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Author Topic: Access for chronic red blood cell exchange

Posts: 219
Post Access for chronic red blood cell exchange
on: November 8, 2012, 19:36

At my institution we have a growing proportion of our sickle cell population who are in their mid to late 40s, and becoming more severely anemic. In many cases their anemia does not respond to hydroxyurea and/or eryhropoetic agents, and thus, are becoming transfusion dependent. Thus, we need to develope a more systematic, proactive approach to stabilizing these patients, vs transfusing them conventionally on a prn basis. While not a perfect solution, scheduled RBC exchange phoresis may provide them with more stable blood counts and less iron overload over the long term. We envision these patients requiring 4-6 exchanges per year Of course, reliable vascular access will be needed. Many of our patients have subcuetaneous ports, but to our knowledge there are no such devices available that are suitable for RBC phoresis. In your opinion what vascular access device(s) would be the best combination of durability, least potential for infection or thrombotic complications, ease of use, and lastly cosmetic quality over the long term? Any insight you can provide would be greatly appreciated.

Posts: 37
Post Re: Access for chronic red blood cell exchange
on: November 9, 2012, 10:47

Great question.

Here in the US most exchanges occur through a centrifugation machine. These machines allow for cytapheresis as well as plasmapheresis. One of the benefits of such a modality is that the blood flows needed are much lower than the alternative method, membrane permeability.

Commonly we use blood flows of 40-50 ml/min to achieve proper cytapheresis. These blood flows can be obtained with peripheral lines in the antecubital fossae. Such peripheral lines would decrease the risk of catheter-related infections and would facilitate faster administration of the therapy (you wouldn't need an interventional radiologist or nephrologist to place a catheter).

I'm not sure about the maximum blood flow rates from a portacath, though I believe it is much lower than 40 ml/min.

For more information about plasmapheresis, check out our 10-Minute Rounds video (http://blog.ecu.edu/sites/nephrologyondemand/?page_id=6949#general

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