Investigation of heparin‐related hypotensive adverse events during photopheresis: utility of a patient care database

Abstract

This study demonstrated the value of a patient database listing lot numbers of all medications and components used in each routine ECP procedure for facilitating rapid determination of common patient exposures, making it easier to determine the cause of adverse events, in this case, a particular lot of heparin responsible for the hypotensive adverse events.

Impact of extracorporeal photopheresis on blood and coagulation parameters

“…The amount of heparin returned at the end of the first cycle of ECP can vary between patients, but is probably in the range of 1000-2000 USP units in a 2-min period. 1,18,19 To our best knowledge, evaluation of systemic coagulation parameters in ECP patients have not been reported in the literature. Based on these considerations, we assessed various coagulation parameters in patients who underwent ECP, but did not observe any significant changes over time.…”

“…In detail, the ECP method includes using small amounts of blood, which are treated with heparin as an anticoagulant, because the leukocytes (should be used consistently in the text…if it's better in American style with leucocytes pl use this consistently) re subsequently collected in 3-6 cycles. 1 At the end of each leukocyte collection cycle, an accumulation of blood (extracorporeal volume: 120-150 ml), with a reduced number of leukocytes, is reinfused from the ECP device into the peripheral circulation before preparing for the next cycle. When all cycles are completed, leucocytes are pretreated with 8-methoxypsoralen and then exposed to UV-A irradiation (corresponding to about 5% of all circulating cells).…”

“…Extracorporeal photopheresis (ECP) procedure involves three stages: (a) leukapheresis, (b) treatment of the collected buffy coat with the photosensitizer 8‐methoxypsoralen followed by UV‐A irradiation, (c) retransfusion of the treated buffy coat. In detail, the ECP method includes using small amounts of blood, which are treated with heparin as an anticoagulant, because the leukocytes (should be used consistently in the text…if it's better in American style with leucocytes pl use this consistently) re subsequently collected in 3–6 cycles 1 . At the end of each leukocyte collection cycle, an accumulation of blood (extracorporeal volume: 120–150 ml), with a reduced number of leukocytes, is reinfused from the ECP device into the peripheral circulation before preparing for the next cycle.…”

“…When all cycles are completed, leucocytes are pretreated with 8‐methoxypsoralen and then exposed to UV‐A irradiation (corresponding to about 5% of all circulating cells). Thereafter, leukocytes are reinfused into the patient 1 . Edelson et al introduced ECP in the early 80s 2 .…”

“…Thereafter, leukocytes are reinfused into the patient. 1 Edelson et al introduced ECP in the early 80s. 2 Although ECP was initially developed for patients with cutaneous T-cell lymphoma (CTCL), it has also shown promising efficacy in a number of other severe and difficult-to-treat diseases, including graftversus-host disease (GvHD), systemic sclerosis (SSc), and atopic dermatitis (AD).…”