Journal of Blood Disorders & Transfusion

Abstract

Red Cell Exchange Transfusion in Sickle Cell Anaemia Patients at the University College Hospital, Ibadan, Nigeria

Akingbola T, Fasola F, Khadijat AS, Alonge T, Chinonso AY

Introduction: The prohibitive cost of Haemopoietic Stem Cell Transplant (HSCT) makes many Nigerians with sickle cell anaemia (SCA) dependent on supportive therapies. Red cell exchange (RCE) transfusion (erythrocytaphersis) provides an effective means of improving the oxygen carrying capacity of the patient’s red blood cells, reduces blood viscosity, sickled cells and prevents vaso-occlusive and hemolytic complications of SCA. We present three case reports of automated RCE highlighting benefits and potential risks observed following the procedure.
Methods: The COBE® Spectra™ version 6.1, which operates by separating blood into its component parts by centrifugation, allowing segmentation by specific gravity, was utilized to conduct automated therapeutic erythrocytapheresis on patients with SCA in this centre. Indications were recurrent priapism, stroke prophylaxis, chronic bone pain crisis, sickle cell nephropathy, pre-surgical requirement, increasing bone pain frequency and chronic transfusion.
Results: Eleven sessions of erythrocytapheresis have been performed on male and female patients at the time of this report. The patient’s age range was 19-46 years (mean age: 29.2 years). Indications included recurrent priapism, chronic vasoocclusive crisis, sickle cell nephropathy, pre-surgical requirement, and chronic transfusion recipients. Fifty-five percent had starting haematocrit (Hct) values less than 25% (mean Hct 21.6%). The average post-erythrocytapheresis haematocrit was 28.6%. Post-procedure HbS levels were less than 40%. Five patients did not experience any adverse effects. Three patients had febrile non-hemolytic transfusion reaction. A patient exhibited symptoms in keeping with acute hypocalcemia and allergic transfusion reaction. Another patient had transfusion-related sepsis.
Conclusion: RCE is an underutilized supportive therapy in SCA. Improving safe blood supply nationwide, subsidizing ancillary investigations and increasing health insurance coverage can make it a preferred option in this setting