Pediatric large-volume leukapheresis: a single institution experience with heparin versus citrate-based anticoagulant regimens.

Published

Journal Article

BACKGROUND: Anticoagulant-associated toxicity may exert significant effects on the safety and efficacy of large-volume leukapheresis (LVL) in children, however, few studies specifically address management of this issue. STUDY DESIGN AND METHODS: Seventy-four consecutive LVL procedures (mean, 4 blood volumes processed) in children weighing less than or equal to 30 kg (minimum, 10.9 kg) were analyzed. The first 21 procedures were evaluated retrospectively; 11 used heparin alone (Group I) and 10 used heparin plus reduced-dose ACD-A (whole blood to anticoagulant ratio > or =20:1) (Group II). The next 53 procedures were evaluated prospectively and used full-dose ACD-A (whole blood to anticoagulant ratio < or =13:1), intravenous divalent cation prophylaxis and no heparin; 11 used calcium alone (Group III) followed by 42 with calcium plus magnesium (Group IV). RESULTS: Seventy-four LVL (56 PBPC and 18 MNC) collections were performed in 38 subjects. One donor in Group I experienced a significant groin hematoma at the site of line placement. One donor each in Groups III and IV had mild paresthesias. Despite a mean citrate infusion rate of 2.6 mg per kg per minute, mean postapheresis serum potassium and ionized magnesium and calcium concentrations in Group IV declined by only 9, 8, and 4 percent, respectively, and stable levels of these variables were maintained 24 hours later. Postapheresis PLT counts declined significantly from baseline preapheresis levels in all groups (mean, 52% decrease). CONCLUSIONS: Use of full-dose citrate anticoagulant with prophylactic intravenous divalent cation infusion offers an effective and safe approach to management of anticoagulant-related toxicity in children undergoing LVL.

Full Text

Duke Authors

Cited Authors

  • Bolan, CD; Yau, YY; Cullis, HC; Horwitz, ME; Mackall, CL; Barrett, AJ; Malech, HL; Rehak, NN; Wayne, AS; Leitman, SF

Published Date

  • February 2004

Published In

Volume / Issue

  • 44 / 2

Start / End Page

  • 229 - 238

PubMed ID

  • 14962314

Pubmed Central ID

  • 14962314

International Standard Serial Number (ISSN)

  • 0041-1132

Digital Object Identifier (DOI)

  • 10.1111/j.1537-2995.2004.00668.x

Language

  • eng

Conference Location

  • United States