Variation in Chronic Automated Red Cell Exchange Practices for Sickle Cell Disease: Insights Into Isovolemic Hemodilution Use

Authors

• Jennifer M. Jones
• Fatima Aldarweesh
• Nicole Aqui
• Aleh Bobr
• Patricia Brunker
• Mischa L. Covington
• Juliana Guarente, Thomas Jefferson UniversityFollow
• Robert Hagar
• Matthew Karafin
• Divjot Singh Lamba
• Grace Lee
• Wen Lu
• Ethan A. Mack
• Gagan Muthur
• Saadiya Nazli
• Halima Olaniyan
• Chinelo P. Onyenekwu
• Jay S. Raval
• Divya Setya
• Yvette C. Tanhehco
• Mamie Thant
• Angelica Vivero, Thomas Jefferson UniversityFollow
• Yanyun Wu
• Edward C. C. Wong
• Nalan Yurtsever
• Yan Zheng
• Patricia A. Shi
• Jennifer Webb

Document Type

Article

Publication Date

6-1-2026

Comments

This article is the author’s final published version in Journal of Clinical Apheresis, Volume 41, Issue 3, 2026, Article number e70146.

The published version is available at https://doi.org/10.1002/jca.70146. Copyright © 2026 The Author(s).

Abstract

Prior surveys of chronic automated red blood cell exchange (RCE) for patients with sickle cell disease (SCD) have identified considerable procedural variability, especially with the use of isovolemic hemodilution red blood cell exchange (IHD-RCE). We conducted a survey of chronic RCE practices among American Society for Apheresis (ASFA) members to identify opportunities for practice harmonization and future studies. The ASFA SCD Research Subcommittee developed a 72-item survey of chronic RCE practices, with a focus on IHD-RCE. The survey was validated internally and distributed by email to all ASFA members from September 2024 to February 2025. One survey response from each institution was retained for data analysis. Descriptive statistics were performed. Sixty-two survey responses, including three from international institutions, were retained for analysis. Sixty-one percent of respondents (38/62) reported using at least one fixed RCE target, with end hematocrit being the most common fixed parameter (40%, 25/62), followed by fraction of cells remaining (31%, 19/62) and hemoglobin S% (27%, 17/62). Most respondents (60%, 37/61) performed IHD-RCE at their institution, though other details such as the minimum hematocrit, exclusion criteria, and response to adverse effects were variable. Consistent pre- and post-RCE laboratory monitoring practices were reported. Consistent with earlier surveys, procedural variability in chronic RCE practices for patients with SCD is observed. This highlights opportunities to compare outcomes where practice variability exists. Consensus guidelines based on institutional practices with optimal outcomes should be developed.

Recommended Citation

Jones, Jennifer M.; Aldarweesh, Fatima; Aqui, Nicole; Bobr, Aleh; Brunker, Patricia; Covington, Mischa L.; Guarente, Juliana; Hagar, Robert; Karafin, Matthew; Lamba, Divjot Singh; Lee, Grace; Lu, Wen; Mack, Ethan A.; Muthur, Gagan; Nazli, Saadiya; Olaniyan, Halima; Onyenekwu, Chinelo P.; Raval, Jay S.; Setya, Divya; Tanhehco, Yvette C.; Thant, Mamie; Vivero, Angelica; Wu, Yanyun; Wong, Edward C. C.; Yurtsever, Nalan; Zheng, Yan; Shi, Patricia A.; and Webb, Jennifer, "Variation in Chronic Automated Red Cell Exchange Practices for Sickle Cell Disease: Insights Into Isovolemic Hemodilution Use" (2026). Department of Pathology, Anatomy, and Cell Biology Faculty Papers. Paper 494.
https://jdc.jefferson.edu/pacbfp/494

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 License.

PubMed ID

42316838

Language

English