Evaluation of red blood cell exchange practices in the management of sickle cell disease across gulf region hospitals Free

Introduction Red blood cell exchange (RBCX) has become a keytherapeutic modalityin managingpatients with sickle cell disease (SCD), enabling the removal of abnormalerythrocytesandimprovingclinical outcomes.Automated exchange offers betterHbScontrol, less iron overload, and greater efficiencyparticularlyin high-volumesettings. SCD is a significant public health concern in many Gulf countries due to high carrier prevalence and consanguineous marriage patterns.Thisstudy aims to evaluate current RBCX practices in selected hospitals across the Gulf region, focusing on both elective and emergency exchange procedures, as well as their clinical indications. Methods A cross-sectional study was conducted between January and April 2025 to evaluate red blood cell exchange practices in the management of sickle cell disease across the Gulf region. The questionnaire was distributed via WhatsApp to healthcare professionals in Saudi Arabia, the United Arab Emirates, Kuwait, Bahrain, Oman, and Qatar. A structured survey was developed, reviewed, validated, and distributed to capture data related to the availability of RBCX, procedure types (manual vs. automated), frequency, clinical settings, institutional guidelines, team roles, and barriers to implementation. Respondents were not limited to specific hospitals; responses were based on individuals who voluntarily participated. Although the survey was circulated broadly, responses were mostly concentrated in Saudi Arabia, and some countries were not represented in the final dataset. Results A total of 94 healthcare professionals from 53 hospitals participated across the Gulf region. Of these, 86 (91.5%) were from Saudi Arabia, and 8 (8.5%) were from other cities within the Gulf region. The survey included responses from both adult and pediatric institutions, reflecting wide spectrum of RBCX paractices. Among the respondents, 88 (93.6%) reported that red blood cell exchange (RBCX) is performed at their institutions. Of these, 29 (33%) relied on manual exchange, 25 (28.4%) employed automated exchange, and 34 (38.6%) utilized both methods. Regarding procedural frequency, 41 respondents (46.6%) reported performing 5 to 15 RBCX procedures per month, 35 (39.8%) reported fewer than 5 procedures, and 12 (13.6%) reported more than 15 procedures per month. Emergency RBCX was most commonly performed in intensive care units (90.9%), followed by wards (40.9%), high dependency units (23.9%), and emergency rooms (10.2%). Elective procedures were primarily conducted in day care units (40.9%), intensive care units under regular admission (30.7%), and inpatient wards (26.1%). Institutional guidelines for RBC exchange in sickle cell disease were reported by 63 participants (71.6%), while 25 (28.4%) lacked standardized protocols. Among the six centers not offering RBCX, the main barriers included insufficient resources (66.7%), lack of institutional support (66.7%), unclear processes or guidelines (50%), and limited staff experience (16.7%). Additionally, role clarity was reported by 78 respondents (88.6%), with physicians overseeing initiation and clinical decisions, nurses managing patient preparation and monitoring, and laboratory staff handling machine operation and blood coordination. Conclusion Red blood cell exchange is widely practiced for the management of sickle cell disease across responding institutions in the Gulf region, with substantial variation in procedural types, clinical settings, and institutional readiness. Expanding access to automated RBCX in high-volume and tertiary care settings may improve patient outcomes and reduce transfusion-related complications. To achieve this, health systems must address barriers such as limited resources, staffing shortages, and the lack of clear institutional guidelines. These findings support the need for regional collaboration and the development of standardized protocols to optimize care quality and clinical outcomes for patients with sickle cell disease. Although our survey did not directly assess long-term monitoring practices or program structures, previous literature has highlighted the benefits of outpatient RBCX programs and the importance of tracking outcomes such as HbS levels, transfusion-related reactions, and iron overload. These areas represent future opportunities for clinical improvement and system-level quality initiatives.