The Role of Red Blood Cell Exchange Transfusion in the Treatment and Prevention of Complications of Sickle Cell Disease

Abstract: Patients with sickle cell disease have abnormal red blood cells (RBCs). This can cause chronic hemolytic anemia and vaso‐occlusion leading to tissue hypoxemia and organ dysfunction. RBC exchange transfusion can, without increasing the whole‐blood viscosity, quickly replace abnormal erythrocytes with normal and raise the hematocrit resulting in improved delivery of oxygen to hypoxic tissues. Unfortunately, transfusion can also be associated with complications. This paper reviews the role of transfusion, both simple and exchange, in the treatment and prevention of sickle‐related complications. The benefits of exchange versus simple transfusion and transfusion versus alternative therapies are discussed.     

紫外线照射血充氧回输对肺心病患者红细胞免疫功能的影响

应用紫外线照射血充氧回输（AUVIB）对24例慢性肺心病患者进行辅助治疗，并对患者治疗前后的红细胞免疫功能及其调节因子进行检测，结果发现肺心病患者与正常对照组比较红细胞C3b受体（RCR）花环率、红细胞C3b受体花环促进率（RFER）明显降低（P＜0.01），红细胞免疫复合物（RCIC）花环率及红细胞C3b受体花环抑制率（RFIR）明显升高（P＜0.05），说明肺心病患者存在红细胞免疫功能缺陷。经AUVIB辅助治疗后，肺心病患者RCR花环率、RFER明显升高（P＜0．05），红细胞免疫复合物（RCIC）花环率及RFIR明显升高（P＜0.05）。说明AUVIB治疗能够增强肺心病患者的红细胞免疫功能。     

Effect of Hemodialysis on the Red Blood Cell Life Span in Patients with End‐Stage Kidney Disease

The aim of this study was to use a CO breath test to investigate hemodialysis effects on red blood cell lifespan in patients with chronic kidney disease. A cohort of 17 non‐smoking men with end‐stage kidney disease undergoing hemodialysis via a polysulfone dialysis membrane (as opposed to a traditional cellulose acetate membrane) were subjected to a repeated Levitt's CO breath test to compare red blood cell lifespan before vs. after dialysis. None of the patients showed significant fluctuations in endogenous CO concentration during the dialysis procedure. The mean red blood cell lifespan was 66.0 ± 31.0 days before dialysis and 72.0 ± 26.0 days after dialysis, with no significant difference between the assessment time points (P > 0.05). In conclusion, dialysis using a polysulfone membrane did not appear to disrupt red blood cells or reduce their lifespan in patients with end‐stage kidney disease.     

Shortened Red Blood Cell Lifespan Is Related to the Dose of Erythropoiesis‐Stimulating Agents Requirement in Patients on Hemodialysis

Renal anemia is an important complication of chronic kidney disease (CKD). One of the most important complications of renal anemia is reduced red blood cell (RBC) lifespan, but there has been little research conducted into the causes of and treatments for this anemia. We measured alveolar carbon monoxide (CO) and then estimated RBC lifespan in patients on hemodialysis (HD). We also examined their requirement for erythropoiesis‐stimulating agents (ESA), HD dose, nutrition factors, iron metabolism factor, reticulocyte counts and % reticulocytes. We enrolled 140 patients undergoing intermittent HD; among this group, 31 were not administered ESA and the others were on ESA therapy. Twelve healthy volunteers served as controls. The RBC lifespans in the healthy volunteers and in the HD patients were 128 ± 28 and 89 ± 28 days (mean ± SD), respectively. The RBC lifespan significantly and negatively correlated with ESA requirement (r = ?0.489, P < 0.0001) in the HD patients. Other factors suspected to influence the RBC lifespan did not significantly correlate with the RBC lifespan in HD patients, in contrast to the correlation observed for S‐Cr, BUN, S‐ALB and total cholesterol vs. RBC lifespan. A shortened RBC lifespan seems to rather significantly affect the ESA requirement. Better nutritional status or active HD patients also seem to have longer RBC lifespans and lower ESA requirement.