title: Anticoagulation in large-volume leukapheresis: comparison between citrate- versus heparin-based anticoagulation on safety and CD34 (+) cell collection efficiency.
abstract: OBJECTIVE
  Little is known of the effect of anticoagulation on peripheral blood progenitor cell (PBPC) harvest during large-volume leukapheresis (LVL). Because of the interaction of heparin with stromal cell-derived factor (SDF)-1α, it has been proposed that a heparin-based anticoagulation may result in an increased PBPC collection efficiency compared with standard citrate-based anticoagulation.
  
  
  METHODS
  We conducted a prospective randomized trial to address the effect of both anticoagulation regimes on safety, subjective comfort and CD34 (+) collection efficiency in 90 adult patients undergoing standardized LVL. Anticoagulation consisted of either citrate (group C) or a combination of heparin and low-dose citrate (group H).
  
  
  RESULTS
  The overall incidence of adverse reactions (AR) during LVL was 17%. AR consisted only of citrate-related AR; no bleeding complications were observed. Determination of parameters of the acid-base balance revealed a higher frequency of metabolic alkalosis in group C. Analysis of serum SDF-1α revealed no differences in SDF-1α plasma levels. There were no differences in the CD34 (+) cell collection efficiency, resulting in the harvest of equal CD34 (+) cell yields independent of the anticoagulation used.
  
  
  CONCLUSIONS
  Our data show no clinical relevant effect of a heparin containing anticoagulation in terms of an increased overall CD34 (+) cell collection during LVL, although this regime shows some benefits in terms of the incidence and subjective tolerance towards AR. Based on our results the decision between a citrate- and heparin-substituted anticoagulation for LVL should be driven by patient-related factors, and should concern potential contraindications of both methods.
authors: Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Austria. markus.dettke@meduniwien.ac.at
authors: Markus
authors: M
authors: Dettke
authors: Christoph
authors: C
authors: Buchta
authors: Helfried
authors: H
authors: Wiesinger
authors: Jens-Holger
authors: JH
authors: Maas
authors: Alexander
authors: A
authors: Strate
authors: Ying
authors: Y
authors: Chen
mesh_terms: D000138:Acidosis; D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000494:pharmacology*; D018952:Antigens, CD34; D001772:Blood Cell Count; D001777:Blood Coagulation; D001810:Blood Volume; D054377:Chemokine CXCL12 / Q000097:blood / Q000737:chemistry; D019343:Citric Acid / Q000009:adverse effects / Q000494:pharmacology*; D005260:Female; D006493:Heparin / Q000009:adverse effects / Q000494:pharmacology*; D006801:Humans; D007937:Leukapheresis / Q000379:methods* / Q000592:standards; D007963:Leukocytes, Mononuclear; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D018952:Antigens, CD34; C515255:CXCL12 protein, human; D054377:Chemokine CXCL12; D019343:Citric Acid; D006493:Heparin