Red Cell Exchange and Sickle Cell Disease

by Pamela L. Malvern, BSN, RN, CNN and Victoria Hall, BSN, RN

Sickle cell disease is the most common indication when red cell exchange is carried out by Carter BloodCare clinical apheresis staff. The procedure can be elective for those sickle cell disease patients whose clinical circumstances are best managed by performing exchange every six to eight weeks. By comparison, emergency exchanges are indicated when a patient presents with such complications as acute chest syndrome, stroke, vaso-occlusive pain crisis, or hepatic or renal dysfunction.

With regard to sickle cell exchange protocols, a number of considerations contribute to a successful outcome:

• The patient’s height, weight, gender, and hematocrit are used to calculate the volume of red cells needed for exchange

• The desired fraction of patient cells remaining and the desired post-procedure hematocrit should be decided. Unless otherwise specified, a desired fraction of patient cells remaining is usually set at 30%

• Vascular access for emergency exchanges most often relies on dialysis type dual lumen catheters, since peripheral access can be difficult in sickle cell disease patients

• With a physician’s order, Carter BloodCare apheresis personnel can carry out a custom prime of the apheresis kit with one unit of leukoreduced red cells for a patient presenting with a hematocrit less than 20%. This custom prime eliminates any delay waiting for a transfusion to increase the patient’s hematocrit before connecting the patient to the extracorporeal circuit.

Comparison of pre and post exchange laboratory testing for hemoglobin S and hematocrit will indicate if the desired outcomes have been achieved.

The Clinical Apheresis department at Carter BloodCare is available 24/7 at 972-788-0650 to answer questions and schedule emergency or elective procedures.