Manual red cell exchange (RBCXm) in acute sickle cell crisis: A feasible modality in resource limited settings

Abstract

This short communication highlights the significance of manual red blood cell exchange (RBCXm) procedure which is an emergency procedure for patients of sickle cell disease (SCD) in sickle cell crisis . To the best of our knowledge there is no standardised technique for performing RBCXm meanwhile, an automated method using an apheresis machine is either unavailable or is unaffordable. As a result, patients end up receiving top up red cell transfusions further associated with risk of iron overload, hyper viscosity and sometimes volume overload overshadowing the benefits of red cell exchange. Therefore, we developed a protocol for manual red cell exchange (RBCXm) and performed it in a patient with painful sickle cell crisis who had cost constraints for automated red cell exchange (RBCXa) procedure. RBCXm provided symptomatic relief to our patient with adequate sickle cell reduction. This RBCXm protocol may be useful in low income (LIC) and low middle income countries (LMIC) where patients have recurrent episodes of sickle cell crisis and there is unavailability or unaffordability for RBCXa using an apheresis equipment.