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Comparative study between chronic automated red blood cell exchange and manual exchange transfusion in patients with sickle cell disease: A single center experience from Saudi Arabia
Nour Al Mozain1, Yasmin Elobied2, Amal Al-Omran3, Alhanouf Aljaloud3, Alanoud Bin Omair3, Reema Bin Tuwaim3, Sara Alkhalifah3, Esraa S Altawil4, Sheena Abraham2, Lejardine Rose Salcedo2, Aljoyce Parena2, Farrukh Shah5, M Tayyeb Ayyoubi2, Daniela Hermelin6, Farjah Al Gahtani7, Mervat Abdalhameed Alfeky8, Ghada El Gohary9
1 Department of Pathology and Laboratory Medicine, King Fiasal Specialised Hospital, Riyadh, Saudi Arabia
2 Department of Blood Bank, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
3 Department of Blood Bank, College of Medicine, King Saud University, Riyadh, Saudi Arabia
4 Department of Pharmacy, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
5 Department of Hematology, Whittington Health, London, UK
6 Department of Pathology, School of Medicine, Saint Louis University, St. Louis, Missouri, United States
7 Oncology Centre, Section of Adult Hematology/HSCT, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
8 Department of Clinical Pathology, Laboratory Hematology, Ain Shams University Hospitals, Cairo, Egypt
9 Oncology Centre, Section of Adult Hematology/HSCT, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; Department of Internal Medicine/Adult Hematology, Ain Shams University Hospital, Cairo, Egypt
Correspondence Address:
Mervat Abdalhameed Alfeky
Department of Clinical Pathology, Ain Shams University Hospitals, Cairo
Egypt
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ajts.ajts_13_21
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BACKGROUND: Red cell transfusion remains the gold standard in managing sickle cell disease (SCD) with severe complications. Offering red blood cell exchange (RBCX) either manual exchange transfusion (MET) or automated RBCX (aRBCX) can reduce the complications of chronic transfusion and maintain target Hb thresholds. This study audits the hospital experience of overseeing adult SCD patients treated with RBCX, both automated and manual, and compares the safety and efficacy.
MATERIALS AND METHODS: This retrospective observational study was conducted as an audit for chronic RBCX for adult patients with SCD in 2015–2019 at King Saud University Medical City, Riyadh, Saudi Arabia.
RESULTS: A total of 344 RBCX for 20 adult SCD patients who were enrolled in regular RBCX, (11/20) patients had regular aRBCX with a total of (157) sessions, and (9/20) patients had MET with a total of (187) sessions. The median level of HbS% post-aRBCX was significantly lower than MET (24.5.9% vs. 47.3%, P < 0.010). Patients on aRBCX had fewer sessions (5 vs. 7.5, P < 0.067) with better disease control. Although the median yearly pRBC units per patient for aRBCX was more than the double needed for MET (28.64 vs. 13.39, P < 0.010), the median ferritin level was 42 μg/L in aRBCX versus 983.7 μg/L in MET, P < 0.012.
CONCLUSION: Compared to MET, aRBCX was more effective in reducing HbS, with fewer hospital visits and better disease control. Although more pRBCs were transfused, the ferritin level was better controlled in the aRBCX group without increasing alloimmunization risk.
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