Red Blood Cell Exchange in Sickle Cell Disease Care: A Comprehensive Review

Erythrocytaphoresis or RBC exchange (RBCX) is a key intervention in the management of sickle cell anemia for both chronic prophylaxis and emergent clinical care during sickle cell disease (SCD) emergencies. RBCX removes sickled RBCs while replacing them with donor RBCs and reducing hemoglobin S (HbS) levels. Unlike simple transfusion, it minimizes iron overload and avoids fluid overload, making it a mainstay for the management of acute stroke, acute chest syndrome, and other settings where fluid overload can complicate disease morbidity. Chronic RBCX has shown benefit in not only improving oxygenation and reducing hospitalization rates but also improving overall quality of life in SCD patients. Advances in apheresis technology and personalized transfusion have brought new opportunities for enhancement in safety, efficacy, and feasibility of this therapeutic modality. In this review, we explore the clinical efficacy and role of chronic RBC exchange and its long-term outcomes in managing complications of SCD.