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Exchange Transfusion

What is an Exchange Transfusion?

Individuals with sickle cell disease have abnormal hemoglobin, called hemoglobin S, in their red blood cells, which causes the cells to be abnormally shaped and rigid. Exchange transfusion is performed to remove the abnormal sickle red blood cells and replace them with normal red blood cells, reducing the incidence of complications, including acute chest syndrome, stroke, and multi-organ failure.

How Does Exchange Transfusion Help?

An exchange transfusion lowers the percentage of hemoglobin S red blood cells in the body. When there are fewer sickled hemoglobin S cells in the bloodstream, there is less likelihood of buildup or blockage in blood vessels.
Exchange transfusion also increases the concentration of normal red blood cells in the body, which supplies more oxygen to the body.

How is Exchange Transfusion Performed?

Exchange transfusion is done either manually or by an automated method.

Manual Exchange
In a manual exchange, most often used for pediatric patients, the exchange is done in cycles. The person's blood is slowly withdrawn using small tubes, called catheters. The catheters, placed in to a vein in the arm of the individual, takes in about 5 to 20 mL of blood at a time, depending on the person's size. This cycle is repeated until the correct volume of blood has been replaced.

Automated Exchange
In an automated exchange, either two large peripheral IVs or a dual-lumen central venous catheter is placed. This permits blood to be withdrawn and returned at the same time. The catheter is connected to sterile tubing in an apheresis machine, which separates the patient's blood into components (red blood cells, platelets, plasma). A portion of the patient's red blood cells are removed by the machine and are replaced with donor red blood cells.

What to Expect Following Treatment?

After the exchange is done, doctors may want to monitor the patient for any negative reactions. If the person has been having repeated transfusions, the doctor might check for iron buildup (overload) in the body.

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