Bérengère Koehl1,2, Julie Sommet2,3,4, Laurent Holvoet5,6, Hendy Abdoul3, Priscilla Boizeau3, Ghislaine Ithier5,6, Florence Missud5,6, Nathalie Couque7, Suzanne Verlhac8, Pauline Voultoury9, Fatiha Sellami9, André Baruchel2,5, Malika Benkerrou4,5,6. 1. Pediatric Unit, AP-HP, Robert Debré Hospital, Paris. 2. Université Paris 7-Diderot, Paris. 3. Clinic Epidemiology Unit, AP-HP, Robert Debré Hospital, Paris. 4. INSERM UMR 1123, Paris, France. 5. Hematology Unit, AP-HP, Robert Debré Hospital, Paris. 6. Reference Centre of Sickle Cell Disease, AP-HP, Robert Debré Hospital, Paris. 7. Biochemistry and Molecular Genetics, AP-HP, Robert Debré Hospital, Paris. 8. Radiology Unit, AP-HP, Robert Debré Hospital, Paris. 9. Etablissement Français du Sang, AP-HP, Robert Debré Hospital, Paris.
Abstract
BACKGROUND: Chronic exchange transfusion is effective for primary and secondary prevention of stroke in children with sickle cell anemia (SCA). Erythrocytapheresis is recognized to be the most efficient approach; however, it is not widely implemented and is not suitable for all patients. The aim of our study was to compare automated exchange transfusion (AET) with our manual method of exchange transfusion and, in particular, to evaluate the efficacy, safety, and cost of our manual method. STUDY DESIGN AND METHODS: Thirty-nine SCA children with stroke and/or abnormal findings on transcranial Doppler were included in the study. We retrospectively analyzed 1353 exchange sessions, including 333 sessions of AET and 1020 sessions of manual exchange transfusion (MET). RESULTS: Both methods were well tolerated. The median decrease in hemoglobin (Hb)S per session was 21.5% with AET and 18.8% with our manual method (p < 0.0001) with no major increase in red blood cell consumption. Iron overload was well controlled, even with the manual method, with a median (interquartile range) ferritin level of 312 (152-994) µg/L after 24 months of transfusions. The main differences in annual cost relate to equipment costs, which were 74 times higher with the automated method. CONCLUSION: Our study shows that continuous MET has comparable efficacy to the automated method in terms of stroke prevention, decrease in HbS, and iron overload prevention. It is feasible in all hospital settings and is often combined with AET successively over time.
BACKGROUND: Chronic exchange transfusion is effective for primary and secondary prevention of stroke in children with sickle cell anemia (SCA). Erythrocytapheresis is recognized to be the most efficient approach; however, it is not widely implemented and is not suitable for all patients. The aim of our study was to compare automated exchange transfusion (AET) with our manual method of exchange transfusion and, in particular, to evaluate the efficacy, safety, and cost of our manual method. STUDY DESIGN AND METHODS: Thirty-nine SCA children with stroke and/or abnormal findings on transcranial Doppler were included in the study. We retrospectively analyzed 1353 exchange sessions, including 333 sessions of AET and 1020 sessions of manual exchange transfusion (MET). RESULTS: Both methods were well tolerated. The median decrease in hemoglobin (Hb)S per session was 21.5% with AET and 18.8% with our manual method (p < 0.0001) with no major increase in red blood cell consumption. Iron overload was well controlled, even with the manual method, with a median (interquartile range) ferritin level of 312 (152-994) µg/L after 24 months of transfusions. The main differences in annual cost relate to equipment costs, which were 74 times higher with the automated method. CONCLUSION: Our study shows that continuous MET has comparable efficacy to the automated method in terms of stroke prevention, decrease in HbS, and iron overload prevention. It is feasible in all hospital settings and is often combined with AET successively over time.
Authors: Stella T Chou; Mouaz Alsawas; Ross M Fasano; Joshua J Field; Jeanne E Hendrickson; Jo Howard; Michelle Kameka; Janet L Kwiatkowski; France Pirenne; Patricia A Shi; Sean R Stowell; Swee Lay Thein; Connie M Westhoff; Trisha E Wong; Elie A Akl Journal: Blood Adv Date: 2020-01-28
Authors: Marianne E M Yee; Cassandra D Josephson; Anne M Winkler; Jennifer Webb; Naomi L C Luban; Traci Leong; Sean R Stowell; John D Roback; Ross M Fasano Journal: Transfusion Date: 2018-04-17 Impact factor: 3.337
Authors: B F Faye; D Sow; M Seck; N Dieng; S A Toure; M Gadji; A B Senghor; Y B Gueye; D Sy; A Sall; T N Dieye; A O Toure; S Diop Journal: Adv Hematol Date: 2017-05-11