Procedure-related complications and adverse events associated with pediatric autologous peripheral blood stem cell collection.
BACKGROUND
Autologous peripheral blood hematopoietic progenitor cell collection (A-HPCC) in pediatric patients is considered relatively safe although technically challenging. Very little is known regarding the incidence, risk factors and impact of procedure-related adverse events (AE) on pediatric A-HPCC outcomes.


METHODS
Prospective 4.5-year review of AE associated with pediatric A-HPCC. AE were graded by severity and type. Potential demographic and procedural risk factors, and the impact on product quality, were compared by t-test, chi-square, and linear regression.


RESULTS
Sixty-two children underwent 110 A-HPCC, including 36 (58%) under 20 kg. Fifty-five AE were documented in 25.4% A-HPCCs and 39% of children (citrate 25%, access 19%, technical 11%, cardiovascular 0%, allergic 1.8%). No AE were noted in children < 10 kg anticoagulated with heparin. Access and technical AE accounted for 73% of severe AE, with line-related problems underlying most technical AE (87.5%, P = 0.006). AE were more likely in older (P = 0.012), heavier patients (P = 0.02), who frequently required more than one A-HPCC (P = 0.012). In contrast, young children were more likely to experience citrate AE with gastrointestinal symptoms (median age, 6 years; P = 0.076). AE had no impact on CD34 collection rates; however, mean CD34 yields (4.2 vs. 20.4 million/kg; P = 0.0035) were decreased in patients with technical AE due to lower peripheral CD34 counts and a high number of aborted procedures (37%).


CONCLUSIONS
Venous access and flow-related issues are a major factor associated with moderate and severe AE, effecting ∼10% of patients. AE are more frequent with increasing patient age, weight, and number of procedures. J. Clin. Apheresis 32:35-48, 2017. © 2016 Wiley Periodicals, Inc.
Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Laura
L
Cooling
Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Sandra
S
Hoffmann
Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Dawn
D
Webb
Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Micheal
M
Meade
Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Chisa
C
Yamada
Department of Pathology, University of Michigan, Ann Arbor, Michigan.
Robertson
R
Davenport
Department of Pediatric Bone Marrow Transplantation, University of Michigan, Ann Arbor, Michigan.
Gregory
G
Yanik
D000293:Adolescent; D000367:Age Factors; D018952:Antigens, CD34 / Q000032:analysis / Q000097:blood; D001835:Body Weight; D002469:Cell Separation / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D006801:Humans; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D000072916:Peripheral Blood Stem Cells / Q000166:cytology*; D014182:Transplantation, Autologous
D018952:Antigens, CD34
adverse event; leukapheresis; pediatric; stem cell