title: Exchange transfusion before cardiopulmonary bypass in sickle cell disease.
abstract: Cardiac operations in patients with sickle cell disease present the surgical team with many challenges. We describe a method of complete intraoperative exchange transfusion in the operating room that reduces the hemoglobin S (Hb S) level to less than 5%, without preoperative exchange transfusions. Plasma and platelet fractions separated intraoperatively from the patient's native red cell mass were used, in addition to hemoconcentration while on cardiopulmonary bypass, to effectively reduce the red cell and clotting factor transfusion requirements after the procedure. The technique is useful in reducing transfusion requirements, avoiding cardiovascular stress associated with exchange transfusion before the operation, and can be used in urgent situations.
authors.affiliation: Department of Cardiac and Thoracic Surgery, North Shore-LIJ Health System, Long Island Jewish Medical Center, New Hyde Park, New York, USA.
authors.forename: Karl A
authors.initials: KA
authors.lastname: Bocchieri
authors.forename: S Jacob
authors.initials: SJ
authors.lastname: Scheinerman
authors.forename: L Michael
authors.initials: LM
authors.lastname: Graver
mesh_terms: D000328:Adult; D000755:Anemia, Sickle Cell / Q000150:complications / Q000628:therapy*; D002315:Cardiopulmonary Bypass / Q000379:methods*; D005078:Exchange Transfusion, Whole Blood / Q000379:methods*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery*; D019990:Perioperative Care