Advantages of isovolemic hemodilution-red cell exchange therapy to prevent recurrent stroke in sickle cell anemia patients
✍ Scribed by Ravi Sarode; Karén Matevosyan; Zora R. Rogers; James D. Burner; Cynthia Rutherford
- Publisher
- John Wiley and Sons
- Year
- 2011
- Tongue
- English
- Weight
- 125 KB
- Volume
- 26
- Category
- Article
- ISSN
- 0733-2459
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✦ Synopsis
Abstract
Chronic simple hypertransfusion (every 3 to 4 weeks) effectively prevents secondary stroke in children with sickle cell anemia but leads to iron overload despite chelation therapy. Conventional red blood cell exchange (C‐RBCx) has advantages over simple transfusion: no net iron gain and less frequent hospital visits. However, C‐RBCx requires more red blood cell units, an apheresis instrument and skilled personnel; it is also more expensive. We developed a modified procedure where isovolemic hemodilution precedes RBCx (IHD‐RBCx) to decrease RBC units required and to increase the interval between procedures. Twenty patients underwent IHD‐RBCx over a period of 7 years. IHD‐RBCx required 11% fewer RBC units and increased inter‐procedure interval from 37 to 53 days compared to C‐RBCx. The median number of annual procedures decreased from 9.8 to 7.0 per patient, resulting in estimated savings of more than $4.5 million over 10 years for 20 patients while providing improved care. Five patients have discontinued chelation therapy; three while on C‐RBCx and two while on IHD‐RBCx. No adverse events occurred related to the isovolemic hemodilution phase and no patients had recurrent stroke. IHD‐RBCx is a safe, efficient, and cost effective therapy for secondary prevention of stroke in patients with sickle cell anemia. J. Clin. Apheresis, 2011. © 2011 Wiley‐Liss, Inc.