Thomas A. Noto

Safety of large-volume leukapheresis for collection of peripheral blood progenitor cells

Large volume leukapheresis (LVL) reduces the number of procedures required to obtain adequate peripheral blood progenitor cells (PBPCs) for autologous hematopoietic reconstitution. LVL involves the processing of >15 L or 5 patient blood volumes using high flow rates. We report our experience with LVL evaluating its efficiency and adverse effects in 71 adult patients with hematologic or solid organ malignancies. All were mobilized with chemotherapy and granulocyte colony‐stimulating factor (G‐CSF). All collections used a double lumen apheresis catheter. Means values per LVL were as follows: blood processed, 24.6 L; patient blood volumes processed, 5.9; ACD‐A used. 1.048 ml; heparin used, 6,148 units; collect time, 290 min; blood flow rate, 89 ml/min. Eighty percent of the collections were completed in one or two procedures to obtain ≥6.0 × 108 MNCs/kg body weight. The most frequent side effect (39%) was parasthesia due to citrate‐related hypocalcemia. This was managed with oral calcium supplements and or slower flow rates. Post‐LVL electrolyte changes were generally asymptomatic. Prophylactic oral potassium supplements were administered in 57% of cases. Other reactions included hypotension (4%), prolonged parasthesia (1.4%), and headache (1.4%). Catheter problems in 9 (13%) of the procedures were attributed to clot formation (37%) or positional effects (63%). No bleeding occurred. Post‐LVL decreases in hematocrit and platelet count averaged 3.5% and 46%, respectively. Six (4%) of the procedures required red blood cell transfusions. Platelet transfusions were given in 19 (13%) of the procedures. We conclude that adverse reactions with LVL are similar to those reported for conventional PBPC collections, making it safe and efficacious as an outpatient procedure. J. Clin Apheresis 12:10–13, 1997.

Alloimmunization to red cell antigens in liver and multivisceral transplant patients.

Background. Alloimmunization to red blood cell (RBC) antigens can significantly impact transfusion support of patients undergoing solid-organ transplantation. This study evaluated the incidence of clinically significant RBC alloantibodies (abs) in 2000 consecutive adults receiving liver (OLTX), intestinal (ITX) or multivisceral (MVT) transplants. Methods. From January 1991 to May 2006, 2000 patients underwent OLTX (n=1892), MVT (n=74), or ITX (n=34). Blood sample for serologic investigation was submitted to the transfusion service no later than 4 hr before surgery. The presence of clinically significant RBC abs before transplant with subsequent transfusion requirements, the incidence of delayed transfusion reactions, and de novo abs after transplant were evaluated. Results. One hundred fifteen patients (5.75%) had clinically significant RBC abs before transplant, with 56.7% directed against Rh system antigens. Forty-six (40%) had multiple abs. A mean of 18 packed RBC units (U) were transfused per patient. Patients requiring >20 U (n=34) or those with multiple abs received antigen-negative units for the first 5–10 U when antibody was still present, switched to antigen-unscreened units during massive blood loss and returned to antigen-negative units for the last 5–10 U transfused. Twelve patients (0.6%) developed de novo abs posttransplant. Twenty-two (1.1%) had delayed serologic transfusion reaction. All patients were successfully managed without delay in initiation of surgery or hemolytic complications. Conclusion. RBC alloimmunization can present a special challenge to solid-organ transplantation. Early serologic testing of the recipient pretransplant and prompt communication between the transfusion service and transplant team facilitates successful transfusion management of these patients.

Donor peripheral blood stem cell infusions in recipients of living- related liver allografts

BACKGROUND In this pilot study, donor peripheral blood stem cell (DPBSC) infusions were performed in three recipients of living-related liver transplants (LRLT). METHODS DPBSCs were obtained by leukapheresis after mobilization with granulocyte-colony-stimulating factor (Filgrastim). Donor leukapheresis was performed on the 5th postoperative day, and half of the DPBSCs were infused into the recipient on the day of collection. The second half of the pheresed product was cryopreserved for delayed administration. RESULTS Results from preliminary studies of chimerism in LRLT recipients, at 20 weeks posttransplant, suggested that the levels of donor cells detected in LRLT recipients treated with DPBSC infusions may be higher than those observed for recipients of cadaver donor liver allografts and vertebral body marrow infusions. CONCLUSIONS The results of this pilot study indicate that administration of mobilized DPBSC to recipients of LRLT is a feasible procedure for both donor and recipient.

Quantitation of human chorionic gonadotropin in urine using the slide immunologic test for pregnancy

Abstract 1. 1. The use of the slide immunologic test in a semiquantitative procedure for determining HCG titers in urine has been described. This method is simple, reliable, and rapid. The test can be performed in one hour. 2. 2. The sensitivity and accuracy of this method have been compared with those of the Friedman test and the results found have been good. 3. 3. The sensitivity of the immunologic test described is approximately 5 I.U. per milliliter, as determined by the use of the Second International Standard for human chorionic gonadotrophin. 4. 4. The geometric mean of titers observed in 295 urine samples obtained at varying times throughout pregnancy is presented. In the practical use of this test, a titer of 1:64 (320 I.U. per milliliter) is considered the high limit of normal during the first trimester of pregnancy. 5. 5. The potential use of this serologic test in the diagnosis of abnormal conditions like hydatidiform moles and chorionepitheliomas is discussed.