Journal of Clinical Apheresis最新文献

Autologous stem cell transplant (ASCT) requires the collection of hematopoietic progenitor cells, commonly by apheresis (HPC-A). These CD34+ cells can be mobilized using Granulocyte Colony Stimulating Factor (G-CSF) only or chemomobilization plus G-CSF. Both methods may additionally include Plerixafor. The emergence of COVID-19 led to recommendations for preferential G-CSF only mobilization. To assess the impact of this recommendation on HPC-A harvesting, we analyzed data from the NHS Blood and Transplant Stem Cell Collection Registry for 1342 patients undergoing 2431 HPC-A procedures between 01/01/2019 and 31/12/2021. We compared G-CSF only, cyclophosphamide plus G-CSF (Cyclo-G) and G-CSF plus alternative chemotherapy (Chemo+G) mobilization. The outcomes collected were pre-apheresis CD34+ count, CD34+ yield per procedure, total CD34+ yield, number of apheresis procedures required to achieve the CD34+ target, mobilization failure, and Plerixafor use (+P). In multiple myeloma (MM), Cyclo-G (+/−P) mobilization produced significantly higher CD34+ yields than G-CSF only (7.44 vs. 4.75 × 10⁶/kg; p < 0.0001). In Hodgkin lymphoma (HL) there was no statistically significant difference between regimes (CD34+ yield 4.53 × 10⁶/kg with G-CSF only (+/−P), 5.52 × 10⁶/kg with Cyclo-G (+/−P), 4.32 × 10⁶/kg with Chemo+G (+/−P)). In Non-Hodgkin lymphoma (NHL), Chemo+G (+/−P) was the most successful regime (5.98 × 10⁶/kg vs. 3.7 × 10⁶/kg with G-CSF only (+/−P) vs. 3.69 × 10⁶/kg with Cyclo-G (+/−P); p < 0.00001). On demand Plerixafor use resulted in > 95% successful mobilization in MM and NHL. CD34+ yields are higher using Cyclo-G and Chemo+G in NHL. In MM, G-CSF only resulted in yields sufficient for at least one transplant. In HL, our data show no evidence to support the use of Cyclo-G over G-CSF only.

Solvent/detergent treated plasma (SD plasma) use in therapeutic plasma exchange (TPE) in pediatric patients is not commonly reported. This study aimed to determine transfusion reaction rates using SD plasma and to compare transfusion reaction rates and adverse events when using SD plasma versus untreated plasma in pediatric TPE. A retrospective review was performed on TPE procedures performed at a single institution over a 3-year period. For each TPE procedure, replacement fluid was determined at the discretion of the transfusion medicine physician, consisting of either 5% albumin, untreated plasma, SD plasma, or a combination of untreated or SD plasma with 5% albumin. SD plasma was used in 51 TPE procedures performed on 17 patients. In comparison, untreated plasma was used in 254 procedures in 68 patients. Patient ages ranged from 6 days to 20 years old. With SD plasma use, 1 procedure (2% incidence) reported a non-severe allergic transfusion reaction, compared to 9 procedures (3.5% incidence) with untreated plasma use. These transfusion reaction rates were not statistically different (p = 0.7036, two-tailed Fisher's exact test). Circuit clotting issues were reported in one patient during two discrete TPE procedures utilizing untreated plasma. No other transfusion reactions or adverse events were reported. SD plasma used for TPE was well tolerated, with transfusion reaction rates similar to those observed in untreated plasma in our pediatric patients. SD plasma may be used for TPE in pediatric patients without apparent increased procedure-related risks or increased risks of transfusion reactions compared to untreated plasma.

Apheresis nurses are well equipped with not only the critical thinking skills but also the important aspects of operating the apheresis machine. As the demand for advanced cellular therapies grew, there was a need to recruit and train more nurses to be competent in apheresis nursing. A new service model was evolved from a physician-led to a nurse-led apheresis service, which empowered the apheresis nurses to lead the service. Since the commencement of the nurse-led service, a total of 32 peripheral hematopoietic progenitor cells collections were documented, and the outcomes of the cell yield were tabulated to study the collection efficiency. Ninety-four percent of the targeted cell yield was achieved with no collections needing beyond 2 days of harvesting. No apheresis-related major adverse event was reported following the implementation of the new service model too.

Therapeutic plasma exchange (TPE) concurrently performed in critically ill pediatric patients with other extracorporeal circuits is a complex process. We sought to characterize tandem procedures, including patient demographics, primary diagnosis, American Society for Apheresis (ASFA) category indications, survival at 24 h and 30 days after completion, blood product utilization, and complications. A retrospective analysis of medical records was performed. Data were collected from July 2014 to January 2021 with institutional review board approval. Patients' demographics, blood product utilization, and adverse events data were collected. In addition, we performed a literature review to identify studies in the pediatric population that were similar in design to our study. Fifty patients underwent 262 procedures. The median age was 9 years, and median weight was 21 kg (42% of patients weighed less than 10 kg). The most frequent indications for plasma exchange included sepsis with multiorgan failure (11 patients) and multiorgan failure (9 patients). ASFA indication category III was the most common (42 patients), followed by uncategorized indications (6 patients). The most common adverse events were hypocalcemia, occurring in 120 (45%) procedures, hypotension in 25 (9.5%) procedures, and circuit clotting in 12 (4.5%) procedures. Citrate, heparin, and bivalirudin were used as anticoagulants. Thirty-nine (78%) patients survived 24 h, and 26 (52%) patients were alive 30 days after completion of tandem procedures. Despite the high level of complexity, tandem procedures can be performed efficiently and safely in critically ill children.

Allergic reactions to intravenous, alteplase have been reported, usually in doses utilized for thrombolysis. Alteplase is also widely used for clearance of occluded catheter lumens, but allergic reactions have not been reported for this route of administration. A 14-year-old patient with sickle cell disease presented with an occluded apheresis port. During alteplase dwell for port occlusion, he developed an initial reaction concerning for anaphylaxis prior to automated red cell exchange, resulting in hospitalization. Findings included angioedema to the tongue and lip as well as urticaria on his abdomen and over a previous port scar, which became warm and firm. Of note, the patient also has a history of severe atopy, uncontrolled eczema, asthma, allergic rhinitis, and elevated eosinophils. The patient was referred to allergy and a skin test to alteplase was negative. The patient underwent an alteplase challenge through his catheter where he experienced anaphylaxis. Despite appropriate treatment, he again required inpatient admission. Post reaction serum tryptase level was not elevated. A clear temporal relationship to alteplase exposure and subsequent allergic reaction was documented in this case. To our knowledge, this is the first reported case of allergic reaction to intraluminal alteplase used for clearance of an occluded apheresis port. The non-elevated tryptase level suggests a non-IgE mediated reaction. Allergic reaction to alteplase dwell for clearance of occluded lumens can occur and is an entity apheresis providers should be aware of. Additionally, traditional skin testing may not be entirely predictive of safety upon rechallenge.

To investigate the effect of different platelet (PLT) counts on the safety and efficacy of the double-plasma molecular absorption system (DPMAS) in patients with acute-on-chronic liver failure (ACLF). A total of 156 patients with ACLF receiving DPMAS were divided into the observed group (40 × 10⁹/L ≤ PLT < 50 × 10⁹/L) and the control group (PLT ≥ 50 × 10⁹/L) according to PLT count level. The safety and efficacy indices of bleeding-related complications, PLT reduction rate, total bilirubin (TBIL) reduction rate, and 28-days survival rate after DPMAS were analyzed and compared between the two groups. The incidence of bleeding complications during and after DPMAS in the observed and control groups (14.3% vs. 14.9%, p = 0.922), the decline rate of PLT immediately and 24 h after treatment (0.13 vs. 0.11/0.05 vs. 0.09, p = 0.256/0.161), and the 28-days survival rate after treatment (76.2% vs. 75.4%, p = 0.923) were not significantly different. The thromboelastogram before DPMAS showed no significant difference in PLT function between the two groups (p > 0.05). Although the TBIL level of the two groups rebounded 24 h after treatment compared with immediately after treatment, it decreased significantly immediately and 24 h after treatment compared with pre-treatment levels (p < 0.05). There was no significant difference in the rate of decline of serum TBIL immediately after treatment and 24 h after treatment between the two groups (0.33 vs. 0.35/0.14 vs. 0.16, p = 0.193 and 0.653, respectively). DPMAS is safe and effective in patients with ACLF with 40 × 10⁹/L ≤ PLT count < 50 × 10⁹/L.

Apheresis is essential to conducting hematopoietic cell transplantation and genetically engineered cellular therapy procedures. Many patients and donors require central venous catheter (CVC) access for apheresis due to lack of adequate peripheral venous access. CVC placement has risks of associated complications and requires additional institutional resources and expertise. We present a single institutional experience with 78 patients, who underwent a total of 87 apheresis procedures after placement of a midline catheter. This included 49 individuals who collected cells for immune effector cell therapy. Apheresis through midline catheter was successful in 81 out of 87 procedures. There were no midline catheter associated thromboses or infections. Six patients required placement of a backup CVC and were able to undergo apheresis without delay. Our experience shows that use of midline catheter for apheresis is feasible and generalizable to most populations requiring cellular therapy, with the potential to decrease utilization of limited healthcare resources.

ABO-incompatible transplantations are increasingly gaining relevance with advancements in therapeutic modalities, thus allowing patients to receive timely solid organ transplants. Therapeutic apheresis (TA) procedures remain instrumental as a preconditioning measure to enable such transplants. This survey was undertaken to find out current trends and practices of TA across major transplant centers in India. The survey was drafted by a working group of transfusion and transplant immunology specialists from six different centers in India. Data were obtained via the use of an online questionnaire. Results were categorized into eight categories: hospital information, range of titers for preconditioning, considerations prior to starting TA, TA procedure details, role of pharmacotherapy in TA, policy for reuse of columns, risk of rebound, and the role of transfusion medicine specialists. The survey highlighted the modalities as well as the methodologies of various TA procedures used across different major transplant centers in India. With the increase in ABO-incompatible kidney and liver transplants across the country, the role of transfusion medicine and transplant immunology specialists have become vital in preconditioning regimes enabling the viability and success of such transplants. This was a unique survey that provided us a snapshot of current trends and practices of TA in preconditioning of patients for ABO-incompatible transplants in India.

A knowledge gap exists between apheresis medicine (AM) physicians and providers who request the service, presenting challenges when coordinating care. We investigated an educational intervention consisting of a 40-min in-person evidence-based lecture for neurology residents, neurology attending physicians, and nephrology fellows. Pre−/post-testing demonstrated substantially improved understanding of apheresis mechanics, indications, complications, and patient consent. We advocate for more educational sessions about AM for the non-apheresis providers to increase awareness about apheresis and foster collaborative interdisciplinary efforts.