Abstract
Background. The aim of our study was to describe the efficacy of RBCx
procedure using a Spectra Optia® automated apheresis system in children
with sickle cell disease (SCD). Methods.We used automated red blood cell
exchange to treat acute and chronic complications in 75 children with
SCD who had a median age of 10 years [7-13]. We analysed 649
exchange sessions. Results. Peripheral venous access was limited in a
number of the children, thus requiring a femoral central double‐lumen
venous catheter. We recommend the use of heparin locking, with 500 units
in each lumen of adouble‐lumen central venous catheter. This method was
well tolerated, with few complications during the procedure. For
preoperative prevention, all of the patients had achieved a post-RCE HbS
level of <30%. For chronic transfusion, with a post-RCE Hb
level of approximately 10-11 g/dL, a blood exchange volume of ≥32 mL/kg,
and an interval between each RBCx procedure of ≤30 days, it is able to
maintain the residual HbS level below 30%. For acute transfusion, a
multiple logistic regression analysis showed that a post-exchange Hb
level >=10 g/dL (p<0.001) and a total exchange
volume >=35 ml/Kg (p = 0.001) are the best way to reduce
the rate of HbS<30%. In this multivariate model, the area of
the ROC curve was 0.84. Conclusion: Erythrocytapheresis is useful and
safe for children with SCD. We recommend the use of heparin locking,
with 500 units in each lumen of a double‐lumen central venous catheter.