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Leukocyte depletion during cardiac operation: A new approach through the venous bypass circuit

ANNALS OF THORACIC SURGERY 1999年第3期67卷 604-609页

作者： Gu, YJ de Vries, AJ Vos, P Boonstra, PW van Oeveren, W Univ Groningen Hosp Dept Cardiothorac Surg NL-9712 KZ Groningen Netherlands Univ Groningen Hosp Dept Anaesthesiol NL-9712 KZ Groningen Netherlands

Background. Leukocyte depletion recently has been introduced for cardiac surgical patients to attenuate leukocyte-mediated inflammation and organ reperfusion injury. We evaluated the feasibility of a new leukocyte depletion method in which systemic leukocyte depletion is achieved through the venous side of the cardiopulmonary bypass circuit under low blood flow. Methods. Forty cardiac surgical patients undergoing cardiopulmonary bypass were allocated randomly to a leukocyte depletion group (n = 20) and a control group (n = 20). In the depletion group, leukocyte filtration was achieved with two filter sets located between the venous drainage and the venous reservoir, Leukocyte filtration was commenced after the start of rewarming but before the release of the aortic cross-clamp, and it was driven by a spare roller pump of the heart-lung machine. Results. All the episodes of filtration went smoothly within a period of 10 minutes and with a blood now rate of 400 mL/min. The mean leukocyte removal rate calculated at the end of filtration was 69%. Circulating leukocytes were reduced by 38% in the depletion group compared with the control group at the moment of crossclamp release (4.3 x 10(9)/L versus 6.8 x 10(9)/L, p < 0.05). The postoperative inflammatory response also was reduced as indicated by less production of interleukin-8 (p < 0.05). Clinically, there was no significant difference between the two groups in postoperative Pao(2) or pulmonary hemodynamics. Conclusions. It is technically feasible to deplete circulating leukocytes through the venous side of the cardiopulmonary bypass-circuit with a low blood now rate. Future studies should focus on the duration and timing of leukocyte depletion to optimize the methodology of leukocyte depletion for cardiac surgical patients. (Ann Thorac Surg 1999;67:604-9) (C) 1999 by The Society of Thoracic Surgeons.

关键词：心脏外科手术心肺转流术/仪器和设备可行性研究过滤/仪器和设备炎症介导素类/血液白细胞介素8/血液 L选择素/血液白细胞去除术/仪器和设备白细胞去除术/方法白细胞计数白细胞弹性蛋白酶/血液老年人女(雌)性人类男(雄)性中年人

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Shorter turn-around-time and improved patient care in peripheral blood progenitor cell collection procedures

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JOURNAL OF CLINICAL APHERESIS 1999年第1期14卷 35-41页

作者： Ratcliffe, N Blume, C John, P Weiss, T Hubbell, C Henry, JB SUNY Hlth Sci Ctr Dept Pathol Syracuse NY 13210 USA

The collection of peripheral blood progenitor cells (PBPC) requires the combined efforts of the Transfusion Medicine/Hemapheresis and Hematology/Oncology services and HLA/Progenitor Cell and Immunology laboratories. Coordination and communication among these different services and laboratories are key to attaining an optimal collection in a timely manner for the patient undergoing PBPC collection. In an effort to improve patient care by same-day decision to cease or continue collections avoiding unnecessary collections, needless patient trips to the hospital and ultimately increasing patient satisfaction, a flow chart was used to capture the sequence of events. The flow chart served as a powerful tracking tool that defined system process and steps to attain enumeration of CD34(+) cells the same day of collection. It provided documentation of work flow from each of the independent operations involved in progenitor cell collection and enumeration turn-around-time including attending and staff time involvement. By using the flow chart, potential and actual problem areas were demonstrated and this allowed for creative thinking and problem solving by individual sections rather than recriminations. Finally, it focused all the staff involved in the common goal of a shorter turn-around-time for CD34(+) cell enumeration the same day of collection. This allowed a prompt decision for subsequent leukapheresis as improved service to oncology patients and their physicians. (C) 1999 Wiley-Liss, Inc.

关键词：白细胞去除术/方法白细胞去除术/护理白细胞计数病案系统计算机化肿瘤/治疗纽约病人医疗小组静脉切开术/护理问题解决软件设计时间因素时间安排时间和运动研究人类

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Storage of G-CSF-mobilized granulocyte concentrates

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TRANSFUSION 2000年第9期40卷 1104-1110页

作者： Lightfoot, T Leitman, SF Stroncek, DF NIH Dept Transfus Med Warren G Magnuson Clin Ctr Bethesda MD 20892 USA

BACKGROUND: Current standards limit granulocyte storage to 24 hours. Since G-CSF inhibits granulocyte apoptosis, it may be possible to store G-CSF-mobilized granulocytes for longer periods while maintaining cell viability and function. However, G-CSF mobilization increases the yield of granulocytes several times, and the resulting higher cell concentrations may diminish viability during storage and significant levels of pyrogenic cytokines may be produced. STUDY DESIGN: Ten granulocyte donors were given dexamethasone (8 mg PO), G-CSF (5 mu g/kg SQ), or both and on the next day granulocyte concentrates were collected using a blood cell separator. Component cell counts, cell viablilities, pH, and IL-1 beta, IL-6, IL-8 and TNF levels were measured at 2 to 4 (2), 20 to 28 (24), and 44 to 52 hours (48 hours). RESULTS: Significantly more granulocytes were collected when donors were given G-CSF (4.2 +/- 2.3 x 10(10)) or G-CSF plus dexamethasone (6.4 +/- 2.5 x 10(10)) compared with that collected with dexamethasone alone (2.2 +/- 1.2 x 10(10));p = 0.03 and p = 0.002, respectively. Storage had little effect on WBC count. Slight but significant increases in IL-1 beta and IL-8 occurred after 24 and 48 hours as compared to the levels at 2 hours' storage. Levels of IL-6 and TNF did not change. The pH dropped significantly with time in granulocytes mobilized with each regimen. Granulocytes mobilized with G-CSF plus dexamethasone were acidic immediately after collection, and pH was below 6.0 after 24 hours. To assess the effect of cell concentrations on pH, serial dilutions were performed on 13 granulocyte concentrates in autologous plasma prior to storage. The pH remained above 7.0 only when dexamethasone-mobilized granulocytes were diluted 1-in-8 and when the G-CSF plus dexamethasone-mobilized granulocytes were diluted 1-in-16. CONCLUSIONS: To optimize storage pH, mobilized granulocyte concentrates require a 1-in-8 to 1-in-16 dilution, which is operationally impractical. Clinica

关键词：细胞凋亡/药物作用血液保存/仪器和设备细胞运动/药物作用地塞米松/药理学粒细胞集落刺激因子/药理学粒细胞/细胞学粒细胞/药物作用粒细胞/移植白细胞去除术/方法人类

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A prospective, randomized, sequential crossover trial of large-volume versus normal-volume leukapheresis procedures:: effects on serum electrolytes, platelet counts, and other coagulation measures

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TRANSFUSION 2000年第3期40卷 368-374页

作者： Humpe, A Riggert, J Munzel, U Köhler, M Univ Gottingen Dept Transfus Med D-37075 Gottingen Germany Univ Gottingen Dept Med Stat D-37075 Gottingen Germany

BACKGROUND: LVL procedures with the administration of heparin as an additional anticoagulant are increasingly performed because of the potentially higher yield of autologous peripheral blood HPCs. A prospective, randomized crossover trial was performed to evaluate the influence of leukapheresis volume-that is, large versus normal-on serum electrolytes, platelet count, and other coagulation measures in 25 patients with breast cancer and 14 patients with non-Hodgkin's lymphoma. STUDY DESIGN AND METHODS: Patients were randomly assigned to start either with an LVL on Day 1 followed by a normal-volume leukapheresis (NVL) on Day 2 or vice versa. In LVL, heparin was administered in addition to ACD-A. Bleeding complications, transfusion support, whole-blood counts, and several coagulation measures as well as plasma heparin levels were evaluated. RESULTS: Although the duration, the infused amount of ACD-A, the flow rate, the drop in platelet count, and the drop in potassium were significantly greater in LVL, and although LVL patients also received heparin, there was no significant difference in clinical tolerance or bleeding complications. After LVL, patients exhibited a significantly longer activated partial thromboplastin time (APTT), with a median of 70 seconds (range, 44-100 sec), and a median anti-factor Xa activity of 0.69 IU per mt (range, 0.10-1.29 IU/mL). The value of the APTT after LVL correlated with anti-factor Xa activity (r = 0.37, p<0.05), but not with platelet count or heparin infusion rate. Markers for coagulation activation did not increase during NVL or LVL. CONCLUSION: LVL with heparin as an additional anticoagulant seems to be a safe procedure in patients with low preleukapheresis platelet counts. No activation of coagulation occurred after NVL or LVL procedures.

关键词：抗凝药/药理学血液凝固因子/代谢乳腺肿瘤/药物疗法交叉研究电解质/血液造血干细胞动员白细胞去除术/方法淋巴瘤非霍奇金/药物疗法血小板计数前瞻性研究成年人女(雌)性人类男(雄)性中年人

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A COMPARISON OF PERIPHERAL-BLOOD STEM-CELL APHERESIS USING THE FENWAL CS3000 PLUS AND COBE SPECTRA

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TRANSFUSION SCIENCE 1995年第1期16卷 71-77页

作者： DZIECZKOWSKI, JS MCGONIGAL, M COOK, J SUGRUE, M ANDERSEN, J ANDERSON, KC Department of Pathology Wayne State University Medical School Detroit MI 48201 USA.

We have compared the leukapheresis products collected on the Fenwal CS3000 Plus and COBE Spectra in a well-controlled patient population. While statistically significant differences were found, i.e. in product hematocrit, volume, number of granulocytes and platelets collected, these are not felt to be physiologically important. Similar efficiency in collecting mononuclear cells and colony forming unit assay results indicate that each instrument is capable of harvesting hematopoietic progenitor cells from peripheral blood.

关键词：抗肿瘤联合化疗方案/治疗应用血细胞计数乳腺肿瘤/血液乳腺肿瘤/治疗卡铂/投药和剂量集落形成单位测定综合疗法环磷酰胺/投药和剂量多柔比星/投药和剂量氟尿嘧啶/投药和剂量粒细胞巨噬细胞集落刺激因子/治疗应用血细胞比容/仪器和设备血细胞比容/方法造血干细胞移植造血干细胞白细胞去除术/仪器和设备白细胞去除术/方法乳房切除术噻替派/投药和剂量成年人女(雌)性人类中年人

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BIOCOMPATIBILITY OF LEUKOCYTE REMOVAL FILTERS DURING BEDSIDE LEUKOCYTE FILTRATION OF RED-CELL CONCENTRATES

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TRANSFUSION SCIENCE 1992年第4期13卷 467-472页

作者： GU, YJ OBSTER, R DEHAAN, J HUET, RCGG VANOEVEREN, W UNIV GRONINGEN HOSP THORAX CTRDIV CARDIOPULM SURG RES59 OOSTERSINGEL9713 EZ GRONINGENNETHERLANDS

The biocompatibility of leukocyte removal filters was evaluated in four different types of leukocyte filters made from different materials during bedside leukocyte filtration of red cell concentrates (RCC). Two units of banked RCC were filtrated through each leukocyte filter inserted into the transfusion line (n=20). The results indicate that there was no significant increase of granulocyte elastase nor the generation of the complement split product C3a during filtration of the first unit of RCC. However, activation of the complement system occurred during filtration of the second unit of RCC in particular by the filters made from cellulose acetate. There was no increase of either clotting or fibrinolytic activity during leukocyte filtration by all these leukocyte removal filters. Samples taken from patients revealed that no increase of these bioactive substances was found in patients who received the transfusion through leukocyte filters. Thus, the evaluated leukocyte removal filters do not compromise patients in terms of biocompatibility and are safe to be used during bedside filtration.

关键词：生物相容性材料血液成分输血/仪器和设备血液成分输血/方法补体激活红细胞输注血液滤过/仪器和设备血液滤过/方法白细胞去除术/仪器和设备白细胞去除术/方法人类

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EVALUATION OF THE FRESENIUS CELL SEPARATOR AS-104 FOR HARVESTING PERIPHERAL-BLOOD STEM-CELLS IN PEDIATRIC-PATIENTS

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TRANSFUSION SCIENCE 1994年第1期15卷 93-99页

作者： LEIBUNDGUT, K MUFF, J HIRT, A MITSCHULAT, H NYDEGGER, UE LUTHY, AR TOBLER, A WAGNER, HP [a]Department of Pediatrics Inselspital University of Bern CH-3010 Bern Switzerland[b]Department of Central Hematology Laboratory Inselspital University of Bern CH-3010 Bern Switzerland[c]Fresenius St. Wendel GmbH Medizintechnik W-6690 St Wendel Germany

In a single institution trial we carried out 35 peripheral blood stem cell harvesting procedures in 12 children with advanced malignancies to evaluate the procedure's safety and the collection efficiency of the Fresenius blood cell separator AS 104 in a pediatric population. Despite a significant mean decrease of 21% (+/-8%) in systolic blood pressure after starting the procedure, all children tolerated leukapheresis without any adverse reaction. After termination of leukapheresis there was a significant decrease of all determined hematological parameters, as compared with pre-harvest values. The mean mononuclear cell recovery was 64% (+/-26%), and in 25/35 (71%) harvesting procedures the minimum progenitor number required for safe autografting could be obtained by one single leukapheresis. We conclude that the Fresenius AS 104 blood cell separator provides a high cell yield and is a safe device for leukapheresis in pediatric patients.

关键词：设备安全性评价研究造血干细胞白细胞去除术/仪器和设备白细胞去除术/方法白血病淋巴细胞急性/治疗神经母细胞瘤/治疗肉瘤 Ewing/治疗青少年成年人儿童儿童学龄前女(雌)性人类婴儿男(雄)性

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白细胞单采术治疗维甲酸所致高白细胞症疗效观察

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中国误诊学杂志 2009年第7期9卷 1578-1579页

作者：黄海燕王志效济宁市中心血站山东济宁272041

目的:探讨白细胞单采术治疗维甲酸所致高白细胞症的临床效果。方法:对39例急性早幼粒细胞白血病(APL)服用全反式维甲酸所致的高白细胞症患者随机分为两组,治疗组20例,采用白细胞单采和DA方案(DNR、A ra-c);对照组19例,采用DA方案,比较... 详细信息

目的:探讨白细胞单采术治疗维甲酸所致高白细胞症的临床效果。方法:对39例急性早幼粒细胞白血病(APL)服用全反式维甲酸所致的高白细胞症患者随机分为两组,治疗组20例,采用白细胞单采和DA方案(DNR、A ra-c);对照组19例,采用DA方案,比较治疗前后两组患者白细胞数的变化。结果:治疗后治疗组白细胞下降程度明显高于对照组,两组白细胞计数和完全缓解率均有统计学差异。结论:白细胞单采治疗维甲酸所致高白细胞症效果良好,有利于APL缓解。

关键词：维甲酸/副作用白细胞增多/化学诱导/治疗白细胞去除术/方法人类

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A prospective, randomized, sequential, crossover trial of large-volume versus normal-volume leukapheresis procedures:: effect on progenitor cells and engraftment

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TRANSFUSION 1999年第10期39卷 1120-1127页

作者： Humpe, A Riggert, J Munzel, U Repas-Humpe, LM Vehmeyer, K Brunner, E Wörmann, B Köhler, M Univ Gottingen Dept Transfus Med D-37075 Gottingen Germany Univ Gottingen Dept Internal Med Div Hematol Oncol D-37075 Gottingen Germany Univ Gottingen Dept Med Stat D-37075 Gottingen Germany

BACKGROUND: The influence of leukapheresis size on the number of harvested peripheral blood progenitor cells is still unclear. A prospective randomized crossover trial was thus performed, to evaluate the effect of large-volume leukapheresis (LVL) versus normal-volume leukapheresis (NVL) on progenitor cells and engraftment in 26 patients with breast cancer and 15 patients with non-Hodgkin's lymphoma who were eligible for peripheral blood progenitor cell transplantation. STUDY DESIGN AND METHODS: Patients were randomly assigned to undergo either LVL on Day 1 and on Day 2 or vice versa. The number of progenitor cells was evaluated in the harvest and before and after leukapheresis in the peripheral blood. RESULTS: The number of harvested CD34+ cells (4.8 x 10(6) vs. 3.4 x 10(6)/kg body weight. p<0.001) and colony-forming units-granulocyte-macrophage (3.1 x 10(5) vs. 2.4 x 10(5)/kg body weight, p = 0.0026) was significantly higher for LVL procedures than for NVL procedures. The median extraction efficacy, defined as the difference between the yield in the harvest and the decrease in the total number of CD34+ cells in peripheral blood during leukapheresis, was significantly (p<0.0001) higher for LVL than for NVL (2.6 x 10(8) and 8 x 10(7), respectively). In patients with breast cancer, the median amount of CD34+ cells in the harvest and the median extraction efficacy were higher for LVL than for NVL (p<0.0001). This was not found for patients with non-Hodgkin's lymphoma. CONCLUSION: LVL results in a higher yield of CD34+ cells and colony-forming units-granulocyte;macrophage than NVL, but only in patients with breast cancer and with high numbers of CD34+ cells in the peripheral blood before leukapheresis.

关键词：抗原 CD34/分析乳腺肿瘤/血液乳腺肿瘤/外科学交叉研究低温保存粒细胞巨噬细胞集落刺激因子/分离和提纯造血干细胞移植造血干细胞/免疫学造血干细胞/生理学白细胞去除术/方法淋巴瘤非霍奇金/血液淋巴瘤非霍奇金/外科学前瞻性研究成年人女(雌)性人类男(雄)性中年人

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