Thread by @HermelinMD

A 32-year-old man with HbS/βThalassemia presented to the ED with weakness in his left arm and slurred speech. His HbS is 71%. Take a look at his peripheral smear below, notice the drepanocytes, or sickle-shaped cells.

Since you are the #BloodBank resident on-call, Heme/Onc requests urgent erythrocytaphereisis, otherwise known as #RedCellExchange. 🗣️You reply?

⚠️Yes! You immediately confirm that the line is placed. According to the ASFA Guidelines, RBC exchange is a Category I Recommendation, first-line therapy, for the acute treatment of a stroke and should be started within 6 hours of admission.

⁉️In RBC exchanges for #SCD, what 🔢calculation is used to determine the red cell replacement volume?

🧮In order to know the RBC replacement volume, you will need to calculate the Fraction of Cells Remaining (FCR). It is the fraction of the HbScells remaining from the portion of blood removed & is dependent on the Hct.
🥅 The goal of RBC exchange is to reduce the HbS below 30%.

One of my favorite #Blooducation Apps is #RBCXCalculator by @terumobct
🛠️Another important tool in your #Blooducation kit!

Now that you have figured out your red blood cell replacement volume, it's time to order your units. There are special RBC indications for #SCD patients. Which of of the following is 𝙉𝙊𝙏 indicated in this clinical situation?

🙌🏽You got it! The RBC replacement must be ABO, Rh compatible and also be HbS negative, leukoreduced and antigen matched (typically C, E and K negative). The units do not have to be irradiated. Irradiation is used to prevent TA-GVHD in select patient populations.

📖To learn more about the role of red blood cell exchange transfusion in the treatment and prevention of complication of sickle cell disease read this great article
👉🏽onlinelibrary.wiley.com/doi/full/10.10…
🧐Any additional pearls from you experience, please add to the conversation below.