Centre de Référence des Syndromes Drépanocytaires Majeurs, Médecine interne, Université Paris-Est Créteil, Créteil, France.
Hôpital Henri-Mondor, Assistance Publique-Hôpitaux de Paris (AP-HP), Créteil, France.
Vox Sang. 2020 Nov;115(8):722-728. doi: 10.1111/vox.12990. Epub 2020 Sep 23.
Blood transfusion is the cornerstone treatment to reduce the clinical severity of sickle cell disease (SCD), but we need to maintain the haematocrit (Hct) within an acceptable range to avoid a deleterious increase in blood viscosity. The aim of this study was to compare the effects of manual versus automated red blood cell (RBC) Exchange on haematological parameters and blood viscosity.
This prospective, single-centre, open nonrandomized observational study included forty-three sickle cell patients: 12 had automated RBC Exchange and 31 manual RBC Exchange. Samples were collected in EDTA tubes just before and within one hour after the end of the RBC Exchange to measure the haematological parameters and blood viscosity.
Both automated and manual RBC Exchange decreased haemoglobin S levels and leucocyte and platelet counts, but the decrease was greater for automated RBC Exchange. Manual RBC Exchange caused a significant rise in haematocrit and haemoglobin levels and did not change blood viscosity. In contrast, automated RBC Exchange decreased blood viscosity without any significant change in haematocrit and only a very slight increase in haemoglobin levels. The change in blood viscosity correlated with the modifications of haematocrit and haemoglobin levels, irrespective of the RBC Exchange procedure. When adjusted for the volume of RBC Exchange, the magnitude of change in each biological parameter was not different between the two procedures.
Our study demonstrates that the automated RBC Exchange provided greater haematological and haemorheological benefits than manual RBC Exchange, mainly because of the higher volume exchanged, suggesting that automated RBC Exchange should be favoured over manual RBC Exchange when possible and indicated.
输血是降低镰状细胞病（SCD）临床严重程度的基石治疗方法，但我们需要将血细胞比容（Hct）维持在可接受的范围内，以避免血液粘度的有害增加。本研究的目的是比较手动与自动红细胞（RBC）交换对血液学参数和血液粘度的影响。
这是一项前瞻性、单中心、开放的非随机观察性研究，共纳入 43 例镰状细胞病患者：12 例接受自动 RBC 交换，31 例接受手动 RBC 交换。在 RBC 交换前和结束后 1 小时内，采集 EDTA 管中的样本，以测量血液学参数和血液粘度。
自动和手动 RBC 交换均降低了血红蛋白 S 水平以及白细胞和血小板计数，但自动 RBC 交换的降低幅度更大。手动 RBC 交换导致血细胞比容和血红蛋白水平显著升高，而血液粘度没有变化。相比之下，自动 RBC 交换降低了血液粘度，而血细胞比容和血红蛋白水平没有显著变化，仅略有升高。血液粘度的变化与血细胞比容和血红蛋白水平的变化相关，与 RBC 交换程序无关。当根据 RBC 交换量进行调整时，两种程序之间每个生物学参数的变化幅度没有差异。
我们的研究表明，自动 RBC 交换比手动 RBC 交换提供了更大的血液学和血液流变学益处，主要是因为交换的体积更大，这表明在可能和需要的情况下，应优先选择自动 RBC 交换而不是手动 RBC 交换。
