Automated Red Cell Exchange in the Management of Sickle Cell Disease
| Autor: | Dimitris A. Tsitsikas, Jibril Abukar, Funmilayo Orebayo, Saket Badle, Manisha Sharma, Afsana Mulla, Natasha Lewis, Roger J. Amos, Rhys Hall, Mohamed Elmi, Oloruntoyin Bello-Sanyaolu, Basabi Chatterjee, Shalini Dave, John Meenan |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
automated red cell exchange Cell lcsh:Medicine Disease Drug resistance 030204 cardiovascular system & hematology Article 03 medical and health sciences 0302 clinical medicine Internal medicine Medicine Platelet iron overload Red Cell business.industry lcsh:R General Medicine Pain management medicine.disease Pulmonary hypertension alloimmunisation medicine.anatomical_structure sickle cell disease business 030215 immunology Kidney disease |
| Zdroj: | Journal of Clinical Medicine, Vol 10, Iss 767, p 767 (2021) Journal of Clinical Medicine Volume 10 Issue 4 |
| ISSN: | 2077-0383 |
| Popis: | Red cell transfusion represents one of the cornerstones of the chronic management of sickle cell disease, as well as its acute complications. Automated red cell exchange can rapidly lower the number of circulating sickle erythrocytes, without causing iron overload. Here, we describe our experience, having offered this intervention since 2011. A transient reduction in the platelet count by 61% was observed after the procedure. This was not associated with any haemorrhagic complications. Despite exposure to large volumes of blood, the alloimmunisation rate was only 0.027/100 units of red cells. The absence of any iron loading was confirmed by serial Ferriscans, performed over a number of years. However, patients with advanced chronic kidney disease showed evidence of iron loading due to reduced innate haemopoiesis and were subsequently switched to simple transfusions. A total of 59% of patients were on regular automated red cell exchange with a history of recurrent painful crises. A total of 77% responded clinically, as evidenced by at least a 25% reduction in their emergency hospital attendance for pain management. The clinical response was gradual and increased the longer patients stayed on the program. The earliest sign of clinical response was a reduction in the length of stay when these patients were hospitalised, indicating that a reduction in the severity of crises precedes the reduction in their frequency. Automated red cell exchange also appeared to be beneficial for patients with recurrent leg ulcers and severe, drug resistant stuttering priapism, while patients with pulmonary hypertension showed a dramatic improvement in their symptoms as well as echocardiographic parameters. |
| Databáze: | OpenAIRE |
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