Red Blood Cell Exchange in a Resource‐Variable Setting: A Scoping Review of Two Decades of Indian Experience

Red blood cell exchange enables rapid reduction of pathological erythrocytes but requires substantial transfusion, apheresis, and immunohematology support. Following JBI methodology and PRISMA-ScR guidance, this scoping review mapped the indications, techniques, outcomes, transfusion support and implementation considerations of RBC exchange in India. Thirty-nine publications from 14 Indian States and Union Territories were included (2000-2026), of which 74.4% were published from 2020 onwards. Most were case reports (56.4%) and case series (28.2%), with no randomized or controlled trial. Sickle cell disease and related disorders were the predominant indications (76.9%), followed by methemoglobinemia (25.6%) and severe malaria (7.7%). Practice evolved from manual and resource-adapted approaches towards increasing use of automated exchanges. Substantial reductions in pathological erythrocyte fractions were reported, although clinical outcomes, transfusion requirements and procedural safety were inconsistently documented. Alloimmunization and compatible-unit procurement presented additional challenges. Published Indian experience demonstrates expanding use and technical feasibility across diverse settings. However, the evidence remains descriptive and uncontrolled, with limited data on comparative effectiveness, long-term outcomes, safety, and cost-effectiveness. Standardized reporting, systematic hemovigilance, prospective multicenter studies, and registry-based surveillance are future priorities.