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
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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.
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