Exchange transfusion therapy and its effects on real-time microcirculation in pediatric sickle cell anemia patients: An intravital microscopy study

Anthony T W Cheung, Joshua W. Miller, Maricel G. Miguelino, Wilson J. To, Jiajing Li, Xin Lin, Peter C. Chen, Sandra L. Samarron, Theodore Wun, Theodore Zwerdling, Ralph Green

Research output: Contribution to journalArticle

10 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)169-174
Number of pages6
JournalJournal of Pediatric Hematology/Oncology
Issue number3
StatePublished - Apr 2012



  • exchange transfusion
  • intravital microscopy
  • microcirculation
  • sickle cell anemia
  • tissue perfusion
  • vasoocclusion

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Oncology
  • Hematology

Cite this