Q: Should I use simple transfusion or exchange transfusion?

Simple transfusion is sufficient when the haematocrit is low and HbS reduction is not urgent. Exchange transfusion is preferred when the haematocrit is near normal (to avoid hyperviscosity) or when rapid HbS reduction is needed (acute stroke, acute chest syndrome).

Q: Is manual exchange transfusion still used?

Yes, especially in resource-limited settings where automated apheresis is unavailable. Manual exchange involves sequential phlebotomy and infusion of donor blood in aliquots of 5–10 mL/kg. The procedure requires careful monitoring of vital signs and volume status.

Q: What are the risks of exchange transfusion?

Risks include transfusion reactions, alloimmunisation, iron overload (with chronic programmes), hypocalcaemia from citrate anticoagulant, catheter-related complications, and infection transmission. Alloinmunisation is particularly problematic in sickle cell disease with rates of 20–40%.

Question 1

What is the target HbS percentage for different indications?

Accepted Answer

For acute stroke and acute chest syndrome, target HbS <30%. For stroke prevention in chronic transfusion programmes, maintain HbS <30% (primary) or <50% (secondary, if on hydroxyurea). For pre-operative preparation, target HbS <30–50%.

Question 2

Should I use simple transfusion or exchange transfusion?

Accepted Answer

Simple transfusion is sufficient when the haematocrit is low and HbS reduction is not urgent. Exchange transfusion is preferred when the haematocrit is near normal (to avoid hyperviscosity) or when rapid HbS reduction is needed (acute stroke, acute chest syndrome).

Question 3

Is manual exchange transfusion still used?

Accepted Answer

Yes, especially in resource-limited settings where automated apheresis is unavailable. Manual exchange involves sequential phlebotomy and infusion of donor blood in aliquots of 5–10 mL/kg. The procedure requires careful monitoring of vital signs and volume status.

Question 4

What are the risks of exchange transfusion?

Accepted Answer

Risks include transfusion reactions, alloimmunisation, iron overload (with chronic programmes), hypocalcaemia from citrate anticoagulant, catheter-related complications, and infection transmission. Alloinmunisation is particularly problematic in sickle cell disease with rates of 20–40%.