title: Advantages of isovolemic hemodilution-red cell exchange therapy to prevent recurrent stroke in sickle cell anemia patients.
abstract: Chronic simple hypertransfusion (every 3 to 4 weeks) effectively prevents secondary stroke in children with sickle cell anemia but leads to iron overload despite chelation therapy. Conventional red blood cell exchange (C-RBCx) has advantages over simple transfusion: no net iron gain and less frequent hospital visits. However, C-RBCx requires more red blood cell units, an apheresis instrument and skilled personnel; it is also more expensive. We developed a modified procedure where isovolemic hemodilution precedes RBCx (IHD-RBCx) to decrease RBC units required and to increase the interval between procedures. Twenty patients underwent IHD-RBCx over a period of 7 years. IHD-RBCx required 11% fewer RBC units and increased inter-procedure interval from 37 to 53 days compared to C-RBCx. The median number of annual procedures decreased from 9.8 to 7.0 per patient, resulting in estimated savings of more than $4.5 million over 10 years for 20 patients while providing improved care. Five patients have discontinued chelation therapy; three while on C-RBCx and two while on IHD-RBCx. No adverse events occurred related to the isovolemic hemodilution phase and no patients had recurrent stroke. IHD-RBCx is a safe, efficient, and cost effective therapy for secondary prevention of stroke in patients with sickle cell anemia.
authors.affiliation: Department of Pathology, University of Texas Southwestern Medical Center, Southwestern Comprehensive Sickle Cell Center, Dallas, Texas 75390-9073, USA. ravi.sarode@utsouthwestern.edu
authors.forename: Ravi
authors.initials: R
authors.lastname: Sarode
authors.forename: Karén
authors.initials: K
authors.lastname: Matevosyan
authors.forename: Zora R
authors.initials: ZR
authors.lastname: Rogers
authors.forename: James D
authors.initials: JD
authors.lastname: Burner
authors.forename: Cynthia
authors.initials: C
authors.lastname: Rutherford
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000097:blood* / Q000503:physiopathology / Q000628:therapy*; D057205:Automation, Laboratory; D001810:Blood Volume; D015913:Chelation Therapy; D002648:Child; D002675:Child, Preschool; D017707:Erythrocyte Transfusion / Q000009:adverse effects; D005260:Female; D006438:Hemodilution / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D055502:Secondary Prevention / Q000379:methods; D020521:Stroke / Q000517:prevention & control*; D055815:Young Adult