Sinan MERSİN, Pelin AYTAN, Mahmut Bakır KOYUNCU, Seher YONTAR, Hamit ÜNVER, Aycan ERKENEKLİ, Esin Oğuz KOCAN, Enver TEKİN, Eyüp Naci TİFTİK
Journal of Current Hematology & Oncology Research - 2026;4(3):110-115
Aims: Automated erythrocytapheresis (red cell exchange; RCE) is an established therapeutic modality in sickle cell disease (SCD), yet procedural complication data from Turkiye and the Eastern Mediterranean region remain limited. This study evaluated the safety profile of RCE in adult SCD patients at a single tertiary center and identified clinical and procedural predictors of adverse events. Methods: We conducted a retrospective cohort study of all automated RCE procedures performed in adult patients (>=18 years) with SCD between January 2015 and December 2020. Adverse events were graded according to the World Apheresis Association (WAA) classification (grades 1-4). Procedures with and without complications were compared using the Mann-Whitney U test for continuous variables and Fisher's exact or Chi-square tests for categorical variables. Results: A total of 274 procedures in 83 patients were analyzed. The overall complication rate was 12.4% (n=34): grade 1 in 4.4%, grade 2 in 5.8%, and grade 3 in 2.2%; no grade 4 events were observed. Vascular and mechanical dysfunction accounted for 67.6% of complications. Complication rates declined from 31.2% in 2015 to 5.5% in 2018, with no severe events after 2016. Higher pre-procedure hemoglobin (9.4 vs. 8.9 g/dl; p=0.021) and hematocrit (27.0% vs. 25.9%; p=0.022) were significantly associated with complication occurrence. MCS(R) procedures had a substantially higher complication rate (42.9% vs. 10.8%; p=0.003) and severe event rate (28.6% vs. 0.8%; OR=51.4; p=0.0001) versus the Spectra Optia(R) system. Indication and hydroxyurea use were not significantly associated with outcomes. Conclusion: Automated RCE is a safe procedure in adult SCD patients with a low rate of severe adverse events. Higher pre-procedure hemoglobin and hematocrit and use of the MCS(R) device were associated with increased complication risk. The marked temporal decline in complication rates reflects institutional learning and device transition to the Spectra Optia(R) platform.
