Postthaw clotting of peripheral blood stem cell products due to insufficient anticoagulant

Reich-Slotky, Ronit; Patel, Neelam; Dael, S.; Semidei-Pomales, Mildred; Stephens, Hannah; Reich, Michael; Schwartz, Joseph

doi:10.1002/jca.20220

Cited by 4 publications

(2 citation statements)

References 12 publications

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“…Donor safety and quality of the collected HPC products are two focal points in HPC leukapheresis, and are closely linked to a proper anticoagulation strategy. Decreasing citrate infusion to the patient limits hypocalcemia , whereas increasing citrate limits platelet clumping in the system . A regimen to encompass both needs is therefore warranted.…”

Section: Discussionmentioning

confidence: 99%

Customizing anticoagulation strategies during leukapheresis to limit citrate exposure

McMannes

Hershberger

Parker

et al. 2016

ISBT Science Series

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Background and Objectives Leukapheresis has become a standard practice to collect CD34 + haematopoietic progenitor cells (HPC) from peripheral blood. Hypocalcemic toxicity (hypocalcaemia) is the most common complication during leukapheresis associated with citrate-based anticoagulation (AC) infusion. This report describes a new approach to limit citrate exposure by increasing the inlet: AC ratio while maintaining original inlet flow rates on the device in order to decrease the AC infusion rate.Materials and Methods A retrospective analysis was performed on 63 autologous and 29 allogeneic HPC collections. Procedures were started at a conservative inlet:AC ratio of 12:1 with gradual ratio ramping (RR) during the procedure, or at an inlet:AC ratio of 13:1 or higher (HIR), with constant inlet flow rates. The clinical decision to change the ratio was based on platelet counts and concomitant medications, such as systemic anticoagulants. Symptoms of citrate toxicity were treated by calcium supplementation.Results Customization of AC management with RR or HIR was performed in 91 of 92 procedures with a final inlet:AC ratio of 13:1-20:1, under careful supervision for platelet clumping episodes. Notably, 33 procedures were completed in individuals chronically treated with aspirin and/or warfarin. Citrate infusion gradually decreased with higher inlet:AC ratios, without affecting procedure time. The HIR strategy resulted in significantly smaller AC infusion volumes compared to RR, and lower frequency of calcium administration. CD34 + collection efficiency was not influenced by increasing inlet:AC ratios.Conclusion Customization of the inlet:AC ratio while maintaining a constant, stable inlet flow rate is effective in limiting citrate exposure during leukapheresis.Limiting citrate exposure in apheresis 299 d P < 0Á05 aspirin + warfarin vs. no anticoagulation. e P < 0Á01 aspirin + warfarin vs. no anticoagulation.

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Section: Discussionmentioning

confidence: 99%

Customizing anticoagulation strategies during leukapheresis to limit citrate exposure

McMannes

Hershberger

Parker

et al. 2016

ISBT Science Series

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“…Both ACD-A alone or combined with heparin may be used as anticoagulation during leukocytapheresis. Concerns about the increased bleeding risk associated with heparin make some clinicians to prefer to exclusively use ACD-A 13,14 ; others use heparin as a strategy to reduce citrate-associated toxicity, 6,17,18,22,23 an important aspect in small children. In our sample, ACD-A was used alone in six leukocytaphereses.…”

Section: Hematopoietic Stem Cell Transplantationmentioning

confidence: 99%

Peripheral blood stem cells collection by apheresis in very low‐weight children with malignant diseases—A single center experience

Vieira

Teixeira

Reis

et al. 2022

J of Clinical Apheresis

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Background Hematopoietic stem cell transplantation is used in the treatment of children with malignant and non‐malignant diseases. However, apheresis of peripheral blood stem cells (PBSC) represents a challenge in children below 10 kg. Methods A retrospective trial was conducted in the Cellular Therapy Department of Portuguese Oncology Institute of Porto. Inclusion criteria: children with body weight inferior to 10 kg who underwent autologous PBSC apheresis until 2021. Demographic and clinical data were collected and our institutional protocol was described. COBE Spectra apheresis system (TerumoBCT, Lakewood, Colorado) until 2012 and then Spectra Optia (TerumoBCT) were used. Results Sixteen leukocytaphereses were performed in 13 patients—nine females (69%). Mean age and weight were 13.31 months (±5.26) and 8.31 kg (±1.17), respectively. The initial CD34+ cells/μL in peripheral blood was 70.8 (±61.9). A central venous catheter (CVC) was exclusively used in all but one patient, in whom a peripheral vein was also required. In 10 procedures, both heparin and anticoagulant citrate dextrose solution—formula A (ACD‐A) were used; in the remaining ones, only ACD‐A was employed. The median duration of each procedure was 168 minutes (±45) and 2.96 blood volumes (±0.31) were processed. Median CD34+ cells yield per leukocytapheresis was 6.52 × 106/kg (±9.87 × 106). CD34+ cell extraction rates were not significantly different between the two apheresis systems. Platelet and magnesium levels were significantly lower after collection (P < .001 and P = .009, respectively). Conclusions Although recommendations are lacking, we have successfully and safely performed leukocytaphereses in children with body weight below 10 kg. The authors believe that a permanent and dynamic comprehensive evaluation of each child is paramount for attaining good results.

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Rapid potency assessment of autologous peripheral blood stem cells by intracellular flow cytometry: the PBSC-IL-3-pSTAT5 assay

et al. 2022

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Postthaw clotting of peripheral blood stem cell products due to insufficient anticoagulant

Cited by 4 publications

References 12 publications

Customizing anticoagulation strategies during leukapheresis to limit citrate exposure

Customizing anticoagulation strategies during leukapheresis to limit citrate exposure

Peripheral blood stem cells collection by apheresis in very low‐weight children with malignant diseases—A single center experience

Rapid potency assessment of autologous peripheral blood stem cells by intracellular flow cytometry: the PBSC-IL-3-pSTAT5 assay

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