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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.
Publisher StatementThis is the peer reviewed version of the following article: Allison, D, Manon, L, Vidanovic, V, Crane, J, Sevcik, J, Janiszewski, S, et al. How do we operate a large monthly red blood cell exchange program. Transfusion. 2023. https://doi.org/10.1111/trf.17245, which has been published in final form at https://doi.org/10.1111/trf.17245. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.
CitationAllison, D, Manon, L, Vidanovic, V, Crane, J, Sevcik, J, Janiszewski, S, et al. How do we operate a large monthly red blood cell exchange program. Transfusion. 2023. https://doi.org/10.1111/trf.17245