Adverse reactions associated with mobile therapeutic apheresis: analysis of 17,940 procedures.
In order to evaluate the nature and frequency of adverse reactions associated with Therapeutic Apheresis (TA), database information from two large mobile apheresis services was analyzed. A total of 17,940 procedures performed on 3,583 patients were studied using an Access Database. Seventy percent (12,558) of the procedures were performed on a Fresenius AS104 blood cell separator and 30% (5,382) were performed on a COBE Spectra. The five most commonly treated diseases were Guillain-Barre Syndrome (25%), thrombotic thrombocytopenic purpura (20%), myasthenia gravis (18%), the hyperviscosity syndrome (12%), and chronic inflammatory demyelinating polyneuropathy (9%). All patients received calcium gluconate supplement during the procedures. Cardiac monitoring was used during 80% of the procedures and blood pressure monitoring was used during all procedures. All procedures were supervised by a physician. Both apheresis services fully comply with the ASFA Guidelines for Therapeutic Apheresis Providers. Adverse reactions occurred in 3.9% of all procedures. The following adverse reactions were documented: reactions related to ACD toxicity (3%), vasovagal reactions (0.5%), vascular access related complications (0.15%), reactions related to FFP (0.12%), hepatitis B from FFP (0.06%), arrhythmias (0.01%), hemolysis due to inappropriate dilution of 25% albumin (0.01%), and one death (from underlying disease) during a TA procedure (0.006%). These data demonstrate that therapeutic apheresis is associated with a low rate of side effects when performed by well-trained and certified nurses under the direction of experienced physicians, even in the diverse setting of large mobile therapeutic apheresis programs.
Kiprov
D D
DD
Division of Immunotherapy, Department of Medicine, California Pacific Medical Center, San Francisco, CA, USA. dkiprov@bamap.com
Golden
P
P
Rohe
R
R
Smith
S
S
Hofmann
J
J
Hunnicutt
J
J
D001781:Blood Component Removal / Q000009:adverse effects* / Q000592:standards / Q000706:statistics & numerical data; D001809:Blood Viscosity; D002404:Catheterization / Q000009:adverse effects; D016208:Databases, Factual; D020275:Guillain-Barre Syndrome / Q000150:complications / Q000628:therapy; D006402:Hematologic Diseases / Q000150:complications / Q000628:therapy; D006801:Humans; D008952:Mobile Health Units / Q000592:standards* / Q000706:statistics & numerical data; D009157:Myasthenia Gravis / Q000150:complications / Q000628:therapy; D019095:Point-of-Care Systems / Q000592:standards / Q000706:statistics & numerical data; D011115:Polyneuropathies / Q000150:complications / Q000628:therapy; D011697:Purpura, Thrombotic Thrombocytopenic / Q000150:complications / Q000628:therapy