OA3-AM24-MN-39 - The Efficacy And Safety Of Whole Blood Exchange Transfusion In Sepsis With Anemia

Monday, October 21, 2024

5:30 PM - 6:30 PM

Location: 342

CE: Zero

Presenting Author(s)

Ning Li, MA PhD MD Professor (he/him/his)

Director
Department of Blood Transfusion, Clinical Transfusion Research Center, Xiangya Hospital, Central South University
changsha, Hunan, China (People's Republic)

Disclosure(s): No financial relationships to disclose

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Disclosure(s):

Ning Li, MA PhD MD Professor: No financial relationships to disclose

Background/Case Studies: Dysregulated immune response and persistently activated, unregulated white blood cells are pivotal in sepsis progression. Furthermore, the inflammation-induced hemolysis mechanism places sepsis patients at high risk of anemia. Whole blood exchange (WBE), incorporating plasma exchange, red cell exchange, and pathogenic cell removal technique, has shown efficacy in severe autoimmune hemolytic anemia. Consequently, it might hold promise as an adjunctive treatment for managing sepsis complicated by anemia. This study aimed to assess the efficacy and safety of WBE in sepsis patients with anemia.

Study

Design/Methods: Clinical data of sepsis patients with anemia at local hospital between January 2020 and September 2023 were collected (Ethics No.202103418). The therapy protocol of this study involves performing WBE in the initial phase, followed by transitioning to lymphoplasmapheresis mode at an appropriate time based on the target hemoglobin levels. Patients receiving WBE were matched with those receiving conventional therapy via propensity score matching (PSM). Regression analyses assessed the association between WBE and clinical outcomes in both pre- and post-matching cohort. Sensitivity analysis was conducted using inverse probability of treatment weighted and covariate adjustment using propensity score to ensure the result robustness. Generalized additive mixed models were used to explore WBE's impact on sequential organ failure assessment (SOFA) scores, vital signs, and laboratory indexes.

Results/Findings:

A total of 219 septic patients with anemia were included, with 49 in the WBE group and 156 in the conventional group. After PSM at a 1:2 ratio, there were 38 and 76 patients in the WBE group and the conventional group, respectively. The overall safety was good with no serious adverse reactions. WBE was significantly associated with decreased risks of in-hospital mortality (26.32% vs. 48.68%, odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.16–0.88, P = 0.024) and incidence of liver failure (16.13% vs. 41.27%, OR: 0.27, 95%CI: 0.09–0.81, P = 0.019) (Table 1). Sensitivity analysis consistently supported these findings. WBE group exhibited significant decreases over time in SOFA scores, activated partial thromboplastin time, bilirubin levels, while mean arterial pressure, oxygen partial pressure, hemoglobin, red blood cell count, and plasminogen levels significantly increased. Interleukin-6 (7.17 vs. 23.00 pg/ml, P = 0.041), C-reactive protein (21.66 vs. 47.40 mg/L, P = 0.020) and erythrocyte sedimentation rate (7.00 vs. 47.00 mm/h, P = 0.048) levels significantly decreased post-WBE.

Conclusions: WBE is a secure modality for managing sepsis with anemia, yielding significant improvements in mortality. Furthermore, WBE exhibited the potential to ameliorate outcomes by improving organ function, coagulation, anemia, and inflammatory status. Our study provides a potential treatment option for sepsis.