Study of Twenty One Cases of Red Cell Exchange in a Tertiary Care Hospital in Southern India.

INTRODUCTION: Red Cell Exchange (RCE) is removal of a patient's red blood cells while replacing with donor red blood cells either manually or using automated systems. RCE is beneficial in patients with Sickle Cell Disease (SCD) either during sickling crisis or prior to major surgical procedures to bring down the sickling percentage as high sickling percentage during prolonged anaesthesia may lead to vaso-occlusive crisis. It is also employed in patients infested with malaria and babesiosis where parasitic index remain high despite medical management. RCE is also tried as an adjuvant therapy in certain poisons like nitrobenzene and carbon monoxide when first line management fails. AIM: To study the effectiveness, clinical outcome, challenges and complications of RCE in various clinical scenario and to understand how this procedure can be effectively utilized in the management of patients in Indian scenario. MATERIALS AND METHODS: This retro prospective study was conducted in tertiary care center in southern India which analyzed 21 RCE procedures performed on patients with different clinical conditions. Of the 21 RCE performed, 18 procedures were performed on patients with case of sickle cell disease, Two procedures were performed on patients infested with severe falciparum malaria and one procedure was performed on a patient with nitrobenzene poisoning. All procedures were performed using Spectra Optia(®) Apheresis System - Terumo BCT. RESULTS: All the 18 patients who underwent the RCE for sickle cell anaemia were admitted for hemi-arthroplasty for avascular necrosis of the head of femur. The average initial HbS levels were between 73-85% and post RCE it was brought down to 22-29% and was achieved in a single sitting in all the cases. Among the two patients infested with severe falciparum malaria, RCE helped in reducing the infestation rate. In case of nitrobenzene poisoning, RCE helped in improvement of oxygen saturation and patient showed significant improvement. CONCLUSION: RCE is an safe and clinically effective therapeutic modality with very minimal to nil side effects. RCE is possibly underutilized therapy in developing world like India due to various reasons like inadequate awareness/ technical expertise, lack of equipments and facilities to identify the clinical conditions per se etc.

Opinions about Blood Donation amongst Medical Personnel's.

OBJECTIVE: There is limited literature in the Indian subcontinent on the attitude of the medical personnel regarding blood donation. The purpose of the present study was to identify and assess the barriers that prevent people from becoming blood donors and also to devise recruitment strategies to increase the blood collection. MATERIALS AND METHODS: This study was conducted in a tertiary care centre with attached medical college in Tamilnadu amongst 750 medical personnel. A self administered questionnaire was used for data collection from each individual. RESULTS: Amongst the 750 medical personnel under study, 470 were never donors and 280 were lapsed donors. The foremost reason for not donating blood among lapsed donors and non donors was never being asked again. CONCLUSION: Donors often donate blood once and rarely return to make a second or subsequent donation. Further education, motivation and dissemination of information would help in recruitment and retention of non-remunerated blood donors.