Many patients with sickle cell disease (SCD) receive chronic RBC transfusions to ensure non-sickled erythrocytes are in circulation. In 20-30% of chronic transfusion episodes, however, transfusion targets are not achieved because of poor survival of donor RBCs. To better understand recipient and donor traits that may affect RBC transfusion survival, 20 chronically transfused patients with SCD (ages 12 to 33 years) were transfused with two to three RBC units (total of 49 RBC units), of which aliquots of each RBC unit had been biotinylated to track RBC survival. Based on blood sampling (15 mins, 24 hours, and weekly up to 16 weeks) post-transfusion, the median post-transfusion recovery was 97% at 24 hours, 80% at 28 days, and 21% at 90 days. In multivariate linear mixed-effects models, recipient spleen size had the largest effect on RBC recovery; spleen size above the mean was associated with decreased RBC survival at all time-points (adjusted effect estimate range -7.7% to -21.4%). Most biotinylated RBC units had similar intra-patient survival, but donor glucose-6-phosphate dehydrogenase (G6PD) deficiency and alpha thalassemia trait were associated with significantly reduced RBC survival. Future studies on the effects of donor and recipient characteristics such as G6PD and alpha thalassemia are needed to better understand the efficiency of RBC transfusions and RBC survival.
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