Use of automated isovolemic hemodilution red‐cell exchange in patients with sickle cell disease: A Canadian single center experience
Bibliographic record
Abstract
BACKGROUND: Red cell exchange (RCE) is an important treatment for sickle cell disease (SCD). It is a resource-intensive intervention requiring large volumes of red blood cells (RBC), which are frequently antigen-matched. Efforts to reduce the volume of units transfused, while maintaining treatment efficacy is an important need. This study evaluates the impact of a change to isovolemic hemodilution (IHD)-RCE on RBC utilization in SCD patients at a Canadian center. STUDY DESIGN AND METHODS: Adult SCD patients receiving chronic automated RCE at the Ottawa Hospital were approached for study inclusion. To safely attain a meaningful reduction in transfused RBCs, RCE parameters were individualized for each patient. IHD-RCE was performed only if an estimated reduction in RBC volume of at least 200 mL was expected, with hematocrit not allowed to decrease below 20%. Data were compared in the 6-months before and after the protocol change. RESULTS: Twenty-two adult patients met the criteria for inclusion. There was a net reduction of 107 RBC units after the transition from standard RCE to IHD-RCE (1035 vs. 928 units; -10.3%). The mean number of RBC units transfused per patient decreased by 4.8 (47.0 vs. 42.2 units; p = .01). No difference in target post-RCE hemoglobin S levels was observed. DISCUSSION: In this study IHD-RCE reduced RBC utilization without impacting efficacy or safety, conserving 107 RBC units (an annualized savings of $95,444 CAD). No adverse events due to saline replacement were observed. Increased awareness of the benefits of IHD-RCE through knowledge translation could promote greater uptake.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".