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Updated: Apr 17, 2026
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Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
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Red cell exchange: special focus on sickle cell disease
1Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Hematology. American Society of Hematology. Education Program
|February 20, 2015
Summary
Red cell exchange (RCE) removes abnormal hemoglobin-containing red blood cells (RBCs) and replaces them with healthy donor RBCs. This review details RCE indications in sickle cell disease and compares manual versus automated methods.
Area of Science:
- Hematology
- Transfusion Medicine
- Apheresis
Background:
- Red blood cells (RBCs) deliver oxygen; compromised oxygen delivery causes tissue hypoxia.
- Hypoxia stems from reduced/increased RBC mass or abnormal hemoglobin (Hb).
- Abnormal Hb includes high-affinity Hb or sickled RBCs causing microvascular occlusion.
Purpose of the Study:
- To present indications for red cell exchange (RCE) in sickle cell disease.
- To discuss the rationale for RCE in specific disorders.
- To compare simple transfusion vs. RCE and manual vs. automated RCE.
Main Methods:
- Review of evidence-based American Society for Apheresis categories for RCE indications.
- Comparison of simple transfusion, RBC depletion, and RCE strategies.
- Evaluation of manual RCE versus automated RCE (erythrocytapheresis) using blood cell separators.
Main Results:
- RCE is indicated for abnormal Hb disorders, replacing diseased RBCs with healthy ones.
- Automated RCE (erythrocytapheresis) offers an alternative to manual exchange.
- Challenges in pediatric erythrocytapheresis and central venous access are discussed.
Conclusions:
- RCE is a crucial therapeutic option for managing abnormal hemoglobin disorders.
- Automated RCE provides an efficient method for RBC replacement.
- Addressing challenges in pediatric RCE is essential for optimizing patient care.
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