Symptomatic Crises of Sickle Cell Anemia Treated by Limited Exchange Transfusion

Abstract

Eight patients with the symptomatic crises of sickle cell anemia were treated by limited exchange transfusion. Buffy coat-free, packed erythrocytes were used in therapy. On the first day 250 ml red cells were given followed by phlebotomy of 500 ml whole blood and an infusion of a second 250 ml of red cells. The second day's program resembled the first except that two 250-ml units of red cells succeeded the phlebotomy. The method is not accompanied by untoward reactions, it rapidly ameliorates fever and bone pain; interrupts the cycle of hypoxia, vasocclusion, and organ injury by diluting autologous circulating erythrocytes containing sickle hemoglobin with those holding hemoglobin A; and raises the oxygen-carrying capacity of the blood with only a minor increase in total blood volume. The average length of hospital stay has been reduced from 7 to 3 days. This program probably should supplant other types of treatment that do not directly influence the dynamic changes involved in the pathogenesis of symptomatic crises in sickle cell anemia.