Plasma exchange in critically ill patients with sickle cell disease.
Red cell exchange transfusion is the recommended therapy for patients with sickle cell disease who have complicated vaso-occlusive episodes. However, the role of the therapeutic plasma exchange in the management of the potentially life-threatening complications in patients with sickle cell disease is not well known. To determine whether plasma exchange had a cumulative effect on the red cell exchange in patients with sickle cell disease who developed multi-organ failure during the post red cell exchange period, we performed plasma exchange in the nine episodes of multi-organ failure of 7 patients with sickle cell anemia. The median age of those patients was 21 years (range, 9-50 years). The criterion of the multi-organ failure was defined as organ failure of two or more organs i.e. lung, liver, or renal, established according to Acute Physiological and Chronic Health Evaluation-II (APACHE-II) criteria. The average total plasma exchange volume was 1.0 times the patient's plasma volume. The patients had a good outcome, with a survival rate at 86% after one year of follow-up. Plasma exchange may have cumulative benefits in the treatment of severe illness in patients with sickle cell disease who underwent automatic red cell exchange therapy.
Boga
C
C
Department of Hematology, Baskent University Faculty of Medicine, 06490, Ankara, Turkey. drcanboga@hotmail.com
Kozanoglu
I
I
Ozdogu
H
H
Ozyurek
Emel
E
D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002648:Child; D016638:Critical Illness; D018572:Disease-Free Survival; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010951:Plasma Exchange; D015996:Survival Rate