Automated erythrocytopheresis for sickle cell anemia during pregnancy.

Automated erythrocytopheresis allows for selective removal of erythrocytes from whole blood by means of extracorporeal centrifugation and separation. Remaining cellular and liquid fractions are returned to the patient, along with donor erythrocytes. Supertransfusion with the use of plasmapheresis and simultaneous direct transfusion of erythrocytes increases the hematocrit while maintaining stable intravascular volume. This technique was used in the prophylactic exchange transfusion in eight pregnant women with sickle hemoglobinopathies. Two patients required repeat procedures 7 and 13 weeks later for hemoglobin A concentration or hematocrit less than 25%. The results from the first five pregnancies are detailed. All pregnancies were carried to term, with the delivery of healthy infants. There was no fetal or neonatal morbidity, and the only maternal morbidity was a case of puerperal endometritis. Erythrocytopheresis has been established as a flexible and useful means of managing gravid patients with sickle hemoglobinopathies.