Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Red Blood Cell Exchange as a Valid Therapeutic Approach for Pregnancy Management in Sickle Cell Disease. Three Explicative Cases and Systematic Review of Literature

Caterina Giovanna Valentini
* ORCID logo ,
Claudio Pellegrino
ORCID logo ,
Sara Ceglie
,
Vincenzo Arena
,
Francesca Di Landro
,
Patrizia Chiusolo
ORCID logo ,
Luciana Teofili
ORCID logo
Version 1 : Received: 12 October 2023 / Approved: 12 October 2023 / Online: 12 October 2023 (13:09:36 CEST)

A peer-reviewed article of this Preprint also exists.

Valentini, C.G.; Pellegrino, C.; Ceglie, S.; Arena, V.; Di Landro, F.; Chiusolo, P.; Teofili, L. Red Blood Cell Exchange as a Valid Therapeutic Approach for Pregnancy Management in Sickle Cell Disease: Three Explicative Cases and Systematic Review of Literature. J. Clin. Med. 2023, 12, 7123. Valentini, C.G.; Pellegrino, C.; Ceglie, S.; Arena, V.; Di Landro, F.; Chiusolo, P.; Teofili, L. Red Blood Cell Exchange as a Valid Therapeutic Approach for Pregnancy Management in Sickle Cell Disease: Three Explicative Cases and Systematic Review of Literature. J. Clin. Med. 2023, 12, 7123.

Abstract

Pregnancy in women with Sickle Cell Disease (SCD) is a high-risk situation, especially during the third trimester of gestation and in the post-partum period, due to chronic hypoxia and vaso-occlusive phenomena occurring in the maternal-fetal microcirculation: as a result, unfavorable outcomes, such as intra-uterine growth restriction, prematurity or fetal loss are more frequent in SCD pregnancies. Therefore, there is a consensus on the need for a strict and multidisciplinary follow-up within specialized structures. Transfusion support remains the mainstay of treatment of SCD pregnancies, although most appropriate modalities are still controversial: the benefit of prophylactic management, either by simple transfusions or by automated Red Blood Cell Exchange (aRBCX), is not unanimously recognized. We illustrate the cases of three SCD pregnant patients who underwent aRBCX procedures at our institution in different clinical scenarios. Moreover, we carried out a careful literature revision to investigate the management of pregnancy in SCD, particularly regarding the practice of aRBCX. Our experience and current literature support using aRBCX in pregnancy as a feasible and safe procedure provided that specialized equipment and an experienced apheresis team are available. However, further research in this high-risk population, with appropriately powered prospective trials, will be desirable to refine indications and timing of aRBCX and confirm this approach's advantages on other transfusion modalities.

Keywords

sickle cell disease; pregnancy; erytrocytapheresis; transfusion; HbS

Subject

Medicine and Pharmacology, Hematology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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