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Risks and methods for peripheral blood progenitor cell collection in small children
Julián Sevilla1, Miguel Angel Díaz, Sandra Fernández-Plaza
1Hospital Infantil Universitario Niño Jesús, Avd Menéndez Pelayo 65, Madrid 28009, Spain. jsevilla.hnjs@salud.madrid.org
Insights
Pediatric apheresis for peripheral blood progenitor cells (PBPC) is safe and effective for hematopoietic stem cell transplantation. Experienced teams can successfully collect sufficient PBPC, minimizing risks compared to traditional methods.
Area of Science:
- Pediatric Hematology
- Transplantation Medicine
- Apheresis Technology
Background:
- Peripheral blood progenitor cells (PBPC) are a key stem cell source for pediatric hematopoietic transplantation.
- Apheresis procedures in children, while technically similar to adults, raise concerns due to patient size and operator inexperience.
Purpose of the Study:
- To evaluate the safety and efficacy of pediatric apheresis for PBPC collection.
- To identify critical technical aspects and potential adverse events in pediatric apheresis.
Main Methods:
- Review of published series on pediatric apheresis procedures.
- Consideration of factors like extracorporeal circuit volume, blood flow rates, anticoagulation, and vascular access.
- Assessment of emotional stress and adverse events.
Main Results:
- Pediatric apheresis, when performed by experienced teams, is safe and yields adequate PBPC for transplantation.
- Key technical considerations include circuit volume, blood flow, anticoagulants, and vascular access.
- Adverse events are primarily related to vascular access or metabolic/hemodynamic changes, comparable to or lower than bone marrow harvesting.
Conclusions:
- Pediatric apheresis is a safe and effective method for collecting PBPC for hematopoietic transplantation.
- Careful management of technical aspects and patient-related factors ensures successful outcomes.
- The risks associated with pediatric apheresis are not greater than those of alternative procedures like bone marrow harvesting.
Abstract:
Peripheral blood progenitor cells (PBPC) are increasingly used as a source of stem cells for either autologous or allogeneic hematopoietic transplantation in children. Although technically similar to adult procedures, apheresis in small children worries some operators and physicians that have little experience in managing pediatric patients or donors. However several published series have showed that these procedures, when performed by experienced teams are safe and can obtain enough amount of PBPC for either autologous or allogeneic hematopoietic transplantation. Some technical aspects must be considered in pediatric apheresis due to the size of the patient/donor. Factors that must be evaluated are extracorporeal circuit volume, blood flow rates, type of anticoagulant and vascular access. Other important issue to be considered is the emotional stress for them and their relatives. Leukaphereses in children may be performed with any of the reported continuous blood cell separator without sedation. Adverse events are mainly related either to vascular access or to metabolic or hemodynamic changes. Anyway, taking all these complications together, they are not higher than those adverse events or toxicities reported after general anesthesia and bone marrow harvesting.
