Subscribe to The Podcast by KevinMD. Catch up on old episodes!

Join us in this insightful podcast episode as we debunk common misconceptions surrounding automated red blood cell exchange (RBCX) therapy. Our guest, Carly Newton, a registered nurse specializing in apheresis treatments, will share her expertise and shed light on the truth about this unique transfusion therapy. We’ll discuss the benefits of automated RBCX for both acute and chronic patients, its role in maintaining iron balance and reducing the need for chelation therapy, the convenience and potential cost savings it offers, and its impact on alloimmunization and viscosity. Carly will also delve into the findings of studies supporting the effectiveness and safety of automated RBCX. Tune in to gain a deeper understanding of this transformative treatment option and its implications for patients with sickle cell disease and other conditions.

Carly Newton is a registered nurse specializing in apheresis treatments.

She discusses her KevinMD article, “5 myths of treating sickle cell disease with automated red blood cell exchange.”

The Podcast by KevinMD is brought to you by the Nuance Dragon Ambient eXperience.

Ambient intelligence augments human capabilities to make our lives easier. The applications are many, especially in health care. Ambient clinical intelligence is offsetting the most pressing challenges in health care today, such as burnout, physician shortages, physician and patient dissatisfaction, and underperforming financial outcomes, by applying the technology to clinical documentation. 

The Nuance Dragon Ambient eXperience, or DAX for short, utilizes artificial intelligence and natural language processing to automatically document care. It securely listens to and captures the natural, clinician-patient encounter conversation unobtrusively, and turns that conversation into a clinical note for the clinician’s review and signature directly in the electronic health record. You just talk naturally, and DAX does the rest. 

DAX is being used by thousands of physicians across 30 different specialties nationwide. It has already won the Silver Stevie award in the health care technology category and was ranked #1 for improving clinician experience in KLAS’s top 20 emerging solutions.

VISIT SPONSOR → https://nuance.com/daxinaction

SUBSCRIBE TO THE PODCAST → https://kevinmd.com/podcast

RECOMMENDED BY KEVINMD → https://kevinmd.com/recommended

GET CME FOR THIS EPISODE → https://earnc.me/z8HRR0

Powered by CMEfy.

Transcript

Kevin Pho: Hi and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Carly Newton. She’s a registered nurse. Her KevinMD article is titled “5 myths of treating sickle cell disease with automated red blood cell exchange.” Carly, welcome to the show.

Carly Newton: Thanks for having me.

Kevin Pho: All right, we’ll get into the article in a little bit. First off, briefly share your story and journey to where you are today.

Carly Newton: Sure thing. So I’m a registered nurse from Australia. I’m currently based in Denver, Colorado. In Australia, I was actually an intensive care nurse, and my passion for education led me to exploring the commercial side of health care. I started educating on apheresis machines in Australia back in 2010, ended up in Singapore leading a clinical team there for four years, and four years ago, I was lucky to end up in Denver, Colorado.

Kevin Pho: Excellent. And for those who aren’t familiar with apheresis, and I know that you’re an apheresis specialist, tell us what that is.

Carly Newton: Good. So apheresis comes from a Greek term for “to remove.” And so with apheresis, we remove some part of the patient’s blood, or some cell, and we can do that more effectively than the body’s own homeostatic mechanisms can.

So when we talk about therapeutic procedures, what we do is we continuously pump blood into our machines. We separate the blood in a centrifuge, so it spins really hard to separate blood into red cells; a buffy coat layer that has some white cells and platelets; and plasma. Then, depending on what therapeutic procedure we do, we send the blood product that we don’t want, or that is causing harm to the patient, to a remove bag, and we continuously replace it with a replacement fluid, like red cells.

Kevin Pho: All right, what are some typical conditions that would require apheresis?

Carly Newton: Yes. So a big one, especially in North America, is what we call red blood cell exchange. So in red blood cell exchange, what we do is we continuously pump the patient’s blood through our apheresis system, and we remove the red blood cells and replace them with healthy donor cells.

A condition that it’s used frequently for, and that is indicated by the FDA in America, is something called sickle cell disease. And the reason why we do automated red blood cell exchange with sickle cell disease is because these patients have a type of red cell called hemoglobin S that can actually cause harm to them. So we remove those hemoglobin S cells while replacing them with healthy donor cells.

Kevin Pho: And typically, when people present with sickle cell disease that requires apheresis, how do they normally present to the hospital?

Carly Newton: Yes. So red blood cell exchange can be used for both acute and chronic sickle cell disease. Unfortunately, there’s no cure for sickle cell disease, so at this stage, physicians and health care professionals are helping patients manage their symptoms.

So with sickle cell disease, it happens because these patients have a type of red blood cell called hemoglobin S. And when these hemoglobin S cells become anemic, they turn into this crescent sickle shape, and they become really hard, and they don’t become flexible, which means that they can’t move through our veins and capillaries and arteries like normal red blood cells can. And what that means is that they can actually have a very common side effect of sickle cell disease, something called vaso-occlusive crisis. And that’s when the sickle cells get stuck in blood vessels and they cause extreme pain. So these patients come in, and they’re just in extraordinary pain.

But based on that as well, these patients can also be at high risk of having stroke or chest crisis as well. So really, with red blood cell exchange and any transfusion therapy for these sickle cell patients, the goal is to increase the RBC oxygen-carrying capacity, and that will reduce the frequency of these vaso-occlusive crises. It reduces the risk of stroke, secondary stroke, and acute chest.

Kevin Pho: Right. Your article is titled “5 myths of treating sickle cell disease with automated red blood cell exchange.” So tell us, how did your article come about?

Carly Newton: With sickle cell disease, even though it’s the most common genetic blood disorder in the U.S., there are only about 100,000 people with it. So it’s a very niche disease. Physicians are taught about sickle cell disease throughout their medical residencies and education, but it is a very niche disease. And so when you think about those 100,000 people, there’s only a very small number that are on transfusion therapy. And because it is such a small number of patients that get treated with transfusion therapy, there seems to be a lot of confusion, or myths, when it comes to the different types of transfusion therapy.

So of the three types of transfusion therapy, there’s simple transfusion, where a patient will come in and just have the red cells simply infused into them. There’s something called manual exchange, and that’s where the patient will come in, they’ll attach a needle and just bleed some red cells out, and then reinfuse with donor cells. That helps manage the iron a little better, because if you think about it, if you just keep coming in for these red blood cell transfusions, the challenge is maintaining an appropriate amount of iron in that body. If you just keep topping up with red cell transfusions, you end up with excess iron in your body, and that can lead to a lot of other complications. So to negate that, sometimes people would do what we call manual transfusion, and they will bleed some of these red cells out.

But what our therapy is, is automated red blood cell exchange. And what that means is that, like we talked about before, as we’re pumping the patient’s blood into our system, we’re removing those defective cells but simultaneously replacing them with donor cells. And so the benefit of that is you have what we call an iron-neutral therapy, so you don’t need to be on chelation therapy, which can have some side effects that patients don’t like as well.

The other thing with this is that we can maintain blood viscosity, meaning, because we’re not adding more red cells than we’re taking away, we can actually reduce the risk of increasing that blood viscosity, or complications associated with that. And we can actually target specific hemoglobin S levels, so it gives the physician a much tighter range to be able to treat these patients with.

But because it’s such a niche procedure, what we found is that there are a lot of misconceptions and a lot of myths around this. So we really developed these five myths of red blood cell exchange to help educate physicians, health care practitioners, nurses, and patients, trying to demystify that “transfusion confusion,” as we call it.

Kevin Pho: So tell us some of the biggest myths when it comes to automated red blood cell exchange.

Carly Newton: Yes. So the first one is that red blood cell exchange is only for acute patients. And so some health care professionals out there are under the assumption that if my patient is having an acute vaso-occlusive crisis, or having some sort of acute episode, that’s the only time I would use red blood cell exchange. And that’s not true. There are a couple of societies out there, the American Society for Apheresis and the American Society of Hematology, that actually recommend automated red blood cell exchange for sickle cell patients with both acute and chronic conditions.

Kevin Pho: Now, if the decision is being made to do a red blood cell exchange, how common is the manual versus the automated version?

Carly Newton: So in the U.S., the most common method of transfusion therapy is simple transfusion. So that’s when the patient comes in probably once to twice per month to have their red cell transfusion. And the reason why that is often preferred is because the health care practitioner thinks that they don’t need specialized therapy, systems, or trained nurses, and they can just come in and have these simple transfusions.

But I think with the automated red blood cell exchange option, it’s not for everybody, but one of the big benefits that has improved patients’ quality of life is the fact that these red blood cell exchanges can be pushed out much further apart. So we talked about these simple transfusions; these patients come in once to twice per month. With red blood cell exchange, they’re coming in on average every four to six weeks. So patients really appreciate the extra time they get to be able to live their life and be healthy.

Kevin Pho: One of the myths that you mentioned was cost and inconvenience. So talk about why that’s a myth.

Carly Newton: So there is a myth out there that RBCX is costly and inconvenient, and the biggest trend around that is the fact that you do use more red blood cells with one red blood cell exchange than you would with a simple transfusion. But if you look at that cost over 12 to 24 months, because the patients are coming in less frequently, and the way they’re being managed with targeted hemoglobin S levels, we have found that that hasn’t been the case.

The other thing is, as we talked about before, with simple transfusion, because these patients just keep getting topped up with red blood cells, their iron levels can increase, and most likely at some stage they’re going to need to be on chelation therapy. Chelation therapy is very costly, and it also comes with side effects that patients are not overly happy with when it comes to their quality of life.

Kevin Pho: And red blood cell exchange, is that typically only available in large academic medical centers? Is it available in the community? What’s the breakdown?

Carly Newton: It’s a really good question, and something we’re really passionate about at Terumo Blood and Cell Technologies: to get better access to red blood cell exchange for patients. At the moment, they are conducted in hospitals. A lot of these patients can be seen in outpatient settings of hospitals, but we’re working with some patient advocate groups and some blood banks to really start to try and explore whether we can get these procedures into more rural areas. And I think that’s a work in progress, but we really want to be able to increase access to these procedures for patients.

Kevin Pho: So talk about the patient experience when they undergo an automated red blood cell exchange.

Carly Newton: Yes. So the procedure lasts about 80 to about 120 minutes. So the nurse practitioners and health care professionals out there that conduct these procedures are great at educating the patients on making sure that they come well hydrated and that they get plenty of sleep the day before, because if they come and they’re dehydrated, it can be harder to access their veins, and the procedure just won’t go as smoothly.

So usually they have their blood taken the day before to look at what levels they are, so the physician can prescribe the treatment. But they’ll come in, and the nurse will gain access to them. What I mean by that is they’ll either put one or two small needles into their hands or their arms, depending. You can do this procedure with one needle or two. A lot of these patients have ports or catheters that are there long term, but we need to be able to access the patient somehow.

And then from there, it’s pretty simple. These procedures are very safe. We do thousands of them every day. The patient will sit there, usually on their iPad or computer, for that 80 to about 120 minutes, and then they’re disconnected from our machine. They usually have some post-procedure observations, and then they’re on their way. So for these patients, especially on these chronic programs, it’s very simple and safe.

Kevin Pho: We’re talking to Carly Newton. She’s a registered nurse. Her KevinMD article is titled “5 myths of treating sickle cell disease with automated red blood cell exchange.” Carly, tell us some of your take-home messages that you want to leave with the KevinMD audience.

Carly Newton: That really, because RBCX is more of a niche procedure, there are a lot of myths that we are working really hard to try and debunk out there. We’re working with patient advocate groups. We’re working with physicians that really want to be able to make sure other physicians understand the benefits and how to actually prescribe red blood cell exchange. And we’re also working with a lot of apheresis units and nurse unit managers.

So I think the wonderful thing about working in this industry is the fact that we’ve got so many committed health care professionals that want to be able to demystify and debunk these myths around red blood cell exchange and really focus on getting better quality of life for sickle cell patients and helping them be as healthy as they possibly can.

Kevin Pho: Carly, thank you so much for sharing your time and insight. Thanks again for being on the show.

Carly Newton: Thanks, Kevin.