Daily Living With Sickle Cell Sickle Cell Blog
Related Articles
Blood Exchange & I
Some years ago, I was going for surgery and had to have blood exchange before surgery. Blood exchange was something that I had never had at that time, and I was intrigued about the whole process, and wanted to write about my experience. I realise that some of you living with Sickle cell might have had blood exchange before or maybe your loved one who suffers from Sickle Cell, nonetheless, it is good to write about it for other people who are yet to have it.
Prior to my going for the blood exchange, I previously had to go and have blood tests done, in order for them to ascertain my blood group, do a crossmatch, check for antibodies and other checks necessary before the blood exchange.
On the day in question, I was told to get to the hospital for 9 am. I got there before the time and the whole process began. It was a long day, and I was very tired and in pain at the end of it all.
Due to the fact that I was going for surgery a few days after the blood exchange, my consultant felt that it was important for me to have ‘good’ blood in me. The process was one of taking out my blood from one tube as another tube was feeding back into me the ‘good’ blood from the blood exchange machine.
The bit that I found painful was them trying to get a vein in order to put the cannula tube in and as the nurse could not find any veins in my hands, it was decided that this femoral line would be inserted into my groin, (this is why the procedure took a long time). I still shudder when I think about it. And oh my, was it painful!
Allow me to explain in a more technical manner about the process.
A femoral line is a larger cannula, that is inserted into the femoral vein near the groin to facilitate the administration of donor blood. This is often necessary for exchange blood transfusions, particularly when employing automated exchange transfusion machines. The insertion procedure is typically performed by an advanced nurse practitioner or specially trained nurse. Prior to femoral line insertion, local anaesthesia can administered to numb the groin area, reducing discomfort. Preparation for the femoral line insertion takes approximately thirty minutes, while the insertion itself usually lasts about fifteen minutes. To prevent dislodgement, the line is securely fastened with a robust dressing or stitches.
I found out the duration of the exchange blood transfusion procedure on the machine typically ranges from one to four hours, contingent upon one’s medical background and the volume of blood required. Anticipate spending the entire day in the day unit, from 10 am to 5 pm or half a day. Approximately 45 minutes are allocated for the femoral insertion, with an additional half and hour required after the machine ceases operation before discharge from the hospital is permitted.
I was also regularly monitored during the exchange (checking blood pressure, temperature, pulse, and breathing rate) and asked how I was feeling.
After completing the exchange process, a sample of blood was drawn from the femoral line to assess the remaining sickle haemoglobin levels. Subsequently, the femoral line was removed, and a gentle pressure was applied to the site by the nurse for approximately five minutes. Following this, I was instructed to remain in a flat position for thirty minutes to minimize the risk of bleeding. A nurse will then conduct a final assessment, and upon clearance, you’ll be discharged to return home.
While I was there, I found out that some people have to come for a blood exchange every 4-12 weeks! I really don’t envy them but it is a matter of life or death.
Let’s educate ourselves on blood exchange for people with sickle cell:
An exchange blood is a procedure that replaces sickle blood with non-sickle blood (from a donor who does not have sickle cell disease).
Why would one need a blood exchange?
This procedure might be needed in an emergency, such as:
· a complicated sickle cell crisis, such as a stroke,
· a chest crisis – sickling in the lungs causing breathing problems.
· a very painful crisis.
A routine or planned exchange transfusion may also be done in the following situations:
· If you have had a stroke, repeated blood exchange can help reduce the risk of further strokes happening.
· If your sickle cell disease is very severe, repeated exchange transfusions can help reduce the number of crises.
· In pregnancy an exchange transfusion may prevent complications to you and your baby.
· If you are going to have a major operation such as a hip replacement, a single exchange reduces the risk of complications from the general anaesthetic and surgery.
· If you have leg ulcers exchange transfusions may aid healing.
· An exchange transfusion may help in cases of severe priapism (painful erections) that have not responded to other forms of treatment or surgery.
Possible Complications:
One may get a skin rash or a minor fever, for example in terms of possible complications of blood exchange. These can be treated easily with paracetamol and antihistamines.
Iron overload is common in people who receive repeated blood exchange or blood transfusions. When necessary, excess iron can be removed by taking medication (injections or tablets
The blood received from a donor is meticulously matched with my own blood. However, there’s a possibility of developing “antibodies” against the donor’s blood, which underscores the importance of promptly informing clinical staff about any post-exchange symptoms. The precautionary waiting period is at least half an hour after the procedure is advised for this reason. The presence of antibodies can complicate the process of finding and preparing a compatible match, potentially prolonging the time required.
