Peripheral blood stem cell recovery following early termination of apheresis due to hypotension in a 4.8-kg infant.
We report a case in which peripheral blood stem cells (PBSC) were successfully recovered following early termination of a collection procedure due to hypotension in a 7-month-old patient. The patient was diagnosed at 4 months of age with neuroblastoma stage IV-S with favorable Shimada histology. She had completed two cycles of chemotherapy before the PBSC collection (PSCC). The procedure was performed on the Cobe Spectra in manual mode, and terminated after 35 min due to severe hypotension. Etiologies considered for the hypotensive episode included a transfusion reaction to the unit of red blood cells (RBC) used for priming the Spectra, citrate reaction, and hypovolemia due to blood drawn for laboratory testing and fluid shifts at the beginning of the procedure. Hypovolemia was ultimately determined to be the most likely etiology. A rinseback was performed into a transfer bag, and the cells were sent to the laboratory for analysis of CD34+ cell yield, volume reduction, and cryopreservation. An adequate number of PBSC were recovered to permit successful autologous transplantation. The ability to recover PBSC from the Spectra white blood cell collection set allowed the patient to avoid undergoing another PSCC. In procedures involving small children, the blood volume drawn for preprocedure testing should be limited to less than 10% of the patient's total blood volume, and the RBC prime should at a minimum replace the entire extracorporeal volume. If the procedure must be terminated early, sufficient PBSC may be recoverable from the blood in the apheresis instrument.
Alex
Jessie
J
DeGowin Blood Center, Department of Pathology, University of Iowa Carver College of Medicine, Iowa City, Iowa 52242, USA.
Bahl
Matthew J
MJ
Schlueter
Annette J
AJ
D016238:Cytapheresis; D017707:Erythrocyte Transfusion; D005260:Female; D006412:Hematopoietic Stem Cells; D006801:Humans; D007022:Hypotension / Q000209:etiology* / Q000628:therapy; D020896:Hypovolemia / Q000209:etiology / Q000628:therapy; D007223:Infant; D009447:Neuroblastoma / Q000628:therapy*; D036102:Peripheral Blood Stem Cell Transplantation; D014182:Transplantation, Autologous