Variation in Chronic Automated Red Cell Exchange Practices for Sickle Cell Disease: Insights Into Isovolemic...

Area of Science:

• Hematology
• Apheresis Medicine
• Clinical Practice Guidelines

Background:

• Chronic red blood cell exchange (RCE) is utilized for managing sickle cell disease (SCD).
• Previous surveys indicate substantial variability in RCE procedures, particularly isovolemic hemodilution RCE (IHD-RCE).
• Opportunities for practice harmonization and future research require current data on RCE practices.

Purpose of the Study:

• To survey current chronic RCE practices among American Society for Apheresis (ASFA) members.
• To identify areas of procedural variability and potential for harmonization in RCE for SCD.
• To inform the development of consensus guidelines for RCE in SCD.

Main Methods:

• A 72-item survey on chronic RCE practices, focusing on IHD-RCE, was developed by the ASFA SCD Research Subcommittee.
• The survey was distributed to ASFA members via email from September 2024 to February 2025.
• Descriptive statistics were performed on responses from 62 institutions.

Main Results:

• Sixty-one percent of respondents used fixed RCE targets (end hematocrit, fraction of cells remaining, or hemoglobin S%).
• Sixty percent of institutions performed IHD-RCE, but details like minimum hematocrit and adverse event management varied.
• Consistent laboratory monitoring practices were reported pre- and post-RCE.

Conclusions:

• Procedural variability in chronic RCE for SCD persists, consistent with prior findings.
• The observed variability presents opportunities for comparative outcome studies.
• Developing consensus guidelines based on institutional best practices is recommended for RCE in SCD.