{Reference Type}: Journal Article
{Title}: Chronic automated red cell exchange therapy for sickle cell disease.
{Author}: Zakieh A;Mercure-Corriveau N;Lanzkron S;Feng X;Vozniak S;Crowe EP;Rai H;Lawrence C;Bekkouri D;Goel R;Tobian AAR;Bloch EM;
{Journal}: Transfusion
{Volume}: 64
{Issue}: 8
{Year}: 2024 Aug 14
{Factor}: 3.337
{DOI}: 10.1111/trf.17924
{Abstract}: <B>BACKGROUND: </B>The data to support chronic automated red cell exchange (RCE) in sickle cell disease (SCD) outside of stroke prevention, is limited, especially in adults.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>Prospective clinical trials are needed to determine which patients are most likely to benefit from chronic RCE and refine selection accordingly.