IMPACT OF RED CELL EXCHANGE TRANSFUSION ON INFLAMMATORY MARKERS IN SICKLE CELL DISEASE
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Keywords
Red Cell Exchange Transfusion, Sickle Cell Disease, Inflammatory Markers, cerebrovascular disease
Abstract
Background: Red Blood Cell Exchange (RBCX) is a common treatment for pediatric sickle cell disease (SCD), particularly in cases complicated by cerebrovascular disease. Since inflammation plays a crucial role in SCD and elevated pro-inflammatory cytokines are observed in these patients, this study hypothesized that RBCX might lower these cytokines and aimed to assess the impact of this technique on these markers.
Methods: This prospective and observational study included pediatric SCD patients (HbSS genotype) enrolled in a chronic RBCX program at a Portuguese Hospital from October 2022 to May 2024. Patients with acute exacerbations were excluded. Blood samples were collected before and after RBCX to assess hematological parameters and inflammatory cytokines. Data were analyzed using SPSSv25Ⓡ (Significance level set at p < 0.05); Informed consents were obtained.
Results: Thirty-one children (median age 10 years) were studied. Fourteen patients were new to RBCX, while 17 were already in a chronic RBCX program. RBCX mainly aimed to prevent cerebrovascular disease (81%). A total of 286 RBCXs were analyzed, showing no major adverse events or disease-related hospitalizations. Hemoglobin levels increased by 1.5g/dL, HbS decreased by 69%, and leukocytes decreased by 20%. IL-1, ferritin and procalcitonin showed high levels before RBCX. IL-1 levels dropped significantly post-RBCX (p<0.001), while other markers like C-Reactive Protein, IL-6, and TNF-α showed no significant changes.
Conclusions: RBCX safely reduces HbS, leukocytes, and IL-1 levels, suggesting a modulatory effect on inflammation in SCD patients. Further research is needed to explore cytokine mechanisms in SCD.
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References
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