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.