5 myths of treating sickle cell illness with automated pink blood cell trade

Not all transfusion therapies are the identical.

Not like different transfusion therapies, automated pink blood cell trade (RBCX) effectively and quickly removes a affected person’s hemoglobin S (HbS)-containing RBCs and replaces them with wholesome RBCs. It’s possible you’ll be shocked to be taught that there are a number of misperceptions surrounding automated RBCX. How do you concentrate on automated RBCX in the present day?

Fable #1: RBCX is just for acute sufferers

Actuality: Automated RBCX is really useful by the American Society for Apheresis (ASFA) and the American Society for Hematology (ASH) for sickle cell illness sufferers with sure continual and acute situations.

In one study, 70 p.c of sufferers with sickle cell illness who obtained common automated RBCX transfusions for the administration of continual recurrent painful crises skilled a imply discount of 40 p.c within the variety of emergency hospital attendances after the primary 12 months.

Fable #2: RBCX places sufferers in danger for iron overload 

Actuality: Throughout automated RBCX, a affected person’s goal hematocrit share (HCT%) may be maintained. This leads to an iron-neutral process, decreasing the necessity for chelation remedy. “Automated RBCX is the simplest means of decreasing the HbS degree shortly, inflicting the least hemodynamic imbalance whereas on the similar time decreasing the danger of iron overload.”

In one study, sufferers with no iron overload at baseline confirmed no proof of iron accumulation after 36 months of receiving automated RBCX. All six sufferers with preexisting iron overload and on chelation remedy confirmed a gradual discount of their liver iron focus, and two sufferers discontinued chelation in the course of the follow-up interval.

Fable #3: RBCX is expensive and inconvenient

Actuality: Many apheresis programs supply outpatient automated RBCX packages and peripheral venous entry. Studies have additionally proven potential for important value financial savings for sufferers on a long-term RBCX program.

An analysis of 23 sufferers with recurrent vaso-occlusive disaster (VOC) present process common RBCX for one to 5 years confirmed that over time, RBCX led to important value financial savings attributable to discount in hospital attendance and restricted want for expensive chelation remedy.

Fable #4: RBCX all the time will increase sufferers’ alloimmunization danger

Actuality: Whereas extra RBCs are used throughout automated RBCX than with easy transfusion, several studies have proven that RBCX was not related to elevated alloimmunization or hostile transfusion reactions.

In one study of youngsters with sickle cell illness receiving continual transfusion remedy, the speed of antibody formation was decrease for these handled with RBCX in comparison with these handled with easy transfusion.

Fable #5: RBCX causes hyperviscosity 

Actuality: Automated RBCX can persistently and precisely obtain the prescribed post-procedure HbS goal utilizing the system-calculated quantity of alternative RBCs with out growing viscosity and may be carried out as an isovolemic process.

A study of 60 sickle cell illness sufferers receiving RBCX remedy confirmed that automated RBCX persistently and precisely achieved the prescribed post-procedure HbS goal. The imply post-procedure HCT was persistently inside 1.03 p.c of the goal.

Carly Newton is a registered nurse specializing in apheresis remedies.