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Therapeutic Apheresis Red Blood Cell Exchange

Learn how automated RBCX transfusion therapy can help patients

Discover the value of RBCX for transfusion management of sickle cell disease in adults and children*

Compared to simple transfusion and manual exchange, RBCX provides the following advantages:

  • Removes red blood cells (RBCs) containing hemoglobin S (HbS) and rapidly replaces them with healthy RBCs while maintaining isovolemia¹⁻⁵
  • Manages iron overload and blood viscosity¹˒⁴˒⁷
  • Controls HbS and hematocrit (Hct)³⁻⁴˒⁶˒⁸⁻⁹

Inspiring patient stories

Patients understand better than anyone how sickle cell disease (SCD) impacts their lives. We share these stories to inspire both patients and clinicians who work every day to manage the balancing act of this disease.

See all patient stories

"Compared to other transfusion therapies, I have found RBC exchange to be a more efficient method of maintaining a low hemoglobin S percentage with minimal iron loading."

Julie Kanter, MD

Director of Sickle Cell Research

Medical University of South Carolina, Charleston, SC

Spectra Optia™ Apheresis System

Discover the value of RBCX for transfusion management of SCD patients

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RBCX information for patients

Watch this video, created for patients with sickle cell disease, for details on how red blood cell exchange works and what you can expect

Procedures

RBCX for transfusion management of SCD

RBCs are removed and simultaneously replaced with healthy RBCs.

Depletion/exchange procedure

The depletion/exchange procedure is a combination of the depletion and exchange phases. The behavior of the system during the depletion and exchange phases is the same as when each is performed as a stand-alone procedure.

Depletion phase

First, the system performs the RBC depletion to lower the patient's Hct to a prescribed level while maintaining isovolemia. This is done by removing the patient's RBCs and replacing them with a non-cellular fluid such as saline.

Exchange phase

After the depletion phase is complete, the system performs the RBC exchange phase to increase the patient's Hct to the prescribed target Hct. This is done by removing the patient's RBCs and replacing them with healthy donor RBCs.

Learn more about red blood cell exchange.

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Contraindications

  • No known contraindications for the system's use, except for those associated with all automated apheresis systems.
  • The infusion of certain solutions and replacement fluids may be contraindicated in some patients.
Possible patient reactions
  • Anxiety, headache, light-headedness, digital and/or facial paresthesia, fever, chills, hematoma, hyperventilation, nausea and vomiting, syncope (fainting), urticaria, hypotension, and allergic reactions.
Reactions to transfused blood products can include10
  • Fever, circulatory overload, shock, allergic reactions, alloimmunization, graft-versus-host disease, and transmission of infection.
Restricted to prescription use only
  • Operators must be familiar with the system's operating instructions.
  • Procedures must be performed by qualified medical personnel.
  • A supervisory practitioner may supervise from a physician office or other nonhospital space that is not officially part of the hospital campus as long as he or she remains immediately available.11

Disclaimers and notes

*Product and protocol availability varies by country.

  1. Adams D, et al, Erythrocytapheresis can reduce iron overload and prevent the need for chelation therapy in chronically transfused pediatric patients. J Pediatr Hematol Oncol. 1996;18(1):46-50.
  2. Danielson C, et al. The role of red blood cell exchange transfusion in the treatment and prevention of complications of sickle cell disease. Ther Apher. 2002;6(1):24-31.
  3. Wahl S, et al. Lower alloimmunization rates in pediatric sickle cell patients on chronic erythrocytapheresis compared to chronic simple transfusions. Transfusion. 2012;52(12):2671-2676.
  4. Lawson SE, et al. Red cell exchange in sickle cell disease. Clin Laboratory Haemotol. 1999;21(2):99-102.
  5. Wayne S, et al. Transfusion management of sickle cell disease. Blood. 1993;81(5):1109-1123.
  6. Cabibbo S, et al. Chronic RBC exchange to prevent clinical complications in sickle cell disease. Transfus Apher Sci. 2005;32(3):315-321.
  7. Hilliard L, et al. Erythrocytapheresis limits iron accumulation in chronically transfused SCD patients. Amer J Hematol. 1998;59(1):28-35.
  8. Duclos C, et al. Long-term red blood cell exchange in children with sickle cell disease: Manual or automatic? Transfus Apher Sci. 2013;48(2):219-222.
  9. Singer S, et al. Erythrocytapheresis for chronically transfused children with sickle cell disease: An effective method for maintaining a low HbS level and reducing iron overload. J Clin Apher. 1999;14(3):122-125. 
  10. AABB (ed.), et al. Circular of Information for the Use of Human Blood and Blood Components. 10th ed. Seattle, WA. Council of Europe Publishing, 
  11. American Society for Apheresis. Guidelines for documentation of therapeutic apheresis procedures in the medical record by apheresis physicians. J Clin Apher. 2007;22(3):183.                            
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