Acute mechanical hemolysis as a complication of extracorporeal photopheresis in a low-weight child

作者：DeSimone Robert A^*; Wontakal Sandeep N; Lyashchenko Alexander K; Schwartz Joseph

来源：Journal of Clinical Apheresis, 2017, 32(6): 571-573.

DOI：10.1002/jca.21520

• adverse event
• pediatric intensive care unit
• apheresis
• hemolysis
• graft-versus-host disease

Graft-versus-host disease (GVHD) is a complication of allogeneic hematopoietic stem cell transplantation with high morbidity and mortality. Extracorporeal photopheresis (ECP) is an effective therapy for treating medication-refractory GVHD, however, there is scant evidence of whether ECP can be safely performed in patients weighing less than 15 kg. Here, we report the implementation of a successful protocol to perform ECP in a 21-month-old, 10.6 kg female with medication-refractory GVHD. Our initial ECP treatment resulted in significant hemolysis that was most likely mechanical. After procedural adjustments that included modifying the anticoagulation dose and whole blood:anticoagulant ratio, as well as whole blood processing time, the patient tolerated future procedures safely without hemolysis or other adverse events. With appropriate technical modifications, we provide a framework for safely performing ECP in children less than 15 kg.

• 出版日期2017-12