Effect of switching to automated exchanges and use of DFX in iron load in SCD for 2 patients treated at University College London Hospitals. (A) The effect of changing from manual exchanges (light shading) to automated RBC exchange (darker shading) is shown in an adult patient with SCD who remained on DFX throughout the period of observation until SF values approached normal levels. The %HbS is maintained < 40% more consistently with automated exchanges. Introduction of DFX lowers SF while on manual exchanges and SF values close to normal ranges are achieved after switching to automated exchanges. (B) Effect on SF of switching from DFO to DFX is shown, followed by the effect of switching from manual (light shading) to automated exchanges (darker shading). SF remained high (> 4000 μg/L) with high LIC (25.8 mg/g dry weight) after years of DFO and manual exchanges. The trend in SF decreases toward the normal range only after introduction of DFX and automated exchange.