Implementation of Automated Red Blood Cell Exchange as a Transfusion Treatment for Sickle Cell Disease Patients in A Low-Middle Income Country

Background/Objectives: Sickle cell disease (SCD) is a prevalent genetic disorder characterized by the presence of hemoglobin S (HbS), leading to significant health complications.This study details the implementation of an automated red blood cell exchange (aRBCx) program at HEMOCE, a public blood center in Cear, Brazil, aimed at improving management for SCD patients.Methods: The program was established with comprehensive protocols for patient selection, donor compatibility, and transfusion logistics, ensuring effective and safe procedures.This is a retrospective study that analyzed data on patients and procedures performed to assess the safety, feasibility and effectiveness of the aRBCX program.Results: From August 2023 to December 2024, 19 patients underwent 146 aRBCx procedures, using a sum of 1072 red blood cells (RBC) units.The indications for aRBCX in the study population were: secondary stroke prevention, pregnancy, recurrent vaso-occlusive crises (VOC) and acute stroke.Only two procedures occurred via a central line and all other 144 procedures occurred via single needle peripheral venous access with intermittent flow.Results indicated a significant reduction in hemoglobin S levels (from 48,9% to 16,0% p< 0,0001), and stable hematocrit levels (mean pre and post hematocrit were 29.0% and 28,9% respectively), with minimal adverse events reported.Conclusions: The successful implementation of automated RBCx at HEMOCE demonstrates the effectiveness of this approach and the feasibility of introducing it in public healthcare settings in low-middle income countries.