评估的数据包括患者人口统计学，转诊指征,和程序细节(例如，血管通路,不良事件,等。).在子分析中，将慢性RCE治疗3年期间的年度急性护理次数与第一次RCE治疗前一年的病例数进行了比较.
结果：共有164例患者因慢性RCE转诊：转诊时的中位年龄为28岁（四分位距[IQR]=22-36），60%为女性。在转诊之前，有70例（42.6％）未接受慢性输血（简单或RCE）。转诊的主要指征是顽固性疼痛（73/164，44.5%）和铁过载（57/164，34.7%）。在研究期间共进行了5090次手术（中位数=19，IQR=5-45）。在138例中央血管通路患者中，8（6％）和16（12％）有≥1个中央线相关的血栓形成和/或感染，分别。在RCE开始时没有进行红细胞免疫的人中，12/105（11.4%）在慢性RCE期间产生了新的抗体。在坚持治疗3年的30名患者中，RCE开始后的急性护理没有显着差异。
结论：需要进行前瞻性临床试验，以确定哪些患者最有可能从慢性RCE中受益，并相应地完善选择。
方法：对我院接受慢性RCE转诊的SCD患者进行了10年的回顾性分析。评估的数据包括患者人口统计学，转诊指征,和程序细节(例如，血管通路,不良事件,等。).在子分析中，将慢性RCE治疗3年期间的年度急性护理次数与第一次RCE治疗前一年的病例数进行了比较.
结果：共有164例患者因慢性RCE转诊：转诊时的中位年龄为28岁（四分位距[IQR]=22-36），60%为女性。在转诊之前，有70例（42.6％）未接受慢性输血（简单或RCE）。转诊的主要指征是顽固性疼痛（73/164，44.5%）和铁过载（57/164，34.7%）。在研究期间共进行了5090次手术（中位数=19，IQR=5-45）。在138例中央血管通路患者中，8（6％）和16（12％）有≥1个中央线相关的血栓形成和/或感染，分别。在RCE开始时没有进行红细胞免疫的人中，12/105（11.4%）在慢性RCE期间产生了新的抗体。在坚持治疗3年的30名患者中，RCE开始后的急性护理没有显着差异。
结论：需要进行前瞻性临床试验，以确定哪些患者最有可能从慢性RCE中受益，并相应地完善选择。
