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Kumawat V, Tripathi PP, Patidar GK. Therapeutic apheresis and non-blood donor related apheresis current practices at various blood centres of healthcare organisations of India: A brief online survey. Transfus Med 2021; 32:45-52. [PMID: 34825419 DOI: 10.1111/tme.12837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/28/2021] [Accepted: 11/02/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the variability in therapeutic apheresis (TA) and non-blood donor related apheresis practices, and the extent of expertise and knowledge of blood centre staff. BACKGROUND Apheresis activity that was earlier limited to therapeutic plasma exchange (TPE) and donor apheresis at few centres in India has seen remarkable surge involving many centres practising TA and non-blood donor related apheresis. The decentralised transfusion medicine practice in country has resulted in wide variability of knowledge and practice of TA. An online survey was conducted to achieve study objectives. STUDY DESIGN AND METHODS A 22 questionnaire survey was sent to the 215 blood centres through e-mail link focussing on three aspects; basic information of the participating centres, details of TA procedures and education and training levels of the staff. RESULTS Majority (71.9%) of centres were teaching institutions among analysed 57 centres. TPE (85.9%) and therapeutic cytapheresis (71.9%) were the most common TA procedures. The clinical haematology (68.4%) followed by neurology (64.9%) were the specialities utilising TA. The 64.9% centres used continuous flow cell separator and central venous access (52%) was preferred vascular access. A combination of normal saline, fresh frozen plasma and 5% albumin replacement fluid was first choice. Doctors involved in TA were trained in apheresis during their MD/DNB degree, but no structured training program existed for other category of staff. CONCLUSION There was a wide variability in TA practice in India and a dedicated training program for all categories of staff was emphasised by majority of participants.
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Affiliation(s)
- Vijay Kumawat
- Transfusion Medicine & Haematology, NIMHANS, Bengaluru, India
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Rajput S, Makroo RN, Chowdhry M, Thakur UK. Changes in hematological parameters post plateletpheresis: Single center study from North India. Transfus Apher Sci 2021; 60:103283. [PMID: 34625349 DOI: 10.1016/j.transci.2021.103283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/01/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Increasing demand for platelet transfusion implies the need to recruit greater numbers of donors. We planned this study to evaluate donor safety issues with regards to changes in hematological values after plateletpheresis to improve donor safety and satisfaction. MATERIALS & METHODS The study was conducted on 1000 healthy plateletpheresis donors over a period of 24 months. Pre- and post-apheresis hematological parameters of donors were analyzed. Recovery of platelet was also observed in plateletpheresis donor who returned to after 48 h. RESULT We observed that the Platelet counts decreased significantly in the plateletpheresis donors (p=<0.001) after each procedure and there was a non-significant decline in Hb (p = 0.34), Hct (p = 0.44) and RBCs (p = 0.08). The hematological changes were within the normal limits with no clinical evidence of anemia or thrombocytopenia. Recovery of platelets in plateletpheresis donors after 48 h was observed in 30 donors (0.03 %). CONCLUSION A significant immediate post procedure decrease in platelet count was observed in our study but the recovery of platelets was adequate suggesting next platelet collection from the donor can be safely done after a period of 48 h.
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Affiliation(s)
- Saroj Rajput
- Department of Transfusion Medicine, Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospital, Delhi-Mathura Road, Sarita Vihar, New Delhi, 110076, India.
| | - Raj Nath Makroo
- Department of Transfusion Medicine, Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospital, Delhi-Mathura Road, Sarita Vihar, New Delhi, 110076, India
| | - Mohit Chowdhry
- Department of Transfusion Medicine, Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospital, Delhi-Mathura Road, Sarita Vihar, New Delhi, 110076, India
| | - Uday K Thakur
- Department of Transfusion Medicine, Molecular Biology and Transplant Immunology, Indraprastha Apollo Hospital, Delhi-Mathura Road, Sarita Vihar, New Delhi, 110076, India
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Chegini A, Moghadami M, Maghary AH. Therapeutic Plasma Exchange in Tehran Between 2011 and 2014. Ther Apher Dial 2019; 24:230-234. [PMID: 31177634 DOI: 10.1111/1744-9987.12864] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 06/04/2019] [Accepted: 06/06/2019] [Indexed: 12/28/2022]
Abstract
The goal of therapeutic plasma exchange (TPE) is to remove autoantibodies, pathogenic molecules, immune complexes, toxins, high concentration lipoproteins, and pathological proteins. We aimed to present the most common indication of TPE and rate of admission to the intensive care unit. From 2011 to 2014, our retrospective study was conducted including 1069 inpatients from the Tehran Blood Transfusion Center, which was responsible for performing therapeutic apheresis in all 122 hospitals of Tehran. The patients, based on their TPE indication, were classified into five groups: hematological and oncological, neurological, renal, rheumatological diseases, and all the remaining diseases. We performed 6329 procedures of TPE on 1069 inpatients. Of the patients, 479 (44.8%) were male and 590 (55.2%) female. Their age varied from a minimum of 2 years to the maximum of 93 years. Overall, the mean of TPE sessions for each patient was 5.92 ± 3.9; 415 (38.8%) patients were admitted to the intensive care unit (ICU). ASFA categories I/II indications were considered an appropriate request for TPE, and 82.97% (887) of all TPE were suitable. The most frequent categories of TPE indications are as follows: neurological, hematological, and renal diseases. Class I/II indications in the neurological diseases, myasthenia gravis (21.7%), Guillain-Barré disease (21%), and multiple sclerosis (13.3%), were the most prevalent. In the hematological category, thrombotic thrombocytopenic purpura (TTP) (14.1%) was observed to be greater than the other indications. We observed that the most prevalent illnesses are neurological (myasthenia gravis), hematological (TTP), and renal.
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Affiliation(s)
- Azita Chegini
- Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran
| | - Mehran Moghadami
- Apheresis Department, Tehran Blood Transfusion Center, Tehran, Iran
| | - Amir H Maghary
- Department of Biostatistics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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De Silvestro G, Tison T, Colpo A, Marson P. The Italian Register of therapeutic apheresis: How it has grown, how it has changed. Transfus Apher Sci 2019; 58:281-286. [DOI: 10.1016/j.transci.2019.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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De Silvestro G, Bagatella P, Vicarioto M, Tison T, Marson P. The Italian Sidem Registry for Apheresis: An Overview of the 2005 Statistics. Int J Artif Organs 2018; 31:354-62. [DOI: 10.1177/039139880803100413] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Data collection on apheresis activities in Italy throughout 2005 including techniques, types of blood cell separators, clinical indications and adverse effects was performed by means of a standardized questionnaire. These data provided by 83 Apheresis Units from 16 Italian regions, albeit rough, are sufficiently informative, mainly in comparison with previous surveys on these statistics (1997 and 2000). In 2005 a total number of 204,746 apheresis procedures were carried out, with a clear-cut prevalence of apheresis production (87.7%), performed by 66 out of 83 Apheresis Units (79.5). Lombardy, Veneto and Tuscany were the most active regions for therapeutic apheresis (51.1% of the total national procedures). An increasing number in extracorporeal photochemotherapy as compared to the 2000 national survey (3,386 vs. 704 procedures) is the most striking observation to emerge from the 2005 data collection on therapeutic apheresis in Italy. Adverse effects, predominantly mild ones (i.e., paresthesia due to citrate-induced hypocalcemia), occurred in 0.12% of apheresis production and 6.04 of therapeutic sessions, particularly in the course of peripheral blood stem cell collection (20.79%), as already reported in the 2000 national survey.
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Affiliation(s)
- G. De Silvestro
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua - Italy
| | - P. Bagatella
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua - Italy
- Venetian Institute of Oncology, Venice - Italy
| | - M. Vicarioto
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua - Italy
| | - T. Tison
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua - Italy
| | - P. Marson
- Apheresis Unit, Blood Transfusion Service, University Hospital of Padua, Padua - Italy
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Kim DK, Kim S, Jeong SH, Kim HO, Kim HJ. Therapeutic plasma exchange using the Spectra Optia cell separator compared with the COBE Spectra. Ann Lab Med 2016. [PMID: 26206687 PMCID: PMC4510503 DOI: 10.3343/alm.2015.35.5.506] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The Spectra Optia (SPO) is a novel continuous-flow centrifugal apheresis system based on the COBE Spectra (CSP) platform. There have been few attempts to validate the advantages of the SPO. We performed a retrospective study comparing the two cell separators for therapeutic plasma exchange (TPE) procedures in kidney transplant (KT) patients and seeing efficacy and safety. Methods We analyzed 720 TPE procedures performed between August 2012 and July 2014. Procedures included desensitization TPE before KT and TPE for the management of acute and chronic antibody-mediated graft rejection. Demographic characteristics, operational TPE variables, and laboratory data were analyzed. Results Demographic characteristics for the SPO (n=389) and CSP (n=331) groups did not differ significantly. The procedure time to exchange one plasma volume was 94.2±10.3 min in the SPO group and 100.4±11.2 min in the CSP group (P<0.001). The plasma removal efficiency (PRE) was 92.5±4.9% in the SPO group and 83.2±3.7% in the CSP group (P<0.001). There were no significant differences across the two apheresis systems for changes in hematologic parameters. Conclusions Compared with the CSP, the SPO was associated with an improved PRE and a shorter procedure time to exchange one plasma volume. Our results in KT patients show that the SPO is superior to the CSP in TPE procedures.
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Affiliation(s)
- Do Kyun Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sinyoung Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Ok Kim
- Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyung Jik Kim
- Department of Internal Medicine and Kidney Research Institute, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
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Arora D, Garg K, Kaushik A, Sharma R, Rawat DS, Mandal AK. A Retrospective Analysis of Apheresis Donor Deferral and Adverse Reactions at a Tertiary Care Centre in India. J Clin Diagn Res 2016; 10:EC22-EC24. [PMID: 28050376 PMCID: PMC5198329 DOI: 10.7860/jcdr/2016/20707.8925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/24/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION With increasing demand of platelet component each day, blood bank plays a pivotal role in ensuring supply of safe blood as and when required. Plateletpheresis procedure is a relatively simple, safe and important adjunct to blood bank inventory. However, recruitment of healthy blood donors is a challenge that the health industry is facing today. AIM To determine the reasons and rates of apheresis donor deferral along with investigation of adverse reactions encountered during the procedure. MATERIALS AND METHODS Records of single donor apheresis were retrospectively analysed from 1st January 2010 to 31st December 2014. The study was carried out at Blood Bank, Safdarjung Hospital, New Delhi, India. The donor details that were studied included - age, sex, type of donation (voluntary/replacement/ repeat), reason for donor deferral and type of adverse reaction, if encountered during the procedure. RESULTS Among the 478 donors screened for plateletpheresis procedure during a study period of 5 years, 134 (28.03%) were deferred. Temporary deferrals accounted for majority (93.28%) of the deferrals. Low platelet count (50.75%) was the main reason of donor deferral followed by low haemoglobin (20.89%). Amongst the 344 selected donors, 15 (4.36%) had some type of adverse reaction associated with the procedure. CONCLUSION We suggest that the selection criteria for plateletpheresis donors should be revised to deal with shortage of apheresis donors. The criteria regarding minimum pre-procedure platelet count (above1.5 lac/μl) and haemoglobin (above 12.5 g/dl) need to be lowered so as to suit the Indian scenario. The lower adverse reaction rates, 14/344 (4.06%) associated with this procedure encourages safety of donors and is important in recruitment of new donors.
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Affiliation(s)
- Disha Arora
- Ex-Senior Resident, Department of Pathology, Safdarjung Hospital, Delhi, India
| | - Ketan Garg
- Senior Resident, Department of Pathology, Safdarjung Hospital, Delhi, India
| | - Ankit Kaushik
- Senior Resident, Department of Pathology, Safdarjung Hospital, Delhi, India
| | - Richa Sharma
- Senior Resident, Department of Pathology, Safdarjung Hospital, Delhi, India
| | - DS Rawat
- Ex-Associate Professor and Head of Blood Bank, Department of Pathology, Safdarjung Hospital, Delhi, India
| | - AK Mandal
- Professor and Head, Department of Pathology, Safdarjung Hospital, Delhi, India
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Li QY, Yu F, Zhou FD, Zhao MH. Plasmapheresis Is Associated With Better Renal Outcomes in Lupus Nephritis Patients With Thrombotic Microangiopathy: A Case Series Study. Medicine (Baltimore) 2016; 95:e3595. [PMID: 27149490 PMCID: PMC4863807 DOI: 10.1097/md.0000000000003595] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to evaluate the efficacy of plasmapheresis in patients with lupus nephritis-combined thrombotic microangiopathy (TMA) in a Chinese cohort.Clinical and therapeutic data of patients with lupus nephritis-combined TMA were collected retrospectively. A comparison between those with and without plasmapheresis was performed.Seventy patients with renal biopsy-proven TMA in lupus nephritis were treated with conventional combined corticosteroid and immunosuppressive agents as induction therapy, 9 of the 70 patients received additional plasmapheresis. The plasmapheresis group presented with more severe SLE and renal activity indices, including a significant higher ratio of neurologic disorder (P = 0.025), lower level of platelet count (P = 0.009), higher value of serum creatinine (P = 0.038), higher percentage of anti-cardiolipin antibodies positive (P = 0.001), and higher Systemic Lupus Erythematosus Disease Activity Index scores (P = 0.012), than that of the nonplasmapheresis group. However, the plasmapheresis group had a significant higher rate of remission and a lower ratio of treatment failure than that of the nonplasmapheresis group (P = 0.03). As the baseline data were significantly different between the 2 groups, the propensity score match was further designed to avoid retrospective bias. After re-analysis, the plasmapheresis group still had a significant higher rate of remission and a lower ratio of treatment failure than that of the nonplasmapheresis group (P = 0.018). More importantly, the plasmapheresis group had significant less composite endpoints than that of the nonplasmapheresis group (P = 0.005).Our study suggested that additional plasmapheresis on conventional induction therapy may benefit patients with lupus nephritis-combined TMA, which warrants further explorations.
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Affiliation(s)
- Qiu-Yu Li
- From the Department of Medicine, Renal Division, Peking University First Hospital; Institute of Nephrology, Peking University; Key laboratory of Renal Disease, Ministry of Health of China; Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China (Q-YL, FY, F-DZ, M-HZ); Department of Nephrology, Peking University International Hospital (FY); and Peking-Tsinghua Center for Life Sciences, Beijing, PR China (M-HZ)
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Siti Nadiah AK, Nor Asiah M, Nur Syimah AT, Normi M, Anza E, Aini AN, Mohd Zahari TH, Shahnaz M, Faraizah AK, Faisal MA. Effects of plateletpheresis on blood coagulation parameters in healthy donors at National Blood Centre, Kuala Lumpur, Malaysia. Transfus Apher Sci 2013; 49:507-10. [PMID: 24055412 DOI: 10.1016/j.transci.2013.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Revised: 08/01/2013] [Accepted: 08/12/2013] [Indexed: 10/26/2022]
Abstract
Plateletpheresis is a method used to remove platelet from the body either from random volunteer donors, patient's family members or HLA matched donors. A cross sectional study was carried out on 59 plateletpheresis donors aged between 18 and 55 years at National Blood Center (NBC), Kuala Lumpur. We compared the blood parameters before and after plateletpheresis and we found that the platelet count, FVIII, fibrinogen and thrombophilia markers anti-thrombin (AT), protein C and protein S were significantly reduced (p<0.05) with prolonged PT and APTT. There were significant changes in blood coagulation parameters but it is within acceptable range.
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Affiliation(s)
- A K Siti Nadiah
- Advanced Medical and Dental Institute (AMDI), Universiti Sains Malaysia, Pulau Pinang, Malaysia; National Blood Centre, Kuala Lumpur, Malaysia
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Therapeutic plasma-exchange in hematologic disease: Results from a single center in Eastern Anatolia. Transfus Apher Sci 2013; 48:335-9. [DOI: 10.1016/j.transci.2013.04.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Stefanutti C, Morozzi C, Di Giacomo S. Italian multicenter study on low-density lipoprotein apheresis Working Group 2009 survey. Ther Apher Dial 2013; 17:169-78. [PMID: 23551673 DOI: 10.1111/j.1744-9987.2012.01142.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
We present results of the second survey of the Italian Multicenter Study on Low-Density Lipoprotein Apheresis (IMSLDLa-WG/2). The study involved 18 centers in 2009, treating 66 males and 35 females, mean age 47 ± 18 years. Mean age for initiation of drug treatment before low-density lipoprotein apheresis (LDLa) was 31 ± 18 years, mean age to the first LDLa was 37 ± 20 years and average duration of treatment was 9 ± 6 years. The techniques used included direct adsorption of lipids, dextran sulfate cellulose adsorption, heparin-mediated low-density lipoprotein (LDL) precipitation, cascade filtration, and plasma exchange. The mean treated plasma/blood volumes/session were 3127 ± 518 mL and 8666 ± 1384 mL, respectively. The average plasma volume substituted was 3500 ± 300 mL. Lipid therapy before LDLa included ezetimibe, statins, ω-3 fatty acids and fenofibrate. Baseline mean LDL cholesterol (LDLC) levels were 386 ± 223 mg/dL. The mean before/after apheresis LDLC level decreased by 67% from 250 ± 108 mg/dL (P = 0.05 vs. baseline) to 83 ± 37 mg/dL (P = 0.001 vs. before). Baseline mean Lipoprotein(a) [Lp(a)] level was 179 ± 136 mg/dL. Mean before/after apheresis Lp(a) level decreased by 71% from 133 ± 120 mg/dL (P = 0.05 vs. baseline) to 39 ± 44 mg/dL (P = 0.001 vs. before). Major and minor side effects occurred in 27 and 62 patients, respectively. Among patients with coronary artery disease (CAD), 62.3% had coronary angiography and 50.4% coronary revascularization before LDLa. Single vessel, double vessel and triple vessel CAD occurred in 19 (30.1%), 15 (23.8%) and 29 (46%) patients, respectively. Both CAD and extra-CAD occurred in 41.5%, 39% had hypertension, 9.9% were smokers, 9.9% consumed alcohol and 42% were physically active. Ischemic cardiovascular events were not observed in any patient over 9 ± 6 years of treatment. Two centers have also treated 34 patients (females: 17/males 17; no. sessions: 36; average plasma volume treated: 3000 mL) for sudden hearing loss (SHL). Relief of symptoms was obtained, independently of the system used (HELP; cascade-filtration).
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Affiliation(s)
- Claudia Stefanutti
- Department of Immunohematology and Transfusion Medicine, Extracorporeal Therapeutic Techniques Unit, University of Rome La Sapienza, Rome, Italy.
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Kadikoylu G, Yavasoglu I, Ozkul A, Akyol A, Yukselen V, Guney E, Bolaman Z. The single center registry for therapeutic apheresis in Turkey: 11-year activity. Transfus Apher Sci 2012; 47:61-5. [DOI: 10.1016/j.transci.2012.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Donmez A, Arik B, Tombuloglu M, Cagirgan S. Risk factors for adverse events during collection of peripheral blood stem cells. Transfus Apher Sci 2011; 45:13-6. [DOI: 10.1016/j.transci.2011.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Patient tolerance regarding different low-density lipoprotein apheresis columns: Frequent minor side effects and high patient satisfaction. J Clin Lipidol 2011; 5:45-9. [DOI: 10.1016/j.jacl.2010.11.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 10/17/2010] [Accepted: 11/09/2010] [Indexed: 11/17/2022]
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Stefanutti C. Italian Multicenter Study on Low-Density Lipoprotein Apheresis: Retrospective Analysis (2007). Ther Apher Dial 2010; 14:79-86. [DOI: 10.1111/j.1744-9987.2009.00704.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Malchesky PS, Koo AP, Skibinski CI, Hadsell AT, Rybicki LA. Apheresis Technologies and Clinical Applications: The 2007 International Apheresis Registry. Ther Apher Dial 2010; 14:52-73. [DOI: 10.1111/j.1744-9987.2009.00716.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tormey CA, Peddinghaus ME, Erickson M, King KE, Cushing MM, Bill J, Goodrich T, Snyder EL. Improved plasma removal efficiency for therapeutic plasma exchange using a new apheresis platform. Transfusion 2009; 50:471-7. [PMID: 19804570 DOI: 10.1111/j.1537-2995.2009.02412.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Spectra Optia (SPO; CaridianBCT) is a new apheresis device based on the COBE Spectra (CSP; CaridianBCT) platform. This study was designed to evaluate the safety and efficiency of the SPO in comparison to the predicate CSP device. STUDY DESIGN AND METHODS Twenty patients were recruited for a randomized, nonblinded, paired (crossover) clinical trial comparing the SPO to the CSP (pivotal trial). The primary outcome measure was plasma removal efficiency (PRE); secondary outcomes included platelet (PLT) content and hemolysis in the waste plasma, changes in patient cellular counts, patient coagulation and complement cascade activation, accuracy of machine fluid balance measurement, and review of significant adverse events (SAEs). RESULTS Overall SPO demonstrated 87% PRE with 1.0% PLT loss; these variables were statistically different from CSP (79 and 3.0%, respectively). The accuracy of anticoagulant usage, plasma removal, and fluid replacement as measured by the SPO fluid pumps was 97% or more; fluid balance was within 2% of the measured value. After apheresis there were no statistical changes in patient cellular counts with respect to the initial values. Patient d-dimer and prothrombin fragment 1.2 assays showed no activation of the coagulation system with either device. Measurement of patient C3a, C5a, and plasma free hemoglobin showed no significant differences between the SPO and the CSP. No SAEs were reported. CONCLUSION The SPO has improved performance characteristics over the CSP. Based on our results, the SPO is acceptable for use in therapeutic plasma exchange programs.
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Affiliation(s)
- Christopher A Tormey
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
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Bláha M, Pták J, Čáp J, Ceeová V, Mašín V, Filip S, Blažek M. WAA apheresis registry in the Czech Republic: Two centers experience. Transfus Apher Sci 2009; 41:27-31. [DOI: 10.1016/j.transci.2009.05.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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De Silvestro G, Tison T, Vicarioto M, Bagatella P, Stefanutti C, Marson P. The Italian registry of pediatric therapeutic apheresis: A report on activity during 2005. J Clin Apher 2009; 24:1-5. [DOI: 10.1002/jca.20184] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
OBJECTIVES Seventy-five centers from many countries have applied for a login code to the WAA apheresis registry. Fifteen centers from 7 countries have been actively entering data at the internet site from 2003 until 2007. We report on data from the registry so far. METHODS This is a web-based registry. A link is available from the WAA homepage (www.worldapheresis.org). So far data from 2013 patients (12,448 procedures) have been included. A median of 6 treatments have been performed (range 1-140). Mean age 51 years (range 1-94 years; 45% women). Seven percent of the patients were < or = 21 years and 4% were < or = 16 years. RESULTS The purpose of the apheresis procedure was therapeutic in 67% and retrieval of blood components in 33%. Main indications: neurological and hematological diseases, lipid apheresis and stemcell collection (autologous, and some allogeneic). Blood access: peripheral vessels (71%), central dialysis catheter through jugular (6.5%) or subclavian veins (6.7%), femoral vein (8%) and AV fistula (4%). ACD was used for anticoagulation in 73% of the procedures. Albumin was mainly used as replacement fluid. Adverse events (AE) were registered in 5.7% of the procedures. AE was graded as mild (2.5%), moderate (2.7%) or severe (0.5%). No death occurred due to treatment. The procedures were interrupted in 2.6%. Most frequent AEs were blood access problems (29%), tingling around the mouth (20%), hypotension (18%), and urticaria (9%). There were significant differences between the centers regarding mild and moderate AEs. Data indicate that centers using continuous infusion of calcium had fewer AEs. CONCLUSION There was a limited number of severe AEs. Centers use various standard procedures for apheresis. By learning from the experience of others the treatment quality will improve further. In the near future, an update of the registry will enable more extensive evaluation of the data.
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Witt V, Stegmayr B, Ptak J, Wikström B, Berlin G, Axelsson CG, Griskevicius A, Centoni PE, Liumbruno GM, Molfettini P, Audzijoniene J, Mokvist K, Sojka BN, Norda R, Ramlow W, Blaha M, Evergren M, Tomaz J. World apheresis registry data from 2003 to 2007, the pediatric and adolescent side of the registry. Transfus Apher Sci 2008; 39:255-60. [PMID: 19010084 DOI: 10.1016/j.transci.2008.09.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVES Paediatric patients are a special group in apheresis. It is general accepted to use adult indications in paediatric patients, but data in this age group are rare. In order to provide more information of apheresis practise in children and young adults (<21a) we will report of knowledge learnt by data from the registry from 2003 until 2007. METHODS This is a web-based registry. A link is available from the WAA homepage (www.worldapheresis.org). So far data from 12,448 procedures have been included. Six hundred and twelve procedures were performed in 135 children and young adults (308 procedures<16a, 237 from 17 to 20a, and 67 with 21a) representing 5% of the total population. The median age was 14 years (range 1-21 years), 74 male and 61 female. These data were entered by 15 centres with a frequency of in median 18 aphereses in young patients per centre (range 1-287) from 2003 to 2007. RESULTS Main indications: haematological diseases and also nephrological, and neurological. The type of aphereses was mainly Leukapheresis (196, 33%), plasma exchange (149, 25%), photopheresis (127, 21%), and lipid aphereses (79, 13%). Blood access: peripheral vessels in 305 procedures (50%, compared to 73% in adults), central venous catheter in 239 (38%), and AV-fistula in 2% and 0.3%, and in 8 (1.31%) procedures an arterial line was used. Anticoagulation was mostly by ACD (71%), heparin (18% or the combination of both (3%). 39 adverse events (AE) were registered in 22 (=3.59%) of the procedures, mostly graded as mild. Treatment was interrupted in 14 procedures (2.29%). AE's were abdominal pain, anaphylactic shock, flush, hyper- and hypotension, nausea, vertigo, cephalea and need for sedation and technical problems with the device and problems with the venous access. The rate of AE's was similar for stem cell harvesting and for plasma exchange (4% and 4.7%, respectively). CONCLUSION The paediatric data compared to the whole registry data set are showing that aphereses are performed as safe in paediatrics as in adults. Centres are mostly handling only a few cases younger than 21. Therefore more exchange of information and experience in paediatric apheresis is warranted.
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Lu Q, Nedelcu E, Ziman A, Bumerts P, Fernando L, Schiller G. Standardized protocol to identify high-risk patients undergoing therapeutic apheresis procedures. J Clin Apher 2008; 23:111-5. [PMID: 18521857 DOI: 10.1002/jca.20167] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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.
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Affiliation(s)
- Qun Lu
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-1732, USA. qunlu@mednet. ucla.edu
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Malchesky PS, Koo AP, Roberson GA, Hadsell AT, Rybicki LA. Apheresis Technologies and Clinical Applications: The 2005 International Apheresis Registry. Ther Apher Dial 2007; 11:341-62. [PMID: 17845394 DOI: 10.1111/j.1744-9987.2007.00507.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The developments in apheresis technologies and techniques and their clinical applications worldwide are technologically, sociologically, and economically motivated. In past apheresis surveys the statistics have highlighted both the differences by geographic region in clinical practice and in the types of technologies utilized. While a national view of apheresis is very important, an international view may be more representative overall of this therapeutic modality than national results that are highly dependent on the local economics and the available technologies. These regional differences have provided a basis for scientific and clinical assessment of these apheresis technologies and their clinical outcomes, and have impacted the marketing and business developments of new technologies worldwide. The results of the International Apheresis Registry for 2005 reporting from 22 centers on 5 continents are presented. The survey collected data exclusively via a secure internet website on 1133 patients for a total of 6501 treatments. Unlike our prior registries, information on stem cell infusions was gathered. Information gathered included patient demographics, medical history, treatment diagnoses, treatment specifics (type, methodology, access type, anticoagulants, drugs, and equipment usage), side-effects, clinical response, and payment provider. As in the prior International Apheresis Registries for 1983, 2000, and 2002 the survey results highlight the regional differences in apheresis usage and treatment methodologies, indicating that an international overview of apheresis may be more representative of the impact of this therapeutic modality.
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Affiliation(s)
- Paul S Malchesky
- The International Center for Artificial Organs and Transplantation, Painesville, OH, USA.
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Yavasoglu I, Kadikoylu G, Akyol A, Bolaman Z. Therapeutic apheresis: Results from a single center in Turkey. Transfus Apher Sci 2007; 36:249-53. [PMID: 17556022 DOI: 10.1016/j.transci.2007.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2006] [Revised: 01/12/2007] [Accepted: 02/12/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Therapeutic apheresis (TA) is carried out for a broad spectrum of diseases and syndromes. AIM We retrospectively evaluated the results of therapeutic apheresis (TA) including plasma exchange, therapeutic plateletpheresis, and leukapheresis during 2000-2006. METHODS A total of 195 procedures were performed in 44 patients (25 male and 19 female, with a mean age of 52+/-15 years). These procedures consist of 165 plasma exchanges, 20 therapeutic plateletpheresis, and 10 leukapheresis. The most common indications were hematological, neurological, and metabolic diseases. Eighty-three percent of plasma exchange, 100% of plateletpheresis and leukapheresis belonged to indication Category I or II, according to the guidelines of the American Society for Apheresis. RESULTS While hemoglobin levels significantly increased (p<0.05), platelet counts decreased (p<0.005) after plasma exchange. Hematological parameters did not statistically change significantly with leukapheresis (p>0.05). Platelet counts significantly decreased with plateletpheresis (p<0.001). Total complications were detected in 21% of the procedures. Adverse events (AE) were seen in 17% of the procedures. None of the patients died (Grade-IV) from any complication. AEs occurred in 14% (Grade-I), 1% (Grade-II), and 2% (Grade-III) of the procedures. The most common AEs were nausea/vomiting, hypotension, and abdominal pain. CONCLUSION TA, an important procedure in Transfusion Medicine, is safely carried out in our center in several hematological, neurological, and metabolic diseases which are similar to previous reports.
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Affiliation(s)
- Irfan Yavasoglu
- Adnan Menderes University Medical Faculty, Divisions of Hematology, 09100 Aydin, Turkey.
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Enein AA, Hussein EA, El Shafie S, Hallouda M. Factors affecting platelet yield and their impact on the platelet increment of patients receiving single donor PLT transfusion. J Clin Apher 2007; 22:5-9. [PMID: 17266120 DOI: 10.1002/jca.20116] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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+/-26.3x10(11). Donors with Hb>or=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.
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Affiliation(s)
- A Aboul Enein
- Department of Hematology, Cairo University, Cairo, Egypt
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27
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Maurício R, de Sousa G, Seghatchian J. What’s happening: An overview of potential adverse reactions associated with apheresis technology. Transfus Apher Sci 2005; 33:351-6. [PMID: 16226918 DOI: 10.1016/j.transci.2005.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2005] [Accepted: 08/16/2005] [Indexed: 11/25/2022]
Abstract
The current status of potential adverse reactions associated with the use of apheresis technology is reviewed, focussing on three main areas: adverse events related to component collection, progenitor cells collection and therapeutic apheresis. Based on available information it is believed that apheresis technologies are safe and increasingly used in transfusion medicine, including in auto-transfusion and different types of therapy. Occasionally, however, for various donor/patient and operational reasons, mild or moderate adverse reactions do occur. The majority of these reactions are related to vascular access and anticoagulants used, which can be mostly eliminated with calcium/magnesium administration. The reactions associated with therapeutic apheresis are more frequent (6.75%) than the multi-components and stem cell collections. Most of these reactions are generally mild and only 0.89% has been classified as severe. A national registry of donor adverse reactions as well as a planned haemovigilance system may prove helpful in identifying the potential causes which might be associated with either to donor/donation and/or with a particular technology or procedure.
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Affiliation(s)
- Ressurreição Maurício
- Lisbon Regional Blood Centre, Portuguese Blood Institute, Parque da Saúde, Av. Brasil, No. 53 Pav. 17, 1749-005 Lisboa, Portugal.
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Valbonesi M, Carlier P, Giannini G, Ruzzenenti MR. Rheotherapy for Vascular Disorders. Int J Artif Organs 2005; 28:1012-7. [PMID: 16288439 DOI: 10.1177/039139880502801008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with vascular disorders are seldom offered apheresis in the management of their symptoms. In this article we review the different apheretical techniques used in these situations.
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Affiliation(s)
- M Valbonesi
- Department of Immunohematology, Immunohematology Services, S. Martino University Hospital, Genova--Italy
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Passalacqua S, Staffolani E, Busnach G, Roccatello D, Pasquali S, Cappelli P, Liuzzo G. The Italian Registry for Therapeutic Apheresis. A report from the Apheresis Study Group of the Italian Society of Nephrology. J Clin Apher 2005; 20:101-6. [PMID: 15880354 DOI: 10.1002/jca.20037] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Many clinical indications and different technical issues have been reported on therapeutic apheresis: much criticism has also been recorded in several instances, mainly due to the lack of large clinical trials to validate collected data. A Registry where all the available data can be organized and analyzed therefore becomes a priority for all the professionals involved in apheresis. The purpose of this report is to describe the data submitted from 1994 to 2004 from 15,285 treatments on 1,477 patients from 44 Centers, including mainly, but not exclusively, Nephrological Units, collected by the Apheresis Study Group of the Italian Society of Nephrology in 15 Italian regions. Plasma exchange accounted for 56.2% of the procedures, and of these 50.4% were performed by filtration. Plasma treatment was used in 40.1% of procedures, namely with Protein A immunoadsorption (14.6%), LDL-Cholesterol dextran sulfate adsorption (9.7%), and semiselective cascade or double filtration (12.6%). Cell apheresis, limited to photopheresis, was used in 0.85% of cases, and whole blood treatment (direct adsorption lipoprotein, and molecular adsorption recirculating system) in 2.7%. The procedures analyzed here account for less than 20% of estimated therapeutic apheresis performed in Italy, according to the national survey of activity performed for year 2000 by the Italian Apheresis Society. Notwithstanding that the data are largely incomplete, they are sufficiently informative for a definite trend: plasma treatment with filtration on fractionation filters and adsorption must be used as often as possible, instead of plasma exchange, thus obtaining the most selective removals.
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Moog R. Apheresis techniques for collection of peripheral blood progenitor cells. Transfus Apher Sci 2004; 31:207-20. [PMID: 15556469 DOI: 10.1016/j.transci.2004.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2004] [Accepted: 07/01/2004] [Indexed: 11/19/2022]
Abstract
The combination of effective mobilisation protocols and efficient use of apheresis machines has caused peripheral blood progenitor cells (PBPC) transplantation to grow rapidly. The development of apheresis technology has improved over the years. Today PBSC procedures have changed towards systems to minimise operator interaction and to reduce the collection of undesired cells such as polymorphonuclear cells and platelets using functionally closed, sterile environments for PBSC collection in keeping with Good Manufacturing Practice guidelines. Blood cell separators with continuous flow technique allow the processing of more blood than intermittent flow devices resulting in higher PBSC yields. Large volume leukapheresis with the processing of 3-4-fold donor's/patient's blood volume can increase the number of collected progenitor cells. Therefore, intermittent flow cell separators are indicated if only single vein access is available. Anticoagulant induced hypocalcaemia is an often observed side effect in long lasting PBPC harvesting and monitoring of electrolytes should be performed especially at the end of the apheresis procedure to supplement low levels of potassium, calcium or magnesium. Refinement and improvement of collection techniques continue to add to the armamentarium of current approaches for cancer and non-malignant conditions and will enable future strategies.
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Affiliation(s)
- Rainer Moog
- Institute for Transfusion Medicine, University Clinics Essen, Hufelandstrasse 55, Essen 45122, Germany.
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