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Safe and Efficient Extracorporeal Photopheresis in Patients with Pre-Procedure Hematocrit below 26
Andriana Pavlovich1, Faith Matthews1, Yamac Akgun1,2
1Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA USA.
Background:
Extracorporeal photopheresis (ECP) is widely used for graft-versus-host disease (GVHD), but manufacturer recommendations suggest maintaining a pre-procedure hematocrit (Hct) above 27%. This study evaluates the safety and efficacy of ECP performed at lower Hct levels.
Methods:
We retrospectively analyzed 13 ECP procedures in three male patients with GVHD, comparing sessions performed at Hct < 26% to those at Hct > 27%. Procedural parameters, hemodynamic stability, and adverse events were assessed.
Results:
All procedures at Hct < 26% were successfully completed without adverse reactions, vascular access issues, or significant hemodynamic changes. Average procedure duration was 97 min at Hct < 26% and 95 min at Hct > 27%, showing no significant impact on efficiency.
Conclusion:
ECP at Hct < 26% is safe and effective, reducing the need for transfusion while maintaining procedural integrity. These findings challenge current Hct thresholds and support more flexible patient selection criteria.
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