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Ziemba Y, Xu C, Fomani KM, Nandi V, Yuan T, Rehmani S, Sachais BS, Appiah-Kubi AO, Aygun B, Louie JE, Shi PA. Safety and benefits of automated red cell depletion-exchange compared to standard exchange in patients with sickle cell disease undergoing chronic transfusion. Transfusion 2021; 61:526-536. [PMID: 33368343 DOI: 10.1111/trf.16225] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The Spectra Optia allows automated performance of red blood cell reduction and isovolemic hemodilution (IHD) prior to standard red cell exchange (RCE), and is primarily intended for patients with sickle cell disease (SCD) undergoing chronic RCE. Data on the safety of inducing transient further anemia and the benefits of IHD-RCE is limited and occasionally contradictory. STUDY DESIGN AND METHODS In this retrospective crossover analysis of six patients with SCD who underwent chronic exchange with standard RCE (Cobe Spectra) followed by IHD-RCE (Spectra Optia), we compared safety and benefit outcomes with IHD-RCE vs standard RCE. RESULTS There were statistically but not clinically significant drops in blood pressure in the post-IHD phase. With IHD-RCE, there were significant reductions in red blood cell (RBC) usage and/or lower fraction of cells and significant increases in postprocedure hematocrit (Hct) associated with increased preprocedure Hct. There were no differences achieved in the time interval between procedures or in the net RBC gain with IHD-RCE. Overall, there were also no significant differences in pre- and postprocedure percentage of hemoglobin S, reticulocyte count, interval daily hemoglobin A decrement, or postprocedure white blood cell, neutrophil, or platelet counts. CONCLUSIONS Our study supports that IHD-RCE can be safely used in patients with stroke risk and compared to standard RCE, results in benefits of lower RBC usage and/or fraction of cells remaining and higher postprocedure Hct associated with higher preprocedure Hct. These findings support wider use of IHD-RCE, especially in the current environment with reduced availability of minority units.
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Affiliation(s)
- Yonah Ziemba
- Long Island Jewish Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - Cindy Xu
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Katayoun M Fomani
- Long Island Jewish Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - Vijay Nandi
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Tiejun Yuan
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Shiraz Rehmani
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
| | - Bruce S Sachais
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
- Clinical Services, New York Blood Center, New York, New York, USA
| | - Abena O Appiah-Kubi
- Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - Banu Aygun
- Cohen Children's Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - James E Louie
- Long Island Jewish Medical Center, Northwell Health, New Hyde Park, New York, USA
| | - Patricia A Shi
- Long Island Jewish Medical Center, Northwell Health, New Hyde Park, New York, USA
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York, USA
- Clinical Services, New York Blood Center, New York, New York, USA
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Fields ME. Personalizing transfusion in sickle cell disease: where is the canary in the mine? Transfusion 2019; 59:2493-2495. [PMID: 31374145 DOI: 10.1111/trf.15453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Melanie E Fields
- Division of Pediatric Hematology/Oncology, Washington University School of Medicine, St. Louis, MO
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