Role of therapeutic automated red cell exchange in patients with sickle cell crisis: Report of six cases from an Indian tertiary care center

This study aims to evaluate the efficacy of automated red cell exchange (RCE) in managing acute complications of sickle cell disease (SCD), particularly vaso-occlusive crises, and to analyze its impact on clinical and laboratory outcomes. Six patients diagnosed with SCD underwent automated RCE between May 2021 and June 2024 at a tertiary care center. Procedures were conducted using the COM.TEC apheresis machine (Fresenius Kabi, Germany) with PL1 kits. Pre-procedure evaluations included blood grouping, extended Rh and Kell phenotyping, antibody screening, complete blood count, liver function tests, and hemoglobin (Hb) electrophoresis. Target hemoglobin S (HbS) levels (<30%) guided the volume of red cells exchanged. Donor blood units, crossmatch-compatible, HbS-negative, and leukoreduced, were used. Central venous access was established through a double-lumen catheter, and patient monitoring during the procedure included vital signs and serum calcium levels. Post-procedure laboratory parameters were assessed to evaluate efficacy. All six patients experienced significant clinical symptom relief and a marked reduction in HbS levels (mean pre-procedure HbS: 72.15%; mean post-procedure HbS: 22.83%). Laboratory parameters showed improvement, including Hb, hematocrit, and total leukocyte counts. The average procedure duration was 89.83 min, with no alloantibodies detected in any patient. No major adverse events were observed. Automated RCE is a safe and effective intervention for acute SCD crises, offering advantages over simple transfusions, including reduced iron overload and alloimmunization risks. This cost-effective approach may be incorporated into treatment protocols for SCD in centers with appropriate resources.