TRANSFUSION OR RED BLOOD
CELL EXCHANGE IN SICKLE-CELL
DISEASE: REVIEW OF ADVANTAGES
AND DISADVANTAGES.
MICKAEL BERAUD, PHD
TERUMO BCT, FRANCE
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Presentation title, Month #, Year. Confidential
Indications for Red Blood Cell Exchange (RBCX)
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Sickle Cell Disease
Beta–Thalassemia major
Hemochromatosis
Protozoal infections (Malaria, Babesiosis)
Incompatible RBC Transfusion
Carbon Monoxide poisoning
SICKLE CELL DISEASE
TRANSFUSION VERSUS
AUTOMATED EXCHANGE
Historitical role of simple transfusion in SCD
 Improves tissue oxygenation
 Can suppress Bone Marrow & reduce HbS
production
 Prevents complications related to SCD
Complications of transfusion
 Blood hyperviscosity
 Haemolytic and Non-Haemolytic transfusion
reactions
 Infections
 Alloimmunisation
 Iron overload requiring chelation therapy
 Delayed growth and sexual maturation due
to endocrine disturbance related to iron
overload
(Abetz L et al, 2006; Roberts D et al, 2005)
Iron Overload – Prevalence and management
 Iron Overload in ~ 33% of SCD patients (Ballas et al, 2001)
 Ferritin in transfused children increased from 164 to
2509 ng/mL after 24 months (Hirst et al, 2002)
 Management :
 Iron chelating drugs with the issue of poor compliance,
40 to 60% and high cost (Davies et al, 1995)
 Automated Red Blood Cell Exchange (RBCX)
THE ROLE OF AUTOMATED
RBCX IN SICKLE CELL
DISEASE
Automated RBCX - Procedure Goals
 Cells separation by centrifugation
 Rapidly reduces the number of SC red
blood cells with an excellent accuracy
 Maintains or modifies the patient’s
hematocrit accurately
 Much greater control of the circulating
volume and fluid balance
Automated RBCX – Iron Neutrality
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RBCX is most effective at iron control if initiated early in
the course of transfusion
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Stabilization of the ferritin levels with possible decrease
after long term treatment
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Chelating therapy could be stopped
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Adding the cost of chelating therapy to the simple
transfusion greatly exceeds the cost of RBCX
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Better patient compliance, improved quality of life
(Kalff et al, 2010; Singer et al, 1999; Hilliard et al, 1998; Adams et al, 1996)
Simple transfusion vs Automated RBCX
Transfusion
Single needle
Poor control on fluid balance
and viscosity
Poor control Hb level
More hospital visits
Iron overload
Time consuming procedure
RBCX
Dual needle
Control of fluid balance and
viscosity
Precise lowering of HbS
Fewer hospital visits
“Iron neutrality”
Short time procedure
Long term cost
RBCX
TECHNIQUE
Flexibility to Perform Multiple Types of RBCX Procedures
Spectra Optia
 Exchange
 Depletion
 Depletion/Exchange
© CaridianBCT 2009. All rights reserved.
Part# 306670-869A
Benefits of Depletion / Exchange procedure
 Reduction of % Hct in selected patients (prevent
hyperviscosity)
 Better reduction of HbS
OR
 Less use of RBC units as a replacement fluid for the same
target
Considerations for Depletion/Exchange
Patient: 5L TBV, Hct 26%, Fluid Balance 100%
Example 1
Example 2
Exchange
Depletion/
Exchange
Exchange
Depletion/
Exchange
Min Hct (%)
26
22
26
22
Target Hct (%)
32
32
32
32
Target FCR (%)
30
30
33
30
3148
2921
2921
2921
Replace Vol (mL)
Same targets
Less blood units
Better targets
Same blood units
16
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