Partial exchange transfusion protocol for patients with sickle cell disease: Standardization and efficacy of a useful new protocol

Exanguinotransfusión parcial en pacientes con anemia de células falciformes: estandarización y eficacia de un nuevo protocolo

Primary and secondary prevention of stroke and other complications in SCD can be done with exchange transfusion. Among the benefits are less iron overload and better hemoglobin S (HbS) control. Due to the technical difficulty it is little used in clinical practice Objective: To evaluate the safety and clinical efficacy of a new protocol for partial exchange transfusion in pediatric patients with SCD. Methods: 33 patients with SCD were included between February 2016 and March 2019 with a lower limit of hemoglobin was 7 gr/dl. The efficacy of the protocol was evaluated with the measurement of hemoglobin, hematocrit, %HbS, ferritin and TAMMvel- MCA, at the beginning of the study and after at least 3 months. Results: We made 355 procedures in 33 patients, age 9 years (IQR 6-16 years). 78.3% homozygous (HbSS). The indication for transfusion was 63.6% primary prevention and 30.3% secondary prevention. Medical complications were 1.1% and success rate 96.3%. In a subgroup of 22 patients, the efficacy of the protocol was assessed. The difference in post and pre ferritin was -33.77 mcg / L (95% CI -647.2 to 579.7 mcg / L); exchange transfusion decreased% HbS -26.16% [95% CI (-37.42 to -14.90) p <0.0001], Hb 0.5955 gr/dl [95% CI (0.2513-0.9396) p 0.0017]; the difference between TAMMvel- MCA was -19.58 cm/s [95% CI (-42.00 to 28.38) p 0.0829]. Conclusion: This protocol is easy, safe and unexpensive; its use could be extended to other centers, including patients with 7 g/dl hemoglobin. It is effective in lowering HbS and is associated with a lower probability of iron overload in patients on chronic transfusion therapy.