title: Partial manual exchange reduces iron accumulation during chronic red cell transfusions for sickle cell disease.
abstract: Iron overload is an inevitable consequence of chronic red cell transfusions without erythrocytapheresis or chelation therapy. The effectiveness of partial manual exchange, a technique used to slow iron loading, has not been evaluated. We evaluated all children with sickle cell disease (SCD) receiving chronic transfusion to identify chelation-naive subjects who had quantitative liver iron concentration (LIC) studies. Seventeen chelation-naive children with SCD received a median of 29 transfusions before first LIC determination. Serum ferritin concentrations were assessed before each transfusion. The mean volume of blood phlebotomized before each transfusion was 5.1±1.8 mL/kg, which cumulatively resulted in a calculated median of 35.0 mg/kg iron removal. Using linear regression, pretransfusion phlebotomy resulted in a statistically significant reduction in ferritin (-8.8 ng/mL of ferritin for each mg/kg of iron phlebotomized, P=0.02). A reduction in LIC from pretransfusion phlebotomy could not be established (P=0.4). Partial manual exchanges appear to be an effective strategy for slowing the pace of iron loading in the setting of chronic transfusion for SCD.
authors.affiliation: Division of Transfusion Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA. wjsavage@partners.org
authors.forename: William J
authors.initials: WJ
authors.lastname: Savage
authors.forename: Shirley
authors.initials: S
authors.lastname: Reddoch
authors.forename: Jaime
authors.initials: J
authors.lastname: Wolfe
authors.forename: James F
authors.initials: JF
authors.lastname: Casella
mesh_terms: D000293:Adolescent; D000328:Adult; D000755:Anemia, Sickle Cell / Q000097:blood* / Q000628:therapy*; D017707:Erythrocyte Transfusion / Q000009:adverse effects*; D005260:Female; D006801:Humans; D019190:Iron Overload / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy / Q000379:methods*; D055815:Young Adult