A safe therapeutic apheresis protocol in paediatric patients weighing 11 to 25 kg

R. W. Maitta, L. V. Vasovic, Kala Mohandas, L. Music-Aplenc, A. Bonzon-Adelson, Joan Uehlinger

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background and Objectives: Erythrocytapheresis and leukapheresis (LPE) of small children are logistically complex and many centres are reluctant to perform these procedures. In children, both sickle cell and leukaemic emergencies demand prompt action to prevent additional morbidity but detailed protocols for small children are lacking, and often are performed using guidelines shown to work in larger patients. We report a 3-year experience with children weighing 11-25 kg at a large academic medical centre. Materials and Methods: All patients were treated with the COBE® Spectra apheresis system; circuit was primed with blood not adjusted for haematocrit and anticoagulant citrate dextrose A was used as anticoagulation. Procedures were performed in the paediatric intensive care unit by apheresis nursing staff. Results: Twenty-five apheresis procedures in 19 patients were performed; 17 of 19 patients presented with sickle cell-related acute complications and two (2/19) with newly diagnosed acute leukaemia and hyperleucocytosis. None of the patients required medications during the procedures. Vital signs and clinical condition remained stable and did not worsen during or postapheresis. One patient had a delayed haemolytic transfusion reaction 1 week posterythrocytapheresis as he developed alloantibodies as a result of the procedure. All sickle cell patients achieved a target haematocrit of 21-30% and Haemoglobin A of ≥68%. Both leukaemia patients who underwent LPE had no further signs of leukostasis and achieved marked reductions in leucocyte counts. Conclusions: Apheresis of children weighing 11-25 kg can be safely performed without increased morbidity. We outline a protocol that can be used to perform apheresis with minimal complications.

Original languageEnglish (US)
Pages (from-to)375-380
Number of pages6
JournalVox Sanguinis
Volume107
Issue number4
DOIs
StatePublished - Nov 1 2014

Fingerprint

Blood Component Removal
Pediatrics
Leukapheresis
Therapeutics
Hematocrit
Leukemia
Leukostasis
Morbidity
Hemoglobin A
Isoantibodies
Pediatric Intensive Care Units
Vital Signs
Nursing Staff
Leukocyte Count
Citric Acid
Anticoagulants
Emergencies
Guidelines
Glucose

Keywords

  • Anticoagulant citrate dextrose A
  • Erythrocytapheresis
  • Leukapheresis
  • Paediatric

ASJC Scopus subject areas

  • Hematology
  • Medicine(all)

Cite this

A safe therapeutic apheresis protocol in paediatric patients weighing 11 to 25 kg. / Maitta, R. W.; Vasovic, L. V.; Mohandas, Kala; Music-Aplenc, L.; Bonzon-Adelson, A.; Uehlinger, Joan.

In: Vox Sanguinis, Vol. 107, No. 4, 01.11.2014, p. 375-380.

Research output: Contribution to journalArticle

Maitta, R. W. ; Vasovic, L. V. ; Mohandas, Kala ; Music-Aplenc, L. ; Bonzon-Adelson, A. ; Uehlinger, Joan. / A safe therapeutic apheresis protocol in paediatric patients weighing 11 to 25 kg. In: Vox Sanguinis. 2014 ; Vol. 107, No. 4. pp. 375-380.
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abstract = "Background and Objectives: Erythrocytapheresis and leukapheresis (LPE) of small children are logistically complex and many centres are reluctant to perform these procedures. In children, both sickle cell and leukaemic emergencies demand prompt action to prevent additional morbidity but detailed protocols for small children are lacking, and often are performed using guidelines shown to work in larger patients. We report a 3-year experience with children weighing 11-25 kg at a large academic medical centre. Materials and Methods: All patients were treated with the COBE{\circledR} Spectra apheresis system; circuit was primed with blood not adjusted for haematocrit and anticoagulant citrate dextrose A was used as anticoagulation. Procedures were performed in the paediatric intensive care unit by apheresis nursing staff. Results: Twenty-five apheresis procedures in 19 patients were performed; 17 of 19 patients presented with sickle cell-related acute complications and two (2/19) with newly diagnosed acute leukaemia and hyperleucocytosis. None of the patients required medications during the procedures. Vital signs and clinical condition remained stable and did not worsen during or postapheresis. One patient had a delayed haemolytic transfusion reaction 1 week posterythrocytapheresis as he developed alloantibodies as a result of the procedure. All sickle cell patients achieved a target haematocrit of 21-30{\%} and Haemoglobin A of ≥68{\%}. Both leukaemia patients who underwent LPE had no further signs of leukostasis and achieved marked reductions in leucocyte counts. Conclusions: Apheresis of children weighing 11-25 kg can be safely performed without increased morbidity. We outline a protocol that can be used to perform apheresis with minimal complications.",
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