“Red Cell Exchange”. A Red Blood Cell Exchange a.k.a Exchange Blood Transfusion is a non-surgical therapy that is highly effective in the treatment and management of sickle cell anemia. The process involves taking out the sickle blood from a patient and replacing it with fresh donor blood. The quantity of blood to be taken out and replaced is determined by various factors like weight and height.

The red cell exchange helps provide necessary oxygen carrying capacity and also helps reduce the viscosity of blood. It can be done in both adults and children. Also, the red cell exchange can be done manually or with an automated machine, however the automated exchange is highly recommended. In countries like the UK and US, some sickle cell warriors are placed on routine red cell exchange transfusions; according to the severity of their condition, some 4, 6 or 8 weekly to help manage it and keep pain episodes to the minimum.

However in some countries, this therapy is greatly underutilized due to various factors like cost, method of transfusion, ease of getting donors and traditional beliefs towards blood transfusion. There are various indications for a red cell exchange and some side effects during the transfusion itself.

Red Exchange Blood transfusion is a potentially life-saving procedure that is done to counteract the effects of serious jaundice or changes in the blood due to diseases such as sickle cell anemia.

The procedure involves slowly removing the person’s blood and replacing it with fresh donor blood or plasma.


An exchange transfusion requires that the person’s blood be removed and replaced. In most cases, this involves placing one or more thin tubes, called catheters, into a blood vessel. The exchange transfusion is done in cycles, each one most often lasts a few minutes.

The person’s blood is slowly withdrawn (most often about 5 to 20 ml at a time, depending on the person’s size and the severity of illness). An equal amount of fresh, warmed blood or plasma flows into the person’s body. This cycle is repeated until the correct volume of blood has been replaced.

After the exchange transfusion, catheters may be left in place in case the procedure needs to be repeated.

In diseases such as sickle cell anemia, blood is removed and replaced with donor blood.

In conditions such as high red blood cell count in a newborn, a specific amount of the child’s blood is removed and replaced with a normal saline solution, plasma (the clear liquid part of blood), or albumin (a solution of blood proteins). This decreases the total number of red blood cells in the body and makes it easier for blood to flow through the body.

Why the Procedure is Performed

An exchange transfusion may be needed to treat the following conditions:

Dangerously high red blood cell count in a newborn

Severe disturbances in body chemistry

Severe newborn jaundice

Severe sickle cell crisis

Toxic effects of certain drugs


General risks are the same as with any transfusion. Other possible complications include:

Blood clots

Changes in blood chemistry (high or low potassium, low calcium, low glucose, change in acid-base balance in the blood)

Heart and lung problems

Infection (very low risk due to careful screening of blood)

Shock if not enough blood is replaced

After the Procedure

The patient may need to be monitored for several days in the hospital after the transfusion. The length of stay depends on what condition the exchange transfusion was performed to treat.

Indications for Exchange Blood Transfusion. There are various indications for having a red cell exchange aka exchange blood transfusion. For people living with sickle cell, some of the below are indications.

Stroke. A major reason of having an Exchange Blood Transfusion is when the doctors sense there is a high possibility of a stroke. Stroke is one of the major complications of sickle cell disorder. In children with sickle cell, there is a test that they do to check the brain. It is called a Trans Cranial Doppler. This test can show if a child is likely to have a stroke. If it shows that, a red cell exchange is one of the therapies introduced to prevent it.

Priapism. This is a condition that affects male warriors. This is when there is persistent sustained painful penile erection without sexual arousal. This can go on for hours and cause severe pain. It is very hard on male warriors and a red cell exchange is usually introduced to keep the painful episodes at bay and as far apart as possible.

Acute Chest Syndrome. A red cell exchange is very good when a patient has acute chest syndrome with respiratory failure. It helps to increase the oxygen carry capacity of the blood.

Severe painful crisis with a high sickling percentage. In some cases, the patient just has severe excruciating pain and blood work shows a high sickling percentage. This mean the level of broken down red cells is high. The best way to treat this is through a red cell exchange.

Neonatal jaundice not responding to light therapy is also another indication for red cell exchange in children. It is best to trust your haematologist and to undergo a red cell exchange as soon the doctor advises..

My Red Cell Exchange Experience”. I went for my first ever red cell exchange as an inpatient. First I had a femoral line put in. This was done in a proper theater which was a bit scary. On getting to the exchange room, the nurse explained that because of the things put in the machine to stop the blood from clotting, it could make my calcium levels drop. I was told I’d feel some numbness or pins & needles and to alert them if I did. The exchange started well but after a while I started to feel numb in my lips. They said it was the effect of the low calcium. I was given a glass of milk to drink and 2 calcium tabs to chew. After that, we continued. I was meant to take 8 pints. However my blood pressure started to drop fast. The exchange was stopped, I was given some saline solution to bring back the BP.
When the BP was back to normal, we continued. I honestly felt I was sleepy so when the nurse said she could no longer continue with the exchange, I resisted. I told her that I was fine, just feeling sleepy, she should just complete it but she insisted because the BP had once again dropped dangerously low and I could pass out at any moment. At that point we had to halt the exchange at 6 & a half pints of blood. I’m grateful for very observant nurses who put my health first and took the correct decision. I was awake all through and alert for the nurses to monitor. A friend mentioned to me later that they were put to sleep during their own exchange but I don’t think this is the norm. You need not fear iron overload issue with an exchange transfusion as it is highly unlikely because taking out your own blood means there’s a balance of iron levels.

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