A simple and effective exchange transfusion method for the treatment of hyperleucocytosis in patients with acute leukemia preliminary results – Original Article

Year 2008, Volume: 43 Issue: 1, 24 - 28, 01.03.2008

Hilmi Apak Serap Karaman Tiraje Celkan Alp Özkan Aylin Canpolat Leman Yantri İnci Yıldız

Abstract

Aim: Acute leukemia may present with extremely high blast counts gt;100 000 mm3 Leukapheresis effectively reduces the blast count in many patients and is routinely used for immediate leukocytoreduction in adult patients But this procedure is expensive requires prompt readiness of specialized blood bank personal Additional measures such as extracorporeal fluid calculation and priming is required in young patients In this study linear peristaltic infusion pump was used for exchange transfusion in pediatric leukemia patients with hyperleukocytosis Material and Method: The blood withdrawn by the pump from the patient was replaced with the same amount of appropriate blood product in order to maintain the isovolumetric state of the patient Results: Eleven patients ranging in age 3 months to 12 years with high blast counts were enrolled into the study Two patients were smaller than 2 years of age six patients were under 20 kg The mean exchange time was 33 hours and mean amount of transfused blood was 2382 ml Their mean initial leukocyte count was 393 000 mm3 Their mean end leukocyte count was 67 982 mm3 No side effects were observed in any of the patients Conclusion: Exchange transfusion of patients with hyperleukocytosis with the use of linear peristaltic pump is a safe and cheap method for this group of patients Turk Arch Ped 2008; 43: 24 8 Key words: Apheresis hyperleukocytosis leukemia treatment transfusion

Keywords

-

Akut lösemili hastalarda hiperlökositoz tedavisinde basit ve etkili kan değişimi yöntemi ön sonuçlar Orijinal Araştırma

Abstract

Amaç: Akut lösemi çok yüksek lökosit değerleri ile karşımıza çıkabilir Lökoferez birçok hastada yüksek blast sayısını etkin olarak azaltmaktadır ve erişkin hastalarda lökosit sayısını hızla azaltmak için kullanılmaktadır Ancak bu işlem pahalıdır ve kan merkezi görevlilerinin sürekli ilgilenmelerini gerektirir Ayrıca küçük hastalarda vücut dışı dolaşımın hesaplanması ve sisteme ayrıca eklenmesi gibi önlemlerin alınması gerekmektedir Bu çalışmada hiperlökositozu olan lösemili çocuk hastalarda lineer peristaltik enfüzyon pompası ile kan değişimi kullanılmıştır Gereç ve Yöntem: Pompanın yardımı ile hastadan çekilen kan miktarı kadar kan ürünü diğer bir pompa yardımıyla geri verilerek hastanın “izovolümetrik” durumu sağlanmış olur Bulgular: Çalışmaya yaşları 3 ay ile 12 yaş arasında değişen 11 hasta alındı İki hasta iki yaşından küçüktü altı hasta 20 kg’ın altında idi Ortalama kan değişim süresi 33 saat ortalama kan değişim miktarı 2 382 ml idi Hastaların başlangıç lökosit düzeyleri ortalama 393 600 mm3 işlem sonu lökosit sayıları 67 982 mm3 idi Hiçbir hastada yan etki gözlenmedi Çıkarımlar: Hiperlökositozlu hastalarda lineer peristaltik enfüzyon pompası yardımıyla kan değişimi yöntemi kullanım kolay ucuz ve etkili bir yöntemdir Türk Ped Arş 2008; 43: 24 8 Anahtar kelimeler: Aferez hiperlökositoz nbsp; lösemi tedavisi transfüzyon

Keywords

Aferez, hiperlökositoz, lösemi tedavisi, transfüzyon

References

• Eguiguren JM, Schell MJ, Crist WM, et al. Complications and outcome in childhood acute lymphoblastic leukemia with hyperleukocytosis. Blood 1992;79:871-5.
• Porcu P, Cripe LD, Elizabeth WN, et al. Hyperleukocytic leukemias and leukostasis: A review of pathophysiology, clini- cal presentation and management. Leukemia and Lymphoma 2000;39:1-18.
• Freireich EJ, Thomas LB, Frei B, Fritz RD, Forkner EE. A dis- tinctive type of intracerebral hemorrhage associated with “blas- tic crisis” in patients with leukemia. Cancer 1960;13:146.
• Przemysiaw N, Zdziarska B, Fryze C, Urasinski I. Co-exis- tence of thrombocytopenia and hyperleukocytosis (“critical period”) as a risk factor of haemorrhage into the central ner- vous system in patients with acute leukemias. Haematologica 2002;31:347-55.
• Bug G, Anargyrou K, Tonn T, et al. Impact of leukapheresis on early death rate in adult acute myeloid leukemia presenting with hyperleukocytosis. Transfusion, 2007;47:1843-50.
• kanlar ve “buffy coat” (sol baştaki ilk atık şişesidir.)
• Creutzig U, Zimmermann M, Reinhardt D, Dworzak M, Stary J, Lehrnbecher T. Early deaths and treatment-related mortality in children undergoing therapy for acute myeloid leukemia: analy- sis of the multicenter clinical trials AML-BFM 93 and AML-BFM 98. J Clin Oncol 2004;22:4384-93.
• McKee LC Jr, Collins RD. Intravascular leukocyte thrombi and aggregates as a cause of morbidity and mortality in leukemia. Medicine 1974;53:463.
• Klose HJ, Kelson S, Schwarzbach K, et al. Initial therapie extremer leukozytose bei akuter kindlicher leukamie durch blu- taustauschtransfusion- rheologische aspekte. Klin Pediatr 1981;193:172-6.
• Giles F, Shen Y, Kantarjian HM, et al. Leukopheresis reduces early mortality in patients with acute myeloid leukemia with high white cell counts but does not improve long term survival. Leukemia and Lymphoma 2001;42:67-73.
• Porcu P, Farag S, Marcucci G, Cataland SR, Kennedy MS, Bissel M. Leukocytoreduction for acute leukemia. Ther Apher 2002;6:15-23.
• Baxter Healthcare Corporation:Flo-Gard 6301, volumetric infu- sion pump, prod code: 2M8063G. Service Manual. Deerfield, USA: 1995.
• Aksakoğlu G. Sağlıkta araştırma teknikleri ve analiz yöntemleri: Parametrik olmayan yöntemler. İzmir Dokuz Eylül Üniversitesi Rektörlük Matbaası, 2001:227-35.
• Philpott MG, Banerjee A. Automated method for exchange transfusion. Arch Dis Child 1972;47:815-7.
• Goldman SL, Tu HC. Automated method for exchange transfu- sion: A new modification. J Pediatr 1983;102:119-21.
• Aranda JV, Sweet AY. Alterations in blood pressure during exchange transfusion. Arch Dis Child 1977;52:545-8.