Automated exchange compared to manual and simple blood transfusion attenuates rise in ferritin level after 1 year of regular blood transfusion therapy in chronically transfused children with sickle cell disease

Department of Epidemiology, Vitalant Research Institute, San Francisco, California, USA. Department of Pediatrics, Division of Hematology/Oncology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA. Rodeghier Consultants, Chicago, Illinois, USA. Department of Pediatrics, Division of Hematology/Oncology, Vanderbilt-Meharry Center for Excellence in Sickle Cell Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA.

Transfusion. 2020
PICO Summary

Population

Children with sickle cell disease and silent cerebral infarcts in their first year of regular transfusions enrolled in the The Silent Cerebral Infarct Multi-Center Clinical Trial (n= 83).

Intervention

Automated exchange transfusion (n= 9).

Comparison

Simple transfusion (n= 40), and manual exchange transfusion (n= 34).

Outcome

At baseline no significant differences in ferritin levels were observed in the three transfusion groups. After 1 year of transfusions the median ferritin levels in the simple transfusion, manual exchange transfusion and automatic exchange transfusion groups were 1800 ng/mL, 1530 ng/mL, and 355 ng/mL, respectively.
Abstract
BACKGROUND Optimal strategies for regular blood transfusion therapy are not well defined in sickle cell disease (SCD). This analysis tested the hypothesis that in the first of year of regular transfusions, when chelation therapy use is minimal, automated exchange transfusion would be the superior method for attenuating the rise in ferritin levels compared to simple and manual exchange transfusions. STUDY DESIGN AND METHODS The Silent Cerebral Infarct Multi-Center Clinical Trial randomly allocated children with SCD and silent cerebral infarcts to receive standard care or regular transfusions with a target pre-transfusion HbS concentration ≤ 30% and minimum hemoglobin level > 9.0 g/dL. Participants with at least nine transfusions and sufficient ferritin testing in the first year of the trial were included in a planned secondary analysis. Ferritin levels by the end of the first study year were compared between participants receiving automatic exchange transfusion, manual exchange transfusion, and simple transfusion. RESULTS A total of 83 participants were analyzed. During the first year of the study, 75.9% of the participants had >80% of transfusions via one transfusion method. At baseline no significant differences in ferritin levels were observed in the three transfusion groups (p = 0.1). After 1 year of transfusions the median (interquartile range) ferritin levels in the simple transfusion (n = 40), manual exchange transfusion (n = 34) and automatic exchange transfusion (n = 9) groups were 1800 ng/mL (1426-2204 ng/mL), 1530 ng/mL (1205-1805 ng/mL), and 355 ng/mL (179-579 ng/mL), respectively (p < 0.001). CONCLUSION Automated exchange transfusion, when compared to other transfusion methods, is the optimal transfusion strategy for attenuating increase in ferritin levels in children with SCD.
Study details
Language : eng
Credits : Bibliographic data from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine