Plasma exchange in critically ill patients with sickle cell disease

• Published in: Transfusion and apheresis science Vol. 37; no. 1; pp. 17 - 22
• Main Authors: Boga, C, Kozanoglu, I, Ozdogu, H, Ozyurek, Emel
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.08.2007
• Subjects: Adolescent; Adult; Anemia, Sickle Cell - complications; Anemia, Sickle Cell - mortality; Anemia, Sickle Cell - therapy; Apheresis; Automatic red cell exchange; Child; Critical Illness; Disease-Free Survival; Erythrocyte Transfusion - adverse effects; Female; Follow-Up Studies; Health technology assessment; Hematology, Oncology and Palliative Medicine; Humans; Male; Middle Aged; Multiple Organ Failure - etiology; Multiple Organ Failure - mortality; Multiple Organ Failure - therapy; Plasma Exchange; Sickle cell disease; Survival Rate; Vaso-occlusive crisis; Plasma exchange; Vaso-occlusive crisis; Sickle cell disease; Apheresis; Automatic red cell exchange
• ISSN: 1473-0502; 1878-1683
• DOI: 10.1016/j.transci.2006.12.009

Abstract 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.