Division of Pulmonary Critical Care and Sleep Medicine, Long Island Jewish Medical Center of the Northwell Health System, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, NY, USA.
Division of Pathology, Blood Bank Services, Long Island Jewish Medical Center of the Northwell Health System, Donald and Barbara Zucker School of Medicine at Hofstra Northwell, New Hyde Park, NY, USA.
J Intensive Care Med. 2020 Feb;35(2):140-148. doi: 10.1177/0885066619874041. Epub 2019 Sep 2.
Red blood cell exchange (RBCE) is the standard of care for patients with sickle cell disease (SCD) who present with severe vaso-occlusive crisis (VOC). However, subsets of these critically ill patients have progressive multiorgan failure (MOF) despite RBCE therapy. The purpose of this case series is to describe the use of plasma exchange (PLEX) for the treatment of SCD-related MOF that is refractory to RBCE.
A retrospective case review of patients with severe MOF from sickle cell crisis unresponsive to RBCE who underwent PLEX in a 14-bed adult medical intensive care unit (ICU) at a tertiary care university hospital over a 4-year time period. Key laboratory data including complete blood count, indices of hemolysis, and markers of organ failure were recorded before and after both RBCE and PLEX.
Our primary objective is to evaluate the effectiveness of PLEX, in addition to RBCE, on organ dysfunction, laboratory indices, and mortality. Of the 7 patients, 6 survived. Of the patients who survived, all remained hemodynamically stable during PLEX sessions and showed both clinical and laboratory evidences of improvement in hemolysis and organ function. Average time from completion of first PLEX treatment to initial laboratory signs of organ failure reversal for patients who survived was 15.6 hours, the average length of stay in the ICU was 5.6 days, and the average total length of stay in the hospital was 14 days.
Plasma exchange, in addition to RBCE, may be a novel synergistic treatment option to decrease risk of mortality in patients with refractory VOC and MOF.
红细胞置换（RBCE）是伴有严重血管阻塞性危象（VOC）的镰状细胞病（SCD）患者的标准治疗方法。然而，这些危重症患者中有一部分尽管接受了 RBCE 治疗，但仍存在进行性多器官衰竭（MOF）。本病例系列的目的是描述使用血浆置换（PLEX）治疗对 RBCE 治疗无反应的 SCD 相关 MOF。
回顾性分析在一家三级护理大学医院的 14 张成人重症监护病房（ICU）中，4 年内对严重 MOF 且对 RBCE 无反应的镰状细胞危象患者进行 PLEX 治疗的病例。记录 RBCE 和 PLEX 前后的关键实验室数据，包括全血细胞计数、溶血指标和器官衰竭标志物。
我们的主要目的是评估 PLEX 联合 RBCE 对器官功能障碍、实验室指标和死亡率的有效性。7 名患者中，有 6 名存活。在存活的患者中，所有患者在 PLEX 期间血流动力学均稳定，且溶血和器官功能均有临床和实验室改善的证据。存活患者首次 PLEX 治疗完成至器官衰竭初始实验室指标逆转的平均时间为 15.6 小时，ICU 平均住院时间为 5.6 天，总平均住院时间为 14 天。
除 RBCE 外，PLEX 可能是一种新颖的协同治疗选择，可降低难治性 VOC 和 MOF 患者的死亡率风险。
