Regional anticoagulation with acid citrate dextrose-A for extracorporeal photoimmunochemotherapy.
OBJECTIVE
During photopheresis, intravenous heparin is used to prevent clotting in the extracorporeal circuit. Regional citrate anticoagulation could lower the risks associated with heparin treatment.


METHODS
Four-hundred and six photophereses procedures that were anticoagulated by acid citrate dextrose-A (ACD-A) (of which 343 were performed in patients at risk for haemorrhage) were analysed together with 278 heparin-anticoagulated treatments.


RESULTS
Four-hundred and four of 406 citrate treatments were completed. Seven transient paresthesias (1.73%), five of which occurred in the first 50 treatments, were observed. Bleeding complications were noted during heparin anticoagulation (1.07%), but not during citrate anticoagulation. During photopheresis, haemoglobin values and platelet counts decreased by 11.4% and 14.6%, respectively (P < 0.0001). Twenty-four hours after treatment, haemoglobin values, and platelet and leucocyte counts were still lower than at baseline (P < 0.0001). The changes of haemoglobin, platelet and leucocyte values did not differ for citrate and heparin.


CONCLUSIONS
In patients with contraindications against heparin use, ACD-A citrate anticoagulation during photopheresis is a safe and efficient alternative. Photopheresis induces profound changes of the blood count, irrespective of the anticoagulation method.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use*; D002648:Child; D019343:Citric Acid / Q000627:therapeutic use; D005260:Female; D005947:Glucose / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006454:Hemoglobins / Q000032:analysis; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D017893:Photopheresis / Q000379:methods*; D010976:Platelet Count; D012039:Regional Blood Flow; D012189:Retrospective Studies
D000925:Anticoagulants; D006454:Hemoglobins; C002113:acid citrate dextrose; D019343:Citric Acid; D006493:Heparin; D005947:Glucose