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A safe therapeutic apheresis protocol in paediatric patients weighing 11 to 25 kg
R W Maitta1, L V Vasovic, K Mohandas
1Departments of Pathology, University Hospitals Case Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Insights
Apheresis procedures, including erythrocytapheresis and leukapheresis (LPE), are safe for small children weighing 11-25 kg. This study outlines a protocol for minimal complications in pediatric patients during these critical treatments.
Area of Science:
- Pediatric Hematology
- Apheresis Technology
- Critical Care Medicine
Background:
- Apheresis procedures like erythrocytapheresis and leukapheresis (LPE) are challenging in small children due to logistical complexities.
- Existing protocols are often adapted from larger patients, lacking specific guidance for pediatric populations.
- Sickle cell disease and leukemia emergencies in children necessitate prompt apheresis interventions.
Purpose of the Study:
- To evaluate the safety and efficacy of apheresis in children weighing 11-25 kg.
- To describe a protocol for performing apheresis in this pediatric cohort.
- To assess the incidence of complications associated with apheresis in small children.
Main Methods:
- Utilized the COBE® Spectra apheresis system for all procedures.
- Employed standard anticoagulant citrate dextrose A (ACDA) without specific hematocrit adjustments.
- Procedures were conducted in the pediatric intensive care unit by specialized nursing staff.
Main Results:
- Successfully performed 25 apheresis procedures on 19 pediatric patients (17 sickle cell, 2 leukemia).
- Patients remained hemodynamically stable during and after apheresis, with no need for intra-procedure medications.
- Achieved target hematocrit and hemoglobin A levels in sickle cell patients and significant leukocyte reduction in leukemia patients.
- One patient experienced a delayed hemolytic transfusion reaction post-erythrocytapheresis.
Conclusions:
- Apheresis is a safe and feasible procedure for children weighing 11-25 kg, with acceptable morbidity.
- The study provides a practical protocol for conducting apheresis in small children.
- This approach can be vital for managing pediatric hematological emergencies effectively.
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.
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