Out with the bad and in with the good; red cell exchange, white cell reduction, and platelet reduction

Abstract

Automated techniques for red cell [red blood cell (RBC)] exchange or depletion of malignant cells from the peripheral blood have allowed patients with life‐threatening conditions to survive long enough to receive definitive treatment. Examples of such conditions include acute chest syndrome in sickle cell disease (SCD) or acute respiratory insufficiency due to leukostasis in acute leukemia. Conversely, other patients with SCD undergo RBC exchanges on a chronic basis to maintain a reasonable quality of life and prevent another stroke. In this review, we will discuss the techniques as well as indications for RBC exchange, leukocytapheresis, and thrombocytapheresis. To illustrate the uses of these therapeutic apheresis procedures, the authors included a summary of the most common diagnoses that comprise the indications for each technique, and the rationale behind their use. J. Clin. Apheresis 29:220–227, 2014. © 2014 Wiley Periodicals, Inc.

Effect of automated red cell exchanges on oxygen saturation on-air, blood parameters and length of hospitalization in sickle cell disease patients with acute chest syndrome

“…Our finding is in agreement with the earlier report of Marques et al ., who observed a reduction in WBC count post-RCE. 21 This could be as a result of the reported post-RCE blunting of inflammation; 20 white cells, particularly neutrophils tend to increase in inflammation, as part of the acute phase response. 24 The Hb concentration increased progressively in all the patients, postprocedure and remained significantly higher than preexchange levels at the point of symptom resolution, this is consistent with the documented increase in Hb content which occurs post-RCE.…”

“…Documented effects of RCE in the setting of ACS include improved tissue oxygenation, changes in Hb oxygen affinity and blood oxygen pressure, increase in transcutaneous oxygen saturation (SpO 2 ), increased HbA content with reduced HbS fraction and reduced WBC count and inflammatory markers. 17 18 19 20 21 …”

How we approach a patient with symptoms of leukostasis requiring emergent leukocytapheresis

“…Fluid balance should be carefully considered before the procedure to reduce the incidence of hypotension. If it occurs, slowing down the procedure and/or infusing of additional 0.9% normal saline, 5% albumin, and/or plasma should be considered …”

“…Leukocytapheresis is only a bridging therapy . Retrospective analyses suggested that although leukocytapheresis may reduce early mortality, there has been no improvement on the overall mortality .…”

“…In patients with acute myeloid leukemia (AML) or acute lymphoblastic leukemia (ALL), it may associate with leukostasis, tumor lysis syndrome, disseminated intravascular coagulation, and an increase in morbidity and mortality . Leukocytapheresis can be used as part of the management for these patients . Leukocytapheresis is also known as leukapheresis.…”