Ultrasound-Guided Peripheral Venous Catheter for Automated Erythrocytapheresis in a Paediatric Population Affected by Sickle Cell Disease.

Introduction: Automated erythrocytapheresis (aEEX) is an effective therapy for severe sickle cell disease (SCD). Its use in paediatrics can be limited by challenges in obtaining reliable venous access. Methods: We conducted a retrospective, single-centre study to evaluate the safety and feasibility of ultrasound (US)-guided peripheral venous catheter (PVC) placement for aEEX compared with central venous catheter (CVC) use in children and adolescents with SCD. Results: Between May 2018 and July 2025, 99 aEEX procedures using PVC were compared with 44 using CVC in 23 patients (median age: 16.4 years). The most frequent indication was severe disease phenotype (62.9%), defined as recurrent vaso-occlusive crises and/or splenic sequestration and/or acute chest syndrome despite optimal hydroxyurea therapy. The procedure success rate was 99.0% for PVC and 97.7% for CVC, with median post-apheresis HbS of 26.5% and 24.0%, respectively. Complications, mostly transient and without clinical impact, occurred in 9.1% of PVC procedures and 6.8% of CVC procedures. No infectious or and thrombotic events were reported. Conclusions: These findings indicate that aEEX under light sedation with US-guided PVC placement is a safe, well-tolerated and effective alternative to CVC in selected paediatric patients with SCD. This approach may expand access to aEEX reducing reliance on CVC and manual exchange procedures. Trial Registration: The authors have confirmed clinical trial registration is not needed for this submission.