What is Therapeutic Apheresis? 

Therapeutic apheresis is a medical procedure that involves directing the blood of the patient through tubing to a machine that separates the blood to its individual components; the diseased component is removed and/or replaced by specific fluids and the remainder of the blood components are reinfused back into the patient.

What is Red Blood Cell Exchange? 

There are three types of red blood cell (RBC) procedures: 
  • RBC Exchange 
  • RBC Exchange and Depletion
  • RBC Depletion
  Red blood cell exchange, or RBCx, is a non-surgical therapeutic apheresis procedure in which abnormal red blood cells are removed from the patient’s blood and replaced with healthy compatible red blood cells donated by blood donors. 

Red cell depletion is a procedure in which blood of the patient is passed through an apheresis machine which separates red blood cells from other components of blood. The red blood cells are removed and replaced with saline solution, when necessary.

What conditions is red cell exchange used for? 

Red cell exchange is commonly used to treat certain conditions such as: 
  • Sickle cell disease – RBCx is most commonly used to treat complications of sickle cell disease. Here the patient’s defective red cells are removed and replaced by normal red cells from a donor. 
  • Red cell Alloimmunization- RBCx is to reduce circulating RhD+ RBCs to a level at which RhIg can be safely administered. 
  • Babesiosis- Here RBCx minimizes the level of parasitemia by replacing infected RBCs with non-infected donor RBCs. 
  • Malaria – Here RBCx lowers the level of parasitemia by replacing infected RBCs with non-infected donor RBCs.
Disclaimer: mentioned above are some of the conditions treated by RBCx. There are numerous other indications for RBCx therapy

What type of vascular access will be used during the procedure? 

During RBCx, blood is removed through one of the below vascular access types

If peripheral intravenous cannulas (IVs) are used, your arms will be raised up on pillows, and you will be asked to squeeze your fist to promote the blood flow.

Does this procedure hurt? 

  • The procedure itself is not painful and most people report little or no discomfort during treatment. However, as with any needle puncture, there may be slight discomfort when the central line or IV cannula is inserted. 
  • Sometimes you might feel different sensations that are not painful, which include a slight pulsing from the instrument’s pump, a slight chill or cold sensation while blood returns  to your body. 

What are the pre-procedure assessment criteria? 

The pre-procedure assessment criteria are:  

Note: Prior to the procedure, vein will be assessed by Apheresis nurse (if you have poor veins, your physician will order a central line catheter)

How long does the procedure take? 

  • Patients may need to come for the pre-procedure appointment two to three days before the actual procedure day for a sample draw, assessment and preparations; this may take about one hour. 
  • On the day of the procedure the length of the procedure varies from one patient to another based on laboratory results, total blood volume, height and weight, access condition and type of replacement fluid. The procedure itself may take up to three hours but the preparation for it on the day of the procedure (blood withdrawal, central line placement etc.) may take another two to three hours.

How will this procedure work for me?

 In general, this procedure will help to reduce the level of diseased RBC’s by replacing them with non-diseased donor RBCs.

 In the case of sickle cell disease, this procedure will help to reduce the percentage of sickle cell RBCs and replace them with normal donor RBCs, which should improve symptoms and health.

What are common side effects of exchange transfusions? 

  • The exchange procedure is well tolerated by most people and the side effects are not common. 
  • Some people may experience fainting or light-headedness; you will be monitored throughout the procedure and if this happens, please let the nurses know immediately as you may need a drip of extra fluid to feel better. 
  • During the procedure, you may occasionally get a “pins and needles” (tingling and numbness) feeling in your fingertips or lips, feel cold or slightly sick due to low calcium levels. If this happens, please inform the apheresis nurse immediately. 
  • Other side effects related to transfusion of blood products are fever, chills, flushes or rashes, less commonly chest tightness. You will be monitored for any transfusion reaction and managed accordingly.
  • Before the procedure, your apheresis care team and physician will go through all the risks and benefits of the procedure with you, and you will have the opportunity to ask questions before signing the consent form.

How often do I need this treatment? 

The frequency of RBCx procedures depends on your disease, condition and the treating physician in coordination with the apheresis team assessment. 

For example, in sickle cell disease, the recommended frequency of a red blood cell exchange is usually every 6 to 8 weeks.

How should I prepare for the procedure?

  • Get a good night’s sleep the night before
  • It is important to stay hydrated 
  • Before the procedure, eat a meal especially calcium rich like (milk, yogurt , egg) and avoid heavy fatty meals 
  • Bring a book, novel or anything for your entertainment 
  • Dress for comfort and warmth 
  • Discuss with Apheresis provider before taking any medicines
  •  We recommend that a family member or friend accompany you on the day of procedure as you may feel tired for the rest of the day

What should I do after the procedure? 

Please follow the below post-procedure instructions:
  • Stay in bed for at least 30 minutes for getting monitored prior to discharge. 
  • Have your light meal before you leave and try to have healthy foods and lots of fluids at home. 
  • If you feel any unpleasant reaction at home such as a rash, allergies, fainting, or breathing difficulties, go to the nearest hospital or the SSMC Emergency Department.
  • Avoid strenuous physical activities for 24 hours post procedure. 
  • Comply with follow-up appointments with your treating physician and the Apheresis Clinic.


  1. A patient’s guide on how sickle cell disease is managed with red blood cell exchange – TerumoBCT 
  2. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice – Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue 
  3. AABB technical manual 20th edition
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