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Dilini Christina Ranasinghe: Exploring Red Cell Exchange in Sickle Cell Disease

Dilini Christina Ranasinghe/LinkedIn

Sep 19, 2026, 09:53

Dilini Christina Ranasinghe: Exploring Red Cell Exchange in Sickle Cell Disease

Dilini Christina Ranasinghe, Registrar in Transfusion Medicine at National Blood Centre, shared a post on LinkedIn:

“Red Cell Exchange in Sickle Cell Disease

Automated red cell exchange (RCE) was performed using the COM.TEC apheresis system for a patient with HbSS sickle cell disease, as part of pre-operative optimisation before an elective laparoscopic cholecystectomy.

Before exchange

Hb: 10.6 g/dL
HbS: 78%

With the haemoglobin already relatively high, there was limited scope for simple top-up transfusion without increasing haematocrit and blood viscosity.

RCE provides a way to remove HbS-containing red cells while replacing them with donor red cells, thereby reducing the circulating sickle-cell burden without simply adding more red-cell mass.

The exchange

Blood volume processed: 3,993 mL
Replacement red-cell volume: 1,850 mL
Haematocrit maintained at approximately 30%

After exchange

HbS: 78% – 25.5%
HbA: 67.5%
Hb: 10.6 – 9.7 g/dL

This illustrates one of the key advantages of RCE – a substantial reduction in HbS while controlling the haemoglobin/haematocrit and limiting hyperviscosity.

Simple transfusion adds red cells.

Red cell exchange removes HbS-containing cells and replaces them with donor red cells – reducing the sickle-cell burden while helping to control viscosity.

An additional transfusion challenge

The patient had anti-E and anti-c, requiring appropriately selected R1R1, K-negative red-cell units, with units less than 7 days old.

In SCD, careful antigen matching and consideration of current and historical alloantibodies are particularly important when selecting blood for transfusion.”

Dilini Christina Ranasinghe