Safety and benefits of automated red cell reduction-exchange compared to standard exchange in patients with sickle cell disease undergoing chronic transfusion
Safety and benefits of automated red cell reduction-exchange compared to standard exchange in patients with sickle cell disease undergoing chronic transfusion
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DOI：
10.1111/trf.16225
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发表时间：
2020-12-24
期刊：
影响因子：
2.9
通讯作者：
Shi, Patricia A.
中科院分区：
文献类型：
--
作者：
Ziemba, Yonah;Xu, Cindy;Shi, Patricia A.
背景Spectra Optia允许在标准红细胞置换（RCE）前自动进行红细胞减少和等容血液稀释（IHD），主要适用于接受慢性RCE的镰状细胞病（SCD）患者。关于诱导暂时性进一步贫血的安全性和IHD-RCE的益处的数据是有限的，偶尔矛盾的。研究设计和方法在这项回顾性交叉分析中，6例SCD患者接受了标准RCE的慢性交换。（Cobe Spectra），然后是IHD-RCE（Spectra Optia），我们比较了IHD-RCE与标准RCE的安全性和获益结果。IHD阶段。使用IHD-RCE时，红细胞（RBC）使用率显著降低和/或细胞分数降低，术后红细胞压积（Hct）显著升高，与术前Hct升高相关。两次手术之间的时间间隔或IHD-RCE的RBC净增益均无差异。总的来说，在术前和术后血红蛋白S百分比、网织红细胞计数、间隔每日血红蛋白A减量或术后白色血细胞、中性粒细胞或血小板计数方面也没有显著差异。结论我们的研究支持IHD-RCE可以安全地用于有卒中风险的患者，与标准RCE相比，导致较低的RBC使用和/或剩余细胞分数以及与较高的术前Hct相关的较高的术后Hct的益处。这些调查结果支持更广泛地使用IHD-RCE，特别是在目前少数民族单位减少的环境下。
Background The Spectra Optia allows automated performance of red blood cell reduction and isovolemic hemodilution (IHD) prior to standard red cell exchange (RCE), and is primarily intended for patients with sickle cell disease (SCD) undergoing chronic RCE. Data on the safety of inducing transient further anemia and the benefits of IHD-RCE is limited and occasionally contradictory.Study Design and Methods In this retrospective crossover analysis of six patients with SCD who underwent chronic exchange with standard RCE (Cobe Spectra) followed by IHD-RCE (Spectra Optia), we compared safety and benefit outcomes with IHD-RCE vs standard RCE.Results There were statistically but not clinically significant drops in blood pressure in the post-IHD phase. With IHD-RCE, there were significant reductions in red blood cell (RBC) usage and/or lower fraction of cells and significant increases in postprocedure hematocrit (Hct) associated with increased preprocedure Hct. There were no differences achieved in the time interval between procedures or in the net RBC gain with IHD-RCE. Overall, there were also no significant differences in pre- and postprocedure percentage of hemoglobin S, reticulocyte count, interval daily hemoglobin A decrement, or postprocedure white blood cell, neutrophil, or platelet counts.Conclusions Our study supports that IHD-RCE can be safely used in patients with stroke risk and compared to standard RCE, results in benefits of lower RBC usage and/or fraction of cells remaining and higher postprocedure Hct associated with higher preprocedure Hct. These findings support wider use of IHD-RCE, especially in the current environment with reduced availability of minority units.