Impact of Isovolemic Hemodilution‐Red Cell Exchange on Health‐Related Quality of Life in Patients With Sickle Cell Disease: A Pilot Study

Sickle cell disease (SCD) negatively affects health-related quality of life (HRQoL). Isovolemic hemodilution (IHD) red-cell exchange (RCE) is being increasingly used to treat SCD-related complications, but its impact on HRQoL has not been characterized. This single-center pilot study assessed the effect of switching from chronic conventional RCE to IHD-RCE on HRQoL. Adults with SCD receiving conventional RCE at the Foothills Medical Centre (Calgary, Canada) were assessed for eligibility to switch to IHD-RCE in March-May 2023. The primary outcome was HRQoL assessed before and 6 months after switching using the Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me) questionnaire. Red blood cell (RBC) utilization, RCE characteristics, clinical parameters, and complications were also assessed before and after switching to IHD-RCE. Five patients were included. Overall, HRQoL was stable 6 months after switching from conventional RCE to IHD-RCE, with numeric improvements from baseline in sleep, stiffness, and emotional impact subscale scores. There were modest reductions in RBC utilization per RCE session but a small increase in RCE sessions per patient, with slightly fewer days between RCE sessions. Clinical parameters were largely unchanged 6 months after switching to IHD-RCE except for decreased ferritin levels and iron saturation and increased total iron-binding capacity. No emergency department visits or transfusion reactions were observed during follow-up. This pilot study suggests that SCD-related HRQoL is maintained after switching from conventional RCE to IHD-RCE, with potential benefits on sleep, stiffness, and emotional impact.