Vnitr Lek 2012, 58(Suppl 2):91-102

Hemapheresis - the efficient therapeutic technique in clinical practice

Z. Gašová

Ústav hematologie a krevní transfuze Praha, ředitel prof. MUDr. Marek Trněný, CSc.

Hemapheresis technique has been used widely in the clinical practice. It enables preparing high yields of blood components or helps to remove the pathogenetic substance from the patient's circulation. In the Institute of Hematology and Blood Transfusion many types of therapeutic methods have been used. Procedures include cell depletion - with removing of the extent of leukocytes, red cell and platelets from the patient's circulation. Other methods are therapeutic plasma exchange, red blood cells exchange, immunoadsorption of IgG, extracorporeal photochemotherapy (ECP), and peripheral blood progenitor cells (PBPC) collections. In our previous studies we have focused to optimization of the PBPC collection techniques in donors and in patients. The large volume leukapheresis technique was proved as more efficient than the standard collections, and would be preferred in all circumstances when donors or patients can tolerate it. "The off line" method of Extracorporeal Photochemotherapy (ECP) was introduced in the therapy of patients with chronic GVHD (cGVHD) and cutaneous T cell lymphomas. We tried to evaluate the immunomodulatory and clinical effect of the "off line" ECP. The immature dendritic cells (DC's) were found in mononuclear cell concentrates in patients with cGVHD, and ECP was efficient in the therapy of patients with cGVHD and CTCL. The frequency and types of the adverse reactions associated with therapeutic hemapheresis were evaluated. The number of 330 reactions (12%) was observed in the course of 2,827 therapeutic procedures, including PBPC collections. Hypocalcemia, insufficient function of the venous access, and hypotension were the most frequent. The majority of reactions was mild to moderate, and reactions were treated efficiently. Only in two patients the acute, severe and life threathening reactions have occured - bleeding in the placement of the central venous catheter and the septic reaction. Fortunately, the serious complications were managed successfully. Despite the adverse reactions, which can occur occasionally, hemapheresis technique is considered as a relatively safe therapeutic procedure. However, preapheresis evaluation of the clinical condition of the patients and identification "risky" patients would be useful.

Keywords: therapeutic hemapheresis; hemapheresis; plasma exchange; red blood cell exchange; leukocytapheresis; PBPC; imunoadsorption; extracorporeal photochemotherapy

Received: May 21, 2012; Published: April 1, 2012  Show citation