How do we operate a large monthly red blood cell exchange program.
red blood cell exchange
sickle cell disease
therapeutic apheresis
Journal
Transfusion
ISSN: 1537-2995
Titre abrégé: Transfusion
Pays: United States
ID NLM: 0417360
Informations de publication
Date de publication:
03 2023
03 2023
Historique:
revised:
08
12
2022
received:
05
10
2022
accepted:
19
12
2022
pubmed:
12
1
2023
medline:
23
3
2023
entrez:
11
1
2023
Statut:
ppublish
Résumé
Red blood cell (RBC) exchange for sickle cell disease presents unique difficulties due to RBC phenotyping, complex antibody work-ups, large number of RBC units required, and vascular access considerations, any of which can delay the procedure. Multidisciplinary coordination and systemic processes ensure that monthly appointments remain on schedule. A high-volume chronic RBC exchange program is described, highlighting the importance of multidisciplinary coordination and process improvement strategies involving initial referral, vascular access, order sets, and allocation of antigen-negative or phenotypically matched RBCs. Approximately 50 outpatient RBC exchanges are performed each month with an 82% kept-appointment rate. Specific factors for program success include open communication across services and improvements to referrals and standardized order sets. A combination of multidisciplinary coordination and process improvement can ensure the success of a high volume RBC exchange program. Frequent communication of upcoming appointments between the referring hematologists, the hemapheresis clinic, transfusion service, and interventional radiology is critical. Advance notice to the immunohematology reference lab of upcoming appointments is needed to allow enough time for allocating antigen-negative RBCs. Order sets can be leveraged to standardize and streamline RBC exchanges. Lastly, numerous mechanisms help patients compensate for the cognitive sequelae of stroke.
Sections du résumé
BACKGROUND
Red blood cell (RBC) exchange for sickle cell disease presents unique difficulties due to RBC phenotyping, complex antibody work-ups, large number of RBC units required, and vascular access considerations, any of which can delay the procedure. Multidisciplinary coordination and systemic processes ensure that monthly appointments remain on schedule.
STUDY DESIGN AND METHODS
A high-volume chronic RBC exchange program is described, highlighting the importance of multidisciplinary coordination and process improvement strategies involving initial referral, vascular access, order sets, and allocation of antigen-negative or phenotypically matched RBCs.
RESULTS
Approximately 50 outpatient RBC exchanges are performed each month with an 82% kept-appointment rate. Specific factors for program success include open communication across services and improvements to referrals and standardized order sets.
CONCLUSION
A combination of multidisciplinary coordination and process improvement can ensure the success of a high volume RBC exchange program. Frequent communication of upcoming appointments between the referring hematologists, the hemapheresis clinic, transfusion service, and interventional radiology is critical. Advance notice to the immunohematology reference lab of upcoming appointments is needed to allow enough time for allocating antigen-negative RBCs. Order sets can be leveraged to standardize and streamline RBC exchanges. Lastly, numerous mechanisms help patients compensate for the cognitive sequelae of stroke.
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
450-456Informations de copyright
© 2023 AABB.
Références
Adams RJ, McKie VC, Hsu L, Files B, Vichinsky E, Pegelow C, et al. Prevention of a first stroke by transfusions in children with sickle cell anemia and abnormal results on transcranial Doppler ultrasonography. N Engl J Med. 1998;339(1):5-11. https://doi.org/10.1056/NEJM199807023390102
DeBaun MR, Jordan LC, King AA, Schatz J, Vichinsky E, Fox CK, et al. American Society of Hematology 2020 guidelines for sickle cell disease: prevention, diagnosis, and treatment of cerebrovascular disease in children and adults. Blood Adv. 2020;4(8):1554-88. https://doi.org/10.1182/bloodadvances.2019001142
Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, 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(3):171-354. https://doi.org/10.1002/jca.21705
https://www.choosingwisely.org/societies/american-society-for-apheresis/
Campbell-Lee SA, Gvozdjan K, Choi KM, Chen YF, Saraf SL, Hsu LL, et al. Red blood cell Alloimmunization in sickle cell disease: assessment of transfusion protocols during two time periods. Transfusion. 2018;58:1588-96.
Narayanan D, Hogan NB, Schaser KA, Ruegsegger P, Rose WN. A case study in process improvement to minimize delays from obtaining blood for red cell exchange for a patient with sickle cell disease and multiple red blood cell alloantibodies. Case Rep Hematol. 2022;2022:1562921. https://doi.org/10.1155/2022/1562921
Schweitzer J. Diversity in the blood donor pool protects patients in need of rare blood. Transfus News. 2022;24(3):14-17.