Multimodality, Multidisciplinary Approach to Overcome Technical Challenges in a Pediatric Stem Cell Harvest for Sickle Cell Disease with Preformed Donor-Specific Antibodies

Abstract Sickle cell disease is a group of disorders caused by a mutation in the beta chain of hemoglobin (Hb) leading to a vicious cycle of HbS polymerization, increased adhesion-mediated vaso-occlusion and hemolysis-mediated endothelial dysfunction. Herein, we describe a multimodality approach undertaken in a 10-year-old girl child with sickle cell anemia with preformed donor specific antibody (DSA). The initial autologous stem cell rescue collection had to be aborted due to excessive clotting in the stem cell collection set due to elevated Hb S levels. Red cell exchange was performed in view of this and the subsequent autologous harvest was successful. Five cycles of therapeutic plasma exchanges were done before allogeneic stem cell transplantation to reduce the mean fluorescent intensity value of DSA. The child tolerated the procedures well without any adverse events.