Comparative evaluation of a heparin‐citrate anticoagulation for LDL‐apheresis in two primary apheresis systems

Handschel, Doris; Janssens, Michiel Etienne; Gericke, Marion; Reys, S De; Borberg, H.

doi:10.1002/jca.21512

Cited by 6 publications

(13 citation statements)

References 27 publications

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“…13 With our citrate regimen and administration of ionized calcium, averaging 0.029 mmol/min, we observed no signs of hypocalcemia, similar to Handschel et al's study. 5 However, the results reported by Mortzell et al 20 were in contrast with our results. If one of their patients received intravenous calcium as prophylaxis, he/she experienced more AEs than those who did not receive calcium, due to citrate load and metabolism or a secondary change of electrolytes.…”

Section: Discussioncontrasting

confidence: 99%

“…Furthermore, they added 10,000 U heparin to a 600-ml ACD-A bag. 5 In contrast, we refrained from a bolus delivery of heparin because alteration of shear stress in blood vessels, which can activate coagulation, does not occur until the start of the apheresis. 18 We detected no clotting, despite the altered procedure.…”

Section: Discussionmentioning

confidence: 99%

“…4 In a recent PubMed search, we found only one report on LA, although LA is a commonly performed procedure in countries where Optia is used. 5 When TPE fails, IA is the treatment of choice for acute life-threatening autoimmune diseases or during acute humoral transplant rejection episodes.…”

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confidence: 99%

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Spectra Optia apheresis system: experience with secondary plasma devices

Rummler¹,

Volkholz²,

Steinke³

et al. 2017

IJCTM

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Abstract:Performing clinical procedures and optimal management of Spectra Optia in combination with secondary plasma devices (SPDs) have not been described in the literature. To contribute to this topic, we examined 300 data log files from patients treated with the Spectra Optia from November 2015 until October 2016. Of these 300 procedures, 149 secondary plasma treatments were conducted in 13 patients (76 immunoadsorption [IA] and 73 lipoprotein apheresis [LA]). Nine patients had IA due to transplantation and autoimmune diseases. Four patients were treated with LA after heart transplantation. Of the procedures, 62% were performed using peripheral venous access, even in patients with a low inlet blood flow. A central catheter was required only in 15% cases, and an arteriovenous fistula in 23% of the procedures. Anticoagulation management differed in both procedures. The LA procedures required a higher amount of citrate as they were performed using only citrate. The IA procedures required less citrate because a mixture of citrate and heparin was used. We did not observe clotting or bleeding, regardless of heparin use. Due to strict calcium management, no patient showed signs of hypocalcemia. Despite our apheresis management, four procedures had to be canceled preliminarily due to patient complications. The targeted substances could be reduced significantly: lipoprotein (a) (Lpa) level by 68% (76%-45%), low-density lipoprotein-cholesterol by 57% (64%-37%), and IgG from 6.6 (1.09-21.0) to 2.61 (0.33-14.7) g/l. The Cobe could be replaced by the Optia system effectively. The Optia has a high plasma extraction efficiency, which allows SPD procedures with peripheral venous access and moderate inlet flow rates.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Spectra Optia apheresis system: experience with secondary plasma devices

Rummler¹,

Volkholz²,

Steinke³

et al. 2017

IJCTM

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“…In this study, none of these complications were observed. Handschel et al also reported visual clumping in the sets for a small number of LDL‐apheresis procedures using a mix of ACD‐A and heparin with a higher inlet:AC ratio . Despite close monitoring for clumping events, no procedures showed clumping in the set during CMNC using Spectra Optia.…”

Section: Discussionmentioning

confidence: 99%

Performance prediction algorithm for autologous PBSC collection in adults and pediatric patients using large volume leukapheresis

Bojanić

Besson

Vidović

et al. 2019

J of Clinical Apheresis

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Background and Objectives The number of CD34+ cells collected in apheresis procedures depends mainly on the collection efficiency of the device and the blood volume processed. Large volume leukapheresis (LVL) can improve CD34+ cell yield and has previously been investigated using the COBE Spectra device (Terumo BCT, USA). Materials and Methods This was a retrospective analysis of LVL performance in patients undergoing continuous mononuclear cell collection (CMNC) using the new Spectra Optia apheresis system (Terumo BCT, USA) at the University Hospital Center, Zagreb, from March 2016 to September 2016. CD34+ cell yield predictability, determined using a customized algorithm, was also assessed. Results In total, 67 procedures performed in 46 adults and 14 performed in 11 children were included in the analysis. In adults, 30 (65.2%) patients successfully reached their target preapheresis CD34+ cell count on day 1, with a median (interquartile range [IQR]) CD34+ collected cell dose of 4.8 × 106/kg (2.3‐10.6 × 106/kg). In the pediatric group, 81.8% successfully collected the target CD34+ cell dose on the first day, with a median (IQR) CD34+ collected cell dose of 11.1 × 106/kg (3.2‐16.3 × 106/kg). The customized algorithm showed a strong and significant linear correlation with actual CD34+ cell dose (P < 0.0001). Conclusion The results of this study support the use of LVL and the customized prediction algorithm in apheresis procedures. The ability to tailor the procedure to meet the needs of the individual patient may help to minimize the blood volume processed, shorten the duration, reduce the volume of infused anticoagulants, and improve patient comfort.

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“…Platelet clumps, when present, are seen traveling through the collect port in the connector . Many factors, such as patients' underlying disease, mobilization regimen, blood contact with artificial surface, and centrifugal speed of the instrument, can contribute to platelet clumping in apheresis systems . Potential patient‐specific factors include the production of procoagulant proteins and high levels of inflammatory cytokines in patients with myeloma as well as the increased thrombin generation and fibrin formation seen in healthy donors who received filgrastim mobilization .…”

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confidence: 99%

Factors influencing platelet clumping during peripheral blood hematopoietic stem cell collection

et al. 2017

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BACKGROUND Platelet clumping is a common occurrence during peripheral blood hematopoietic stem cell (HSC) collection using the Spectra Optia mononuclear cell (MNC) protocol. If clumping persists, it may prevent continuation of the collection and interfere with proper MNC separation. This study is the first to report the incidence of clumping, identify precollection factors associated with platelet clumping, and describe the degree to which platelet clumping interferes with HSC product yield. STUDY DESIGN AND METHODS In total, 258 HSC collections performed on 116 patients using the Optia MNC protocol were reviewed. Collections utilized heparin in anticoagulant citrate dextrose to facilitate large-volume leukapheresis. Linear and logistic regression models were utilized to determine which precollection factors were predictive of platelet clumping and whether clumping was associated with product yield or collection efficiency. RESULTS Platelet clumping was observed in 63% of collections. Multivariable analysis revealed that a lower white blood cell count was an independent predictor of clumping occurrence. Chemotherapy mobilization and a lower peripheral blood CD34+ cell count were predictors of the degree of clumping. Procedures with clumping had higher collection efficiency but lower blood volume processed on average, resulting in no difference in collection yields. Citrate toxicity did not correlate with clumping. CONCLUSION Although platelet clumping is a common technical problem seen during HSC collection, the total CD34+ cell-collection yields were not affected by clumping. WBC count, mobilization approach, and peripheral blood CD34+ cell count can help predict clumping and potentially drive interventions to proactively manage clumping.

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Comparative evaluation of a heparin‐citrate anticoagulation for LDL‐apheresis in two primary apheresis systems

Abstract: Apheresis procedures on the Spectra Optia system with low-dose heparin-citrate anticoagulation are feasible and safe.

Cited by 6 publications

References 27 publications

Spectra Optia apheresis system: experience with secondary plasma devices

Spectra Optia apheresis system: experience with secondary plasma devices

Performance prediction algorithm for autologous PBSC collection in adults and pediatric patients using large volume leukapheresis

Factors influencing platelet clumping during peripheral blood hematopoietic stem cell collection

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