Automated RBC Exchange has a greater effect on whole blood viscosity than manual whole blood exchange in adult patients with sickle cell disease.
RBC Exchange
blood viscosity
haematological parameters
sickle cell disease
transfusion
Journal
Vox sanguinis
ISSN: 1423-0410
Titre abrégé: Vox Sang
Pays: England
ID NLM: 0413606
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
22
04
2019
revised:
12
07
2020
accepted:
20
07
2020
pubmed:
24
9
2020
medline:
16
3
2021
entrez:
23
9
2020
Statut:
ppublish
Résumé
Blood transfusion is the cornerstone treatment to reduce the clinical severity of sickle cell disease (SCD), but we need to maintain the haematocrit (Hct) within an acceptable range to avoid a deleterious increase in blood viscosity. The aim of this study was to compare the effects of manual versus automated red blood cell (RBC) Exchange on haematological parameters and blood viscosity. This prospective, single-centre, open nonrandomized observational study included forty-three sickle cell patients: 12 had automated RBC Exchange and 31 manual RBC Exchange. Samples were collected in EDTA tubes just before and within one hour after the end of the RBC Exchange to measure the haematological parameters and blood viscosity. Both automated and manual RBC Exchange decreased haemoglobin S levels and leucocyte and platelet counts, but the decrease was greater for automated RBC Exchange. Manual RBC Exchange caused a significant rise in haematocrit and haemoglobin levels and did not change blood viscosity. In contrast, automated RBC Exchange decreased blood viscosity without any significant change in haematocrit and only a very slight increase in haemoglobin levels. The change in blood viscosity correlated with the modifications of haematocrit and haemoglobin levels, irrespective of the RBC Exchange procedure. When adjusted for the volume of RBC Exchange, the magnitude of change in each biological parameter was not different between the two procedures. Our study demonstrates that the automated RBC Exchange provided greater haematological and haemorheological benefits than manual RBC Exchange, mainly because of the higher volume exchanged, suggesting that automated RBC Exchange should be favoured over manual RBC Exchange when possible and indicated.
Sections du résumé
BACKGROUND
BACKGROUND
Blood transfusion is the cornerstone treatment to reduce the clinical severity of sickle cell disease (SCD), but we need to maintain the haematocrit (Hct) within an acceptable range to avoid a deleterious increase in blood viscosity. The aim of this study was to compare the effects of manual versus automated red blood cell (RBC) Exchange on haematological parameters and blood viscosity.
STUDY DESIGN AND METHODS
METHODS
This prospective, single-centre, open nonrandomized observational study included forty-three sickle cell patients: 12 had automated RBC Exchange and 31 manual RBC Exchange. Samples were collected in EDTA tubes just before and within one hour after the end of the RBC Exchange to measure the haematological parameters and blood viscosity.
RESULTS
RESULTS
Both automated and manual RBC Exchange decreased haemoglobin S levels and leucocyte and platelet counts, but the decrease was greater for automated RBC Exchange. Manual RBC Exchange caused a significant rise in haematocrit and haemoglobin levels and did not change blood viscosity. In contrast, automated RBC Exchange decreased blood viscosity without any significant change in haematocrit and only a very slight increase in haemoglobin levels. The change in blood viscosity correlated with the modifications of haematocrit and haemoglobin levels, irrespective of the RBC Exchange procedure. When adjusted for the volume of RBC Exchange, the magnitude of change in each biological parameter was not different between the two procedures.
CONCLUSION
CONCLUSIONS
Our study demonstrates that the automated RBC Exchange provided greater haematological and haemorheological benefits than manual RBC Exchange, mainly because of the higher volume exchanged, suggesting that automated RBC Exchange should be favoured over manual RBC Exchange when possible and indicated.
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
722-728Informations de copyright
© 2020 International Society of Blood Transfusion.
Références
Abboud MR, Yim E, Musallam KM, et al.: Discontinuing prophylactic transfusions increases the risk of silent brain infarction in children with sickle cell disease: data from STOP II. Blood 2011; 118:894-898
Adams RJ: Lessons from the stroke prevention trial in sickle cell anemia (STOP) study. J Child Neurol 2000; 15:344-349
Habibi A, Arlet JB, Stankovic K, et al.: French guidelines for the management of adult sickle cell disease: 2015 update. Rev Med Interne 2015; 36:5S3-84
Lee MT, Piomelli S, Granger S, et al.: Stroke Prevention Trial in Sickle Cell Anemia (STOP): extended follow-up and final results. Blood 2006; 108:847-852
Miller ST, Wright E, Abboud M, et al.: Impact of chronic transfusion on incidence of pain and acute chest syndrome during the Stroke Prevention Trial (STOP) in sickle-cell anemia. J Pediatr 2001; 139:785-789
Wayne AS, Kevy SV, Nathan DG: Transfusion management of sickle cell disease. Blood 1993; 81:1109-1123
Alexy T, Pais E, Armstrong JK, et al.: Rheologic behavior of sickle and normal red blood cell mixtures in sickle plasma: implications for transfusion therapy. Transfusion 2006; 46:912-918
Coates TD: So what if blood is thicker than water? Blood 2011; 117:745-746
Detterich J, Alexy T, Rabai M, et al.: Low-shear red blood cell oxygen transport effectiveness is adversely affected by transfusion and further worsened by deoxygenation in sickle cell disease patients on chronic transfusion therapy. Transfusion 2013; 53:297-305
Baskurt OK, Boynard M, Cokelet GC, et al.: New guidelines for hemorheological laboratory techniques. Clin Hemorheol Microcirc 2009; 42:75-97
Padmanabhan A, Connelly-Smith L, Aqui N, et al.: Guidelines on the use of therapeutic apheresis in clinical practice - evidence-based approach from the writing committee of the American Society for apheresis: The Eighth special issue. J Clin Apher 2019; 34:171-354. https://doi.org/10.1002/jca.21705.
Swerdlow PS: Red cell exchange in sickle cell disease. Hematology Am Soc Hematol Educ Program 2006; 2006:48-53
Jan K, Usami S, Smith JA: Effects of transfusion on rheological properties of blood in sickle cell anemia. Transfusion 1982; 22:17-20
Charlot K, Romana M, Moeckesch B, et al.: Which side of the balance determines the frequency of vaso-occlusive crises in children with sickle cell anemia: Blood viscosity or microvascular dysfunction? Blood Cells Mol Dis 2016; 56:41-45
Lamarre Y, Romana M, Waltz X, et al.: Hemorheological risk factors of acute chest syndrome and painful vaso-occlusive crisis in children with sickle cell disease. Haematologica 2012; 97:1641-1647
Nebor D, Bowers A, Hardy-Dessources MD, et al.: Frequency of pain crises in sickle cell anemia and its relationship with the sympatho-vagal balance, blood viscosity and inflammation. Haematologica 2011; 96:1589-1594
Thurston GB, Henderson NM, Jeng M: Effects of erythrocytapheresis transfusion on the viscoelasticity of sickle cell blood. Clin Hemorheol Microcirc 2004; 30:83-97
Nader E, Connes P, Lamarre Y, et al.: Plasmapheresis may improve clinical condition in sickle cell disease through its effects on red blood cell rheology. Am J Hematol 2017; 92:E629-30. https://doi.org/10.1002/ajh.24870
Dedeken L, Lê PQ, Rozen L, et al.: Automated RBC exchange compared to manual exchange transfusion for children with sickle cell disease is cost-effective and reduces iron overload. Transfusion 2018; 58:1356-1362. https://doi.org/10.1111/trf.14575. Epub 2018 Mar 25
Fasano RM, Leong T, Kaushal M, et al.: Effectiveness of red blood cell exchange, partial manual exchange, and simple transfusion concurrently with iron chelation therapy in reducing iron overload in chronically transfused sickle cell anemia patients. Transfusion 2016; 56:1707-15. https://doi.org/10.1111/trf.13558. Epub 2016 Mar 20
Koehl B, Sommet J, Holvoet L, et al.: Comparison of automated erythrocytapheresis versus manual exchange transfusion to treat cerebral macrovasculopathy in sickle cell anemia. Transfusion 2016; 56:1121-8. https://doi.org/10.1111/trf.13548. Epub 2016 Mar 28
Sherrod DeVerse J, Sandhu AS, Mendoza N, et al.: Shear stress modulates VCAM-1 expression in response to TNF-α and dietary lipids via interferon regulatory factor-1 in cultured endothelium. Am J Physiol Heart Circ Physiol 2013; 305:H1149-57. https://doi.org/10.1152/ajpheart.00311.2013. Epub 2013 Aug 9.
Wagner MC, Eckman JR, Wick TM: Sickle cell adhesion depends on hemodynamics and endothelial activation. J Lab Clin Med. 2004; 144:260-7; discussion 227-8. https://doi.org/10.1016/j.lab.2004.08.004.
Baskurt OK, Meiselman HJ: Blood rheology and hemodynamics. Semin Thromb Hemost 2003; 29:435-450