The Efficacy of Whole Blood Exchange- Lymphoplasmapheresis Combined Transfusion in Sepsis with Anemia

BACKGROUND: Sepsis progression is driven by a dysregulated immune response and persistent leukocyte activation. Inflammation-induced hemolysis also places septic patients at high risk for anemia. Whole blood exchange has shown efficacy in severe autoimmune hemolytic anemia. Consequently, whole blood exchange-lymphoplasmapheresis combined transfusion (WLCT) is hypothesized as a potential adjunctive therapy for sepsis complicated by anemia. METHOD: This retrospective study analyzed data from 219 anemic septic patients (49 WLCT vs. 156 conventional therapy) treated between January 1, 2020 and September 30, 2023. After 1:2 propensity score matching (PSM), 38 WLCT patients were compared to 76 conventional patients. Associations between WLCT and clinical outcomes were assessed using regression analyses, with robustness verified by sensitivity analyses. A generalized additive mixed model was employed to evaluate the trends in sequential organ failure assessment (SOFA) scores, vital signs, and laboratory indexes in two groups. RESULTS: Post-matching, WLCT was significantly associated with decreased risks of in-hospital mortality (26.32% vs. 48.68%, odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.16-0.88, P = 0.024) and incidence of liver failure (16.13% vs. 41.27%, OR: 0.27, 95%CI: 0.09-0.81, P = 0.019). Sensitivity analysis consistently supported these findings. Compared with conventional group, WLCT group demonstrated significant decreases over time in SOFA scores, activated partial thromboplastin time, bilirubin levels, alongside increased in mean arterial pressure, oxygen partial pressure, hemoglobin, red blood cell count, and plasminogen levels. Compared to pre-WLCT, levels of Interleukin-6 (18.81±22.63 vs. 116.86±277.53 pg/ml, P = 0.041), C-reactive protein (37.90±41.30 vs. 72.77±65.59 mg/L, P = 0.020) and erythrocyte sedimentation rate (18.46±22.97 vs. 50.44±45.79 mm/h, P = 0.048) were significantly lower post-WLCT. After treatment, the WLCT group demonstrated significantly lower CD3+ T lymphocytes % (53.63 ± 16.31 vs. 66.14 ± 14.94, P = 0.041) and CD3+CD4+ T lymphocytes % (28.08 ± 8.90 vs. 39.18 ± 10.70, P = 0.004), but higher CD19+ B lymphocytes % (36.09 ± 18.06 vs. 19.23 ± 12.30, P = 0.007) compared to the conventional group. CONCLUSIONS: This study evaluated the impact of WLCT therapy on mortality and other clinical outcomes in sepsis with anemia. WLCT might be an effective adjunctive treatment for managing sepsis with anemia, which was significantly associated with reduced mortality. Furthermore, WLCT might exhibit the potential to ameliorate outcomes by improving organ function, coagulation, anemia, and inflammatory status. Our study provides a potential treatment option for sepsis.