Plasma exchange—A useful adjunct therapy to red cell exchange in patients with sickle cell disease and multiorgan dysfunction

• Published in: Transfusion (Philadelphia, Pa.) Vol. 63; no. 7; pp. 1384 - 1390
• Main Authors: Webb, C. B., Yates, S. G., Sarode, R., Kim, J.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01-07-2023; Wiley Subscription Services, Inc
• Subjects: Acute Chest Syndrome - therapy; Anemia, Sickle Cell - complications; Anemia, Sickle Cell - therapy; Apheresis; Blood Component Removal; Complications; Erythrocytes; Exchanging; Health services; Hospitals; Humans; Intensive care units; Mortality; Multiple organ dysfunction syndrome; Patients; Plasma Exchange - adverse effects; RBC transfusion; Sickle cell disease; therapeutic apheresis; RBC transfusion; therapeutic apheresis
• ISSN: 0041-1132; 1537-2995
• DOI: 10.1111/trf.17448

Background
Urgent red cell exchange (RBCx) is indicated for many complications of sickle cell disease (SCD), including acute chest syndrome, stroke, and hepatic/splenic sequestration. Many who receive RBCx remain hospitalized and develop further complications, including multiple organ dysfunction syndrome (MODS), a leading cause of death in intensive care units. Therapeutic plasma exchange (TPE) has been advocated as an effective treatment of MODS, but its role in SCD compared with RBCx alone is not well studied.
Methods
We identified all ICU encounters from 2013 to 2019 involving RBCx procedures for MODS or SCD crisis that progressed to MODS, a total of 12 encounters. Data regarding hospital length of stay (LOS), survival, number of TPE procedures following RBCx, and procedure characteristics were collected. Surrogate laboratory markers of end‐organ damage and disease severity scores were recorded at the time of admission, post‐RBCx, post‐TPE, and at discharge.
Results
Eight encounters involved RBCx followed by TPE (TPE group) while four involved RBCx alone (RBCx group). The TPE group had a higher SOFA score at ICU admission (9.5 vs. 7.0), greater predicted mortality, and a statistical trend toward higher disease severity scores following RBCx relative to the RBCx group (p = 0.10). The TPE group showed a significantly greater decrease in SOFA score between RBCx and discharge (p = 0.04). No significant difference in mortality or hospital LOS was observed between the groups.
Conclusion
The findings suggest TPE may be considered as an adjunct treatment for patients with acute complications of SCD that progress to MODS, especially in cases where there is no significant improvement following RBCx.