Exchange transfusion through the heart-lung machine in a sickle cell disease patient undergoing aortic valve replacement: proposition for a pragmatic protocol

BackgroundIn sickle cell patients scheduled for cardiac surgery, preoperative decrease in hemoglobin S (HbS) by exchange transfusion is advocated; however, protocol may vary according to institution. In this report, we provide a standardized framework that allow to perform an intraoperative tailored exchange-transfusion directly through the heart-lung machine.Case ReportA 74-year-old male patient, with a SC genotype sickle cell disease (preoperative HbS at 51%), underwent bioprosthetic aortic valve replacement. The required volume for exchange transfusion was calculated to obtain an HbS level at 30%. The exchange transfusion was performed directly through cardiopulmonary bypass (CPB) circuit. Surgery was conducted in normothermia, with warm blood cardioplegia, high flow rates, and careful monitoring of oxygenation and pH level. Surgery and postoperative care were uneventful, allowing complete discharge from intensive care unit (ICU) at day two.ConclusionA standardized exchange transfusion protocol directly through the CPB circuit allow to confidently decrease HbS to the targeted value just prior surgery.