Exchange Transfusion

[placebo_B12]

When is an exchange transfusion indicated for sickle cell acute chest syndrome? How do you do it? Is it done throught a double lumen dialysis catheter or a regular central line?

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[southerndoc]

There is no way you can do an exchange transfusion through a regular central line. Think about it: it's like dialysis. You take as much blood out as you are putting in. A dialysis catheter is necessary.

UpToDate (an excellent resource by the way) has this to say: Exchange transfusion is recommended in the setting of progressive infiltrates and hypoxemia refractory to conventional therapy. Reduction of the HbS level to below 30 percent, along with a hematocrit of approximately 30 percent, can lead to marked improvement in the majority of cases [37,38]. Unless thromboembolic phenomena are documented, empiric anticoagulant therapy is not recommended because of the potential risk of intracranial and renal bleeding.

 

[placebo_B12]

How do you know what the percent Hgb S is? hemoglobin electrophoresis???

 

[BADMD]

When is an exchange transfusion indicated for sickle cell acute chest syndrome? How do you do it? Is it done throught a double lumen dialysis catheter or a regular central line?

I can't speak for adults, but when I was in the PICU and did an exchange transfusion we did it through a plain old IV catheter. I pulled off 5 ml / kg and gave him back 12 ml / kg. The goal is just to lower the amount of Hgb S.

We did it because of an acute pain crisis with worsening hypoxia and infiltrate despite good hydration, oxygen and pain control.