Blood cell exchange in the treatment of exercise-induced rhabdomyolysis in a patient with sickle cell trait

We report the use of red blood cell exchange (RBCex) to treat rhabdomyolysis complicated by acute kidney injury in a 16-year-old African-American female with sickle cell trait (SCT). Treatment with aggressive fluid and electrolyte management failed to stem the rise in her creatine kinase, and RBCex was instituted 27 hours after symptom onset. She had a transient improvement in her creatine kinase following this treatment although it failed to resolve a developing lower extremity compartment syndrome, requiring bilateral lower extremity fasciotomies. The mechanism of exercise-induced rhabdomyolysis in individuals with SCT is theorized to result from localized hypoxia and acidosis within exercising muscle significant enough to cause a localized sickling crisis with resultant rhabdomyolysis. Despite the unique pathophysiology of rhabdomyolysis in individuals with SCT, there is a paucity of adjunctive treatment options beyond fluid and electrolyte therapy. To the best of our knowledge, RBCex for treatment of rhabdomyolysis in a patient with SCT has been described only once before by Huang et al. We report here a second case in the use of RBCex in the treatment of rhadbomyolysis in a patient with SCT.