Optimization of single-needle red cell exchange in patients with sickle cell disease

IF 16.4 1区化学 Q1 CHEMISTRY, MULTIDISCIPLINARY

Accounts of Chemical Research Pub Date : 2024-04-29 DOI:10.1002/jca.22118

Lilora Kearney, Regina Bosnick, Haley Phillips, Amanda Ghio, Dierdre Cullen, Lori Sweat, Yan Zheng

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Abstract

The hypercoagulable state associated with sickle cell disease (SCD) can be challenging for apheresis procedures. Among 62 single-needle red cell exchanges (SN-RCEs) performed over a 15-month period, 4 patients experienced 6 hemolytic events with a discolored plasma layer, elevated plasma/RBC interface in the centrifuge, and accompanying alarms of “Cells were detected in plasma line from centrifuge” or “AIM system detected RBC at top of connector.” The hemolysis originated from the apheresis instrument because samples from the apheresis belt but not the patients' peripheral blood were positive for hemolysis. Further analysis showed the alarms occurred more often in SN-RCEs (20.4%) than double-needle RCEs (2.7%), and the hemolysis was probably secondary to clumping. To optimize SN-RCE, we increased the anticoagulant dosage by changing Inlet/AC ratio from 13 to 8 and lowered the inlet rate to the level comparable to double-needle RCE. The adjustments were well-tolerated with no more hemolysis.

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优化镰状细胞病患者的单针红细胞置换术

与镰状细胞病（SCD）相关的高凝状态对无血细胞置换手术来说是个挑战。在15个月内进行的62次单针红细胞置换（SN-RCE）中，4名患者经历了6次溶血事件，血浆层变色，离心机中血浆/红细胞界面升高，并伴有 "离心机血浆管中检测到细胞 "或 "AIM系统在连接器顶部检测到RBC "的警报。溶血源于离心仪器，因为来自离心带而非患者外周血的样本溶血阳性。进一步分析表明，报警发生在SN-RCE（20.4%）中的频率高于双针RCE（2.7%），溶血可能是继发于结块。为了优化 SN-RCE，我们增加了抗凝剂的用量，将输入/AC 比率从 13 改为 8，并将输入率降低到与双针 RCE 相当的水平。调整后的效果很好，没有再发生溶血。

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来源期刊

Accounts of Chemical Research 化学-化学综合

CiteScore

31.40

自引率

1.10%

发文量

312

审稿时长

2 months

期刊介绍： Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.