How do we operate a large monthly red blood cell exchange program

Background: Red blood cell (RBC) exchange for sickle cell disease presents unique difficulties due to RBC phenotyping, complex antibody work-ups, large number of RBC units required, and vascular access considerations, any of which can delay the procedure. Multidisciplinary coordination and systemic processes ensure monthly appointments remain on schedule.

Study Design and Methods: A high-volume chronic red cell exchange program is described, highlighting the importance of multidisciplinary coordination and process improvement strategies involving initial referral, vascular access, order sets, and allocation of antigen-negative or phenotypically matched RBCs.

Results: Approximately fifty outpatient red cell exchanges are performed each month with an 82% kept-appointment rate. Specific factors for program success include open communication across services and improvements to referrals and standardized order sets.

Conclusion: A combination of multidisciplinary coordination and process improvement can ensure the  success of a high volume red cell exchange program Frequent communication of upcoming appointments between the referring hematologists, the hemapheresis clinic, transfusion service, and interventional radiology is critical. Advance notice to the immunohematology reference lab of upcoming appointments is needed to allow enough time for allocating antigen-negative RBCs. Order sets can be leveraged to standardize and streamline red blood cell exchanges. Lastly, numerous mechanisms help patients compensate for the cognitive sequelae of stroke.