Red Cell Exchange

Red blood cell exchange (RBC) is a non-surgical therapy that removes abnormal red blood cells and replaces them with healthy red blood cells derived from blood donors.

This therapy is mainly used to treat complications of sickle cell disease. In sickle cell disease, red blood cells are abnormal in shape and do not flow well through small blood vessels, which can prevent oxygen from reaching the tissues. This can result in damage to organs of the body and symptoms such as stroke, acute chest syndrome, or other organ failure. Red blood cells exchanges are also used to treat certain infections affecting red blood cells, such as malaria, or may be used in ABO-incompatible bone marrow transplants.

During red blood cell exchange therapy, small amounts of blood are gradually removed through an inserted needle or central line catheter and circulated through a machine that separates the blood into red cells, white cells, platelets, and plasma. These abnormal-shaped red blood cells are discarded and replaced with healthy red blood cells provided by a blood donor. The donor red blood cells are added back to the patient’s other blood components (white cells, platelets, and plasma) through a return access of either a needle or central line catheter. In the cases of sickle cell disease, procedures are typically performed every 5 to 8 weeks to maintain an adequate number of healthy red cells. Red cell exchange programs have helped reduced complications of the disease.

What to Expect

The procedure typically lasts 2 to 3 hours, but can last shorter or longer depending on a variety of factors. After starting the procedure, one may experience some mild numbness, tingling, lightheadedness or nausea. If intravenous catheters are placed, the arms will be propped on pillows and you will be asked to intermittently pump a fist to help promote blood flow. One may experience bruising or discomfort at the insertion sites. If a larger catheter or port is used, one will have free use of their arms during the procedure. An apheresis staff member specialized with the procedure will be with you throughout the treatment and should be notified of any side effects to help alleviate the symptoms.