Koehl Bérengère, Sommet Julie, Holvoet Laurent, Abdoul Hendy, Boizeau Priscilla, Ithier Ghislaine, Missud Florence, Couque Nathalie, Verlhac Suzanne, Voultoury Pauline, Sellami Fatiha, Baruchel André, Benkerrou Malika
Pediatric Unit, AP-HP, Robert Debré Hospital, Paris.
Université Paris 7-Diderot, Paris.
Transfusion. 2016 May;56(5):1121-8. doi: 10.1111/trf.13548. Epub 2016 Mar 28.
Chronic exchange transfusion is effective for primary and secondary prevention of stroke in children with sickle cell anemia (SCA). Erythrocytapheresis is recognized to be the most efficient approach; however, it is not widely implemented and is not suitable for all patients. The aim of our study was to compare automated exchange transfusion (AET) with our manual method of exchange transfusion and, in particular, to evaluate the efficacy, safety, and cost of our manual method.
Thirty-nine SCA children with stroke and/or abnormal findings on transcranial Doppler were included in the study. We retrospectively analyzed 1353 exchange sessions, including 333 sessions of AET and 1020 sessions of manual exchange transfusion (MET).
Both methods were well tolerated. The median decrease in hemoglobin (Hb)S per session was 21.5% with AET and 18.8% with our manual method (p < 0.0001) with no major increase in red blood cell consumption. Iron overload was well controlled, even with the manual method, with a median (interquartile range) ferritin level of 312 (152-994) µg/L after 24 months of transfusions. The main differences in annual cost relate to equipment costs, which were 74 times higher with the automated method.
Our study shows that continuous MET has comparable efficacy to the automated method in terms of stroke prevention, decrease in HbS, and iron overload prevention. It is feasible in all hospital settings and is often combined with AET successively over time.
慢性换血疗法对镰状细胞贫血（SCA）患儿中风的一级和二级预防有效。红细胞单采术被认为是最有效的方法；然而，它并未得到广泛应用，且并非适用于所有患者。我们研究的目的是比较自动换血（AET）和我们的手动换血方法，特别是评估我们手动方法的疗效、安全性和成本。
39例患有中风和/或经颅多普勒检查有异常结果的SCA患儿纳入研究。我们回顾性分析了1353次换血疗程，包括333次AET疗程和1020次手动换血（MET）疗程。
两种方法耐受性均良好。每次疗程中，AET使血红蛋白（Hb）S的中位数下降21.5%，我们的手动方法使HbS中位数下降18.8%（p < 0.0001），红细胞消耗没有大幅增加。即使采用手动方法，铁过载也得到了很好的控制，输血24个月后，铁蛋白水平的中位数（四分位间距）为312（152 - 994）μg/L。年度成本的主要差异与设备成本有关，自动方法的设备成本高出74倍。
我们的研究表明，在预防中风、降低HbS和预防铁过载方面，持续MET与自动方法具有相当的疗效。它在所有医院环境中都是可行的，并且随着时间的推移通常会先后与AET联合使用。
