Establishing an institutional therapeutic apheresis registry

Abstract

Apheresis was first performed as a therapeutic procedure in the 1950s. The first national therapeutic apheresis (TA) registry was established in Canada in 1981 and other national registries followed, including two attempts at establishing an international TA registry. There is no national registry in the United States. Our large, academic, tertiary hospital has a very active TA service. We created a TA database to track all procedures performed by the apheresis service by transferring data from paper appointment logs and the electronic medical records into a Microsoft Access database. Retrospective data from each TA procedure performed at UAB from January 1, 2003 through December 31, 2012 were entered, including the type of procedure, indication, date, and patient demographics. Microsoft Excel was used for data analysis. During the 10-year period, our TA service treated 1,060 patients and performed 11,718 procedures. Of these patients, 70% received therapeutic plasma exchange (TPE), 21% received extracorporeal photopheresis (ECP), 4.5% received red cell exchange (RCE), 4.2% received leukocytapheresis, and 0.6% underwent platelet depletion. Among the procedures, 54% were TPEs, 44% were ECPs, 1.3% were RCEs, 0.5% were leukocytaphereses, and 0.1% were platelet depletions. According to the current literature, national and international TA use is underreported. We believe that the UAB TA registry provides useful information about TA practices in our region and can serve as a model for other institutions. Furthermore, data from multiple institutional registries can be used for clinical research to increase the available evidence for the role of TA in various conditions. J. Clin. Apheresis 31:516-522, 2016. © 2015 Wiley Periodicals, Inc.

Vascular access for therapeutic plasma exchange

“…Among the different TA modalities, TPE was most often affected by vascular access difficulties at 0.5%, with many procedures having to be discontinued . This finding is not surprising, because TPE is one of the most commonly utilized TA procedures at many institutions, roughly comprising at least 70% of the total …”

“…Among therapeutic apheresis (TA) modalities, such as red blood cell exchange, leukocytapheresis, and extracorporeal photopheresis, TPE is the most commonly performed procedure in most institutions, perhaps with the exception of cancer centers. At the University of Alabama at Birmingham, TPE comprised 70% of the total number of TA procedures performed by the apheresis service from 2003 to 2012 . More recently, the number of annual TPEs from 2012 to 2016 at the University of Alabama at Birmingham was approximately 1200 procedures, which is a substantial increase from 544 TPEs performed in 2003 .…”

“…At the University of Alabama at Birmingham, TPE comprised 70% of the total number of TA procedures performed by the apheresis service from 2003 to 2012 . More recently, the number of annual TPEs from 2012 to 2016 at the University of Alabama at Birmingham was approximately 1200 procedures, which is a substantial increase from 544 TPEs performed in 2003 . The New York Blood Center, which performs apheresis for 95 hospitals in the New York metropolitan area, performed 76.8% of their total procedures (N = 7193) for therapeutic reasons rather than donor apheresis during 2011 and 2012 .…”

“…Unlike HD, which is lifelong unless a transplant occurs, most TPE treatment series are short and are based on clinical and/or laboratory parameters. For example, in a 10‐year review of a single‐institution experience, patients underwent a mean of seven TPE procedures . Conversely, more TPEs were required for the treatment of thrombotic thrombocytopenic purpura (TTP); the number varied widely from four to 21, with an average of 13 TPEs, in a publication by the Thrombotic Microangiopathy Registry of North America .…”

New subcutaneous PowerFlow port results in cost and time‐savings in a busy outpatient apheresis clinic

“…This study was prompted by our interest in cost and time efficiency in our busy outpatient apheresis service. 22 As most of our patients either have inadequate antecubital veins or do not wish to undergo repeated peripheral access attempts at each apheresis appointment, we often arrange for placement of a central venous access device. Though tunneled CVC are certainly an option for some patients, the risk of infection and the risk of accidental removal of the line is a concern.…”