Use of automated isovolemic hemodilution red-cell exchange in patients with sickle cell disease: A Canadian single center experience.

Abstract

Background: Red cell exchange (RCE) is an important treatment for sickle cell disease (SCD). It is a resource-intensive intervention requiring large volumes of red blood cells (RBC), which are frequently antigen-matched. Efforts to reduce the volume of units transfused, while maintaining treatment efficacy is an important need. This study evaluates the impact of a change to isovolemic hemodilution (IHD)-RCE on RBC utilization in SCD patients at a Canadian center.

Study design and methods: Adult SCD patients receiving chronic automated RCE at the Ottawa Hospital were approached for study inclusion. To safely attain a meaningful reduction in transfused RBCs, RCE parameters were individualized for each patient. IHD-RCE was performed only if an estimated reduction in RBC volume of at least 200 mL was expected, with hematocrit not allowed to decrease below 20%. Data were compared in the 6-months before and after the protocol change.

Results: Twenty-two adult patients met the criteria for inclusion. There was a net reduction of 107 RBC units after the transition from standard RCE to IHD-RCE (1035 vs. 928 units; -10.3%). The mean number of RBC units transfused per patient decreased by 4.8 (47.0 vs. 42.2 units; p = .01). No difference in target post-RCE hemoglobin S levels was observed.

Discussion: In this study IHD-RCE reduced RBC utilization without impacting efficacy or safety, conserving 107 RBC units (an annualized savings of $95,444 CAD). No adverse events due to saline replacement were observed. Increased awareness of the benefits of IHD-RCE through knowledge translation could promote greater uptake.