PRINCE ©F WALES
(i U
Dr. Vasilios Berdoukas MB BS, FRACP
Senior Staff Speciaflst
382.167ó
or 382.1111
Fax: 382.1787
High Street, Randwick NSW 2031
Australia
VAB:mo
9 February 1996
The Refugees Worldwide
Charity Organisation
29 Rushden Gardens
Ilford,.
Essex
1G5 OBP
Dear Dr Yardurnian
RE: Automated red cell exchanges for Thalassaemia major patients
Thank you for your letter
about red cell exchange. In our unit we have about 60 transfusion dependant patients. Of these about 35 are on regular red
cell exchanges. The exchange transfusions are done between every 7 and 8 weeks on the patients and it has significant acceptance
amongst our patients. If we suggest that we stop this treatment we would have grave concerns expressed by the patients and
have therefore continued doing it.
The principle values to the patient are the Increased Interval between transfusions
and the short time of admission i.e. It is usually only a 2-3 hour admission.
I forward to you the protocol we use for
the red cell exchanges and also a copy of the original article we published on this. There have been a few other publications,
the principal one being one by Alan Coen and his co-workers on using this for sickle cell anaemia. For sickle cell anaemia
we now do isohaernatocrit exchange transfusions and this means we do not raise the haernoglobin of the patients at all but
we basically rid their bodies of their haemoglobin S and replace it with normal haernoglobin A. They then would continue to
produce haemoglobln S until the next transfusion but would not get above levels which could cause problems. I.e. We aim to
keep the haemoglobln S level below 50% at all times. With this type of regime, the patients do not have any significant Iron
overload at all.
There are some difficulties In making sure that one can get the best transfusion intervals with this type
of therapy. it is very important to use more blood than originally thought and now we are guided more by the fraction of cells
remaining at the end of an exchange transfusion rather than by what they would normally receive in
cont....
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conventional transfusions. Therefore we aliu for FCR’s between 20-25% as this gives us the
best transluclon Intervals without the patients falling below haemoglobins of 9.5.
I did manage to speak to a relative
of your patient who visited here and I did Indicate to him that there was no point In people raising money for a machine unless
the unit for which they wish to purchase It was interested In setting up the system. The advantages, as I said, are increased
transfusion Intervals, shortened transfusion time, however the disadvantages are that one needs larger amounts of blood over
a 1 2 month period and increased exposure to units. The cost of the machine plus the disposables may also be prohibitive.
We also use filters with the patients who are receiving concentrated cells and we also have some patients who receive triple
wash packed cells, therefore the cost per transfusion Is significantly higher than that with normal transfusions.
The decision
on whether our unit can provide this type of service Is one that the unit only kself can make. It vould have to weight all
the positives, rue advantages to the patients and to the unit kseif against the disadvantages. The machine we use is a Cobe
Spectra. it is very versatile and has many other uses. in particular we use it for component collections to support our bone
marrow transplantation unit, stern cell collections and piasmapheresis.
I have taken the liberty of giving your name to
the local Cobe representative here and perhaps somebody from that company may get In touch with you in the near future.
Should
you require additional information, I would be happy to provide ft. With best regards, Yours sincerely
Vasill Berdoukas
A member of the Hospital Group Including Prince Henry, Prince of Wales, and Royal South Sydney Hospitals
Facilities
of the South Eastern Sydney Area Health Service
