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Apheresis Procedures (apheresis + procedure)
Selected AbstractsTherapeutic Apheresis procedures: mechanisms of action and Immunomodulatory effectsISBT SCIENCE SERIES: THE INTERNATIONAL JOURNAL OF INTRACELLULAR TRANSPORT, Issue 1 2008J. Munoz [source] The number of CD34+ cells in peripheral blood as a predictor of the CD34+ yield in patients going to autologous stem cell transplantationJOURNAL OF CLINICAL APHERESIS, Issue 2 2006A.L. Basquiera Abstract The number of CD34+ cells in peripheral blood (PB) is a guide to the optimal timing to harvest peripheral blood progenitor cells (PBPC). The objective was to determine the number of CD34+ cells in PB that allows achieving a final apheresis product containing ,1.5 × 106 CD34+ cells/kg, performing up to three aphereses. Between March 1999 and August 2003, patients with hematological and solid malignancies who underwent leukapheresis for autologous bone marrow transplantation were prospectively evaluated. Seventy-two aphereses in 48 patients were performed (mean 1.45 per patient; range 1,3). PBPC were mobilized with cyclophosphamide plus recombinant human granulocyte-colony stimulating factor (G-CSF) (n = 40), other chemotherapy drugs plus G-CSF (n = 7), or G-CSF alone (n = 1). We found a strong correlation between the CD34+ cells count in peripheral blood and the CD34+ cells yielded (r = 0.903; P < 0.0001). Using receiver-operating characteristic (ROC) curves, the minimum number of CD34+ cells in PB to obtain ,1.5 × 106/kg in the first apheresis was 16.48 cells/,L (sensitivity 100%; specificity 95%). The best cut-off point necessary to obtain the same target in the final harvest was 15.48 cells/,L, performing up to three aphereses (sensitivity 89%; specificity 100%). In our experience, ,15 CD34+ cells/,L is the best predictor to begin the apheresis procedure. Based on this threshold level, it is possible to achieve at least 1.5 × 106/kg CD34+ cells in the graft with ,3 collections. J. Clin. Apheresis 2005. © 2005 Wiley-Liss, Inc. [source] Collection of peripheral progenitor cells in paediatric patients with a new programme for the collection of mononuclear cellsJOURNAL OF CLINICAL APHERESIS, Issue 3 2003R. Moog Abstract When harvesting peripheral progenitor cells (PPC) in children, the special situation of their circulatory system has to be taken into account. Therefore, extracorporeal blood volume and product volume should be small to avoid side effects. Nine children (age 2,14 years, weight 12.8,58.5 kg) with malignancies underwent 10 PPC collections with the MNC programme of the Amicus blood cell separator. The disposable kit was primed with red blood cells (RBCs) or human albumin to avoid circulatory side effects. The children were monitored for blood pressure and heart rate during the whole apheresis procedure. A median blood volume of 4,577 ml (range 3,536,8,596 ml) was processed in a separation time of 270 min (range 176,331 min). The median product weight was 81 g (range 53,107 g) and the yield of CD 34 antigen expressing cells was 12.5 × 106/kg body weight (range 1.8,26 × 106/kg body weight). Only one child had to undergo a second apheresis to collect the desired transplantation dose. The median platelet contamination of the product was 0.32 × 1011 (0.13,0.85 × 1011). No circulatory side effects were observed. Blood flow alarms occurred in seven of ten aphereses and one collection had to be terminated due to insufficient flow. PPC can be efficiently collected in children with the MNC programme without circulatory side effects. The platelet contamination of the product was low due to the elutriation principle of the collection process, thereby avoiding thrombocytopenic bleeding episodes in the patients. J. Clin. Apheresis, 18:111,114, 2003. © 2003 Wiley-Liss, Inc. [source] Prospective evaluation of cell kinetics, yields and donor experiences during a single large-volume apheresis versus two smaller volume consecutive day collections of allogeneic peripheral blood stem cellsBRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2003Charles D. Bolan Summary. We report cell kinetics, yields and donation experiences of 20 demographically matched allogeneic peripheral blood stem cell (PBSC) donors who were prospectively assigned to undergo either a single 25 l or two consecutive daily 15 l (15 l × 2) apheresis procedures. Procedures were performed using prophylactic intravenous calcium administration after standard granulocyte colony-stimulating factor (GCSF) mobilization (10 ,g/kg/d). Central line placements (two each), initial CD34 cell counts (0·077 vs 0·078 × 109/l) and yields (7·9 vs 8·1 × 108 CD34 cells) were similar in the two groups; however, 25 l donors spent significantly less time both in the clinic (7·5 vs 10·8 h) and with central venous catheters in place (8·5 vs 29·5 h) than 15 l × 2 donors. End-procedure platelet counts were below 100 × 109/l in one out of 10 25 l donors versus five out of 10 in 15 l × 2 donors (41%vs 53% mean decrease in platelet counts, P = 0·02). PBSC collection efficiency increased by 37% after 15 l of the 25-l volume had been processed, compared with no significant change during 15 l × 2 procedures. Results similar to these prospective findings were also observed in CD34 yields, symptoms and platelet counts in additional 25 l and 15 l procedures performed during the same period and evaluated retrospectively. This study indicates that a single 25-l apheresis procedure results in similar yields and symptoms, but less donor thrombocytopenia and inconvenience than two consecutive daily 15-l procedures. [source] Increased risk of citrate reactions in patients with multiple myeloma during peripheral blood stem cell leukapheresisJOURNAL OF CLINICAL APHERESIS, Issue 4 2010Jill Adamski Abstract The citrate based anticoagulant ACD is commonly used in apheresis procedures. Due to its ability to decrease ionized calcium, citrate may cause unpleasant symptoms, such as paresthesias and muscle cramps, in patients undergoing therapeutic and donor apheresis. We noticed that patients with multiple myeloma (MM) undergoing autologous stem cell leukapheresis appeared to have more citrate reactions when compared to other patients undergoing the same procedure. A retrospective chart review was performed to evaluate 139 (of 151) consecutive patients with MM, amyloidosis, hematological and solid malignancies who had autologous peripheral blood stem cell collection between January 2007 and February 2008. Citrate reactions, ranging from mild (e.g., perioral tingling and parasthesias) to severe (e.g., nausea/vomiting and muscle cramps) were noted for 35 patients. Twenty-three of 63 patients with MM had documented citrate reactions, which was significantly higher than those with other hematological and solid malignancies (37% vs. 20%; P < 0.05, Relative Risk (RR) = 1.9). The severities of citrate reactions were the same in both groups; approximately 50% of patients in each group received i.v. calcium gluconate for treatment of hypocalcemia. No correlation between bisphosphonate therapy and citrate reactions were noted in our study group. Examination of available laboratory values related to calcium homeostasis, liver, and renal function failed to reveal a mechanism for the increase in citrate reactions observed. In summary, this single institution retrospective study indicates that patients with MM are more sensitive to citrate-induced hypocalcemia during leukapheresis when compared to patients with other hematological and solid malignancies. Strategies for decreasing citrate reactions (e.g., supplemental calcium and slowing return rates) should be considered for patient safety and comfort, especially in the MM population, on a prophylactic rather than reactive basis. J. Clin. Apheresis 25:188,194, 2010. © 2010 Wiley-Liss, Inc. [source] The Italian registry of pediatric therapeutic apheresis: A report on activity during 2005JOURNAL OF CLINICAL APHERESIS, Issue 1 2009Giustina De Silvestro Abstract The results of the 2005 Survey of the Italian Society for Apheresis and Cell Manipulation (SIdEM) reporting on the pediatric procedures carried out in 18 Italian Apheresis Units are presented here. Utilizing a standardized questionnaire, the survey collected data on techniques, types of blood separators, clinical indications, and adverse events. A total of 1,693 apheresis procedures were carried out in 355 pediatric patients: 219 plasma-exchange, 291 peripheral blood stem cell collections, 791 extracorporeal photochemotherapy (ECP), 265 LDL-apheresis, 71 erythro-exchange, 9 cytoreductive apheresis, 47 immunoadsorption sessions. Adverse events were registered in 94 procedures (5.6%), most of which of mild entity, e.g., insufficient flow rate (50.0%) and symptomatic hypocalcemia (24.4%). Our data indicate that all types of apheresis procedures can be safely carried out in children. ECP, utilized primarily for the treatment of graft versus host disease (GvHD) and rejection of solid organ transplantation, are burgeoning procedures in pediatric patients, whereas plasma exchange, which is a common treatment in adults, is infrequently utilized in pediatric medicine. J. Clin. Apheresis, 2009. © 2008 Wiley-Liss, Inc. [source] Standardized protocol to identify high-risk patients undergoing therapeutic apheresis proceduresJOURNAL OF CLINICAL APHERESIS, Issue 3 2008Qun Lu Abstract As the scope of therapeutic apheresis (TA) expands and more procedures are requested for critically ill patients, adverse reactions (AR) associated with TA become a major concern for physicians, nurses, patients and their families. To assess the risks for ARs associated with patients' underlying diseases, we developed a preprocedure assessment tool with a set of high-risk criteria which included: (1) unstable vital signs, (2) active nonphysiological bleeding, (3) evidence of severe bronchoconstriction, (4) severe anemia, (5) projected extracorporeal volume (ECV) >15% of total blood volume (TBV) in adults or >10% of TBV in pediatric patients, (6) pregnancy, and (7) conditions requiring continuous nursing support. A standard operating procedure with a "Request for Apheresis Procedure on High-Risk Patient" form and protocol were developed to identify patients as high-risk before initiation of a TA procedure. Here we report our experience in the 3-year period following the implementation of this protocol. During this period, a total of 3,254 TA procedures were performed, 44 of which were for patients identified as high-risk by the protocol. The incidence of overall ARs was 8% for all TA procedures and 45.5% for procedures performed for high-risk patients. The incidence of moderate-to-severe ARs was 3.7% for all TA procedures and 36.4% for procedures performed for high-risk patients. The protocol identified a group of patients with an increased risk for ARs, especially moderate-to-severe reactions during and/or immediately following TA. J. Clin. Apheresis, 2008. © 2008 Wiley-Liss, Inc. [source] Factors affecting platelet yield and their impact on the platelet increment of patients receiving single donor PLT transfusion,JOURNAL OF CLINICAL APHERESIS, Issue 1 2007A. Aboul Enein Abstract The aim of this study was to analyze the impact of various donor and machine parameters on PLT yield in 127 PLT apheresis procedures, to optimize PLT yield achieving clinical and economic advantages. One hundred and twenty-seven apheresis procedures were analyzed. Age, gender, volume processed, Hb, and PLT precounts were included as donor predicting variables. AC infusion rate, processing time, and plasma volume collected with PLTs were assessed as machine parameters. We evaluated the post-transfusion effectiveness in 23 patients with thrombocytopenia, studying the effect of PLT dose, ABO group, and PLT storage time. Females gave higher yields, compared to males, P < 0.01. PLT yield correlated positively with PLT precount (r = 0.512), and TBV (r = 0.404), and negatively with donor preapheresis Hb (r = ,0.306). Processing time and AC infusion rate had a positive impact on PLT yield. Post-apheresis decrease in PLT count was 53.6 ± 26.3 × 1011. Donors with Hb , 12 g/dl, donated safely. Most of the complications were citrate related (13.4% of all procedures). PLT increments in transfused patients correlated positively with the number of units transfused (r = 0.41), and negatively with PLT storage days (r = ,0.342). PLT increments in patients receiving ABO-compatible PLTs were 75% higher, compared to the increments in patients receiving incompatible PLTs. PLT count and volume processed were the main predictors of PLT yield. Increasing the processing time, the AC infusion rate, or the volume of plasma obtained with PLTs can increase PLT yields. High PLT dose, short storage time, as well as ABO compatibility should be considered during PLT transfusion. J. Clin. Apheresis, 2007 © 2007 Wiley-Liss, Inc. [source] Large-volume leukapheresis using femoral venous access for harvesting peripheral blood stem cells with the Fenwal CS 3000 Plus from normal healthy donors: Predictors of CD34+ cell yield and collection efficiencyJOURNAL OF CLINICAL APHERESIS, Issue 1 2003Sang Kyun Sohn Abstract The current paper reports on the predicting factors associated with satisfactory peripheral blood stem cell collection and the efficacy of large-volume leukapheresis (LVL) using femoral vein catheterization to harvest PBSCs with Fenwal CS 3000 Plus from normal healthy donors for allogeneic transplantation. A total of 113 apheresis procedures in 57 patients were performed. The median number of MNCs, CD3+ cells, and CD34+ cells harvested per apheresis was 5.3 × 108/kg (range, 0.3,11.0 × 108/kg), 3.0 × 108/kg (range, 0.2,6.6 × 108/kg), and 7.9 × 106/kg (range, 0.1,188.9 × 106/kg), respectively. The median collection efficiency of MNCs and CD34+ cells was 49.8% and 49.7%, respectively. A highly significant correlation was found between the collected CD34+ cell counts and the pre-apheresis WBC counts in the donors (P = 0.013), and between the collected CD34+ cell counts and the pre-apheresis peripheral blood (PB) CD34+ cell counts (P<0.001). Harvesting at least >4 × 106/kg CD34+ cells from the 1st LVL was achieved in 44 (77.2%) out of 57 donors and in 19 (90.5%) out of 21 donors with a PB-CD34+ cell count of >40/,l. There was no significant difference in the harvested MNC and CD34+ cell counts between the 1st and 2nd apheresis. The catheter-related complications included catheter obstruction (n = 2) and hematoma at the insertion site (n = 3). Accordingly, LVL using femoral venous access for allogeneic PBSC collection from normal healthy donors would appear to be safe and effective. J. Clin. Apheresis 18:10,15, 2003. © 2003 Wiley-Liss, Inc. [source] Prospective evaluation of cell kinetics, yields and donor experiences during a single large-volume apheresis versus two smaller volume consecutive day collections of allogeneic peripheral blood stem cellsBRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2003Charles D. Bolan Summary. We report cell kinetics, yields and donation experiences of 20 demographically matched allogeneic peripheral blood stem cell (PBSC) donors who were prospectively assigned to undergo either a single 25 l or two consecutive daily 15 l (15 l × 2) apheresis procedures. Procedures were performed using prophylactic intravenous calcium administration after standard granulocyte colony-stimulating factor (GCSF) mobilization (10 ,g/kg/d). Central line placements (two each), initial CD34 cell counts (0·077 vs 0·078 × 109/l) and yields (7·9 vs 8·1 × 108 CD34 cells) were similar in the two groups; however, 25 l donors spent significantly less time both in the clinic (7·5 vs 10·8 h) and with central venous catheters in place (8·5 vs 29·5 h) than 15 l × 2 donors. End-procedure platelet counts were below 100 × 109/l in one out of 10 25 l donors versus five out of 10 in 15 l × 2 donors (41%vs 53% mean decrease in platelet counts, P = 0·02). PBSC collection efficiency increased by 37% after 15 l of the 25-l volume had been processed, compared with no significant change during 15 l × 2 procedures. Results similar to these prospective findings were also observed in CD34 yields, symptoms and platelet counts in additional 25 l and 15 l procedures performed during the same period and evaluated retrospectively. This study indicates that a single 25-l apheresis procedure results in similar yields and symptoms, but less donor thrombocytopenia and inconvenience than two consecutive daily 15-l procedures. [source] | ||||||||||