TY - JOUR
T1 - Exchange transfusion therapy and its effects on real-time microcirculation in pediatric sickle cell anemia patients
T2 - An intravital microscopy study
AU - Cheung, Anthony T W
AU - Miller, Joshua W.
AU - Miguelino, Maricel G.
AU - To, Wilson J.
AU - Li, Jiajing
AU - Lin, Xin
AU - Chen, Peter C.
AU - Samarron, Sandra L.
AU - Wun, Theodore
AU - Zwerdling, Theodore
AU - Green, Ralph
PY - 2012/4
Y1 - 2012/4
N2 - Periodic blood exchange transfusion is a treatment modality commonly used to manage pediatric sickle cell anemia at the University of California Davis Medical Center. The goal of exchange transfusion therapy is to ameliorate vasoocclusion and improve tissue perfusion by removing sickled red blood cells and introducing normal red blood cells. Using computer-assisted intravital microscopy, pretransfusion and posttransfusion microvascular characteristics were analyzed. In this study, the bulbar conjunctiva exhibited a "blanched" a vascular appearance in all 6 pediatric sickle cell anemia patients before transfusion, indicative of tissue hypoperfusion and ischemia. Immediately after transfusion, substantial improvement in vascularization and tissue perfusion resulted, reflected by the enhanced appearance of capillaries and arterioles. In addition, a decrease in red cell velocity was observed. These observations provide evidence that exchange transfusion therapy is beneficial in ameliorating vasoocclusion and improving tissue perfusion. However, with the paradoxical posttransfusion decrease in red cell velocity presumably due to induced hyperviscosity from the large transfusion volume, blood flow is still impaired. This decreased velocity may thwart efforts to improve oxygen delivery through transfusion and may, to some extent, promote vasoocclusion instead. This paradoxical result warrants further investigation on the effects of transfusion volume and viscosity in the exchange transfusion process.
AB - Periodic blood exchange transfusion is a treatment modality commonly used to manage pediatric sickle cell anemia at the University of California Davis Medical Center. The goal of exchange transfusion therapy is to ameliorate vasoocclusion and improve tissue perfusion by removing sickled red blood cells and introducing normal red blood cells. Using computer-assisted intravital microscopy, pretransfusion and posttransfusion microvascular characteristics were analyzed. In this study, the bulbar conjunctiva exhibited a "blanched" a vascular appearance in all 6 pediatric sickle cell anemia patients before transfusion, indicative of tissue hypoperfusion and ischemia. Immediately after transfusion, substantial improvement in vascularization and tissue perfusion resulted, reflected by the enhanced appearance of capillaries and arterioles. In addition, a decrease in red cell velocity was observed. These observations provide evidence that exchange transfusion therapy is beneficial in ameliorating vasoocclusion and improving tissue perfusion. However, with the paradoxical posttransfusion decrease in red cell velocity presumably due to induced hyperviscosity from the large transfusion volume, blood flow is still impaired. This decreased velocity may thwart efforts to improve oxygen delivery through transfusion and may, to some extent, promote vasoocclusion instead. This paradoxical result warrants further investigation on the effects of transfusion volume and viscosity in the exchange transfusion process.
KW - exchange transfusion
KW - intravital microscopy
KW - microcirculation
KW - sickle cell anemia
KW - tissue perfusion
KW - vasoocclusion
UR - http://www.scopus.com/inward/record.url?scp=84862785341&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84862785341&partnerID=8YFLogxK
U2 - 10.1097/MPH.0b013e31823c27ef
DO - 10.1097/MPH.0b013e31823c27ef
M3 - Article
C2 - 22278200
AN - SCOPUS:84862785341
VL - 34
SP - 169
EP - 174
JO - Journal of Pediatric Hematology/Oncology
JF - Journal of Pediatric Hematology/Oncology
SN - 1077-4114
IS - 3
ER -