title: Large volume leukapheresis is efficient and safe even in small children up to 15 kg body weight.
abstract: BACKGROUND
  The collection of peripheral blood stem cells, although now a routine procedure, is still a challenge in low body weight children because of specific technical and clinical issues. For paediatric patients it is crucial to obtain an adequate number of CD34+ cells with the minimum number of procedures: this can be done using large volume leukapheresis (LVL).
  
  
  METHODS
  We analysed the efficacy and safety of 54 autologous LVL performed in 50 children (33 [66%] males and 17 [34%] females), median age 2 years (range, 1-5) and median body weight 12 kg (range, 6-15). The procedures were performed with a COBE Spectra previously primed with red blood cells; ACD-A solution and heparin were used as anticoagulants.
  
  
  RESULTS
  The target CD34+ cell dose (≥5×10/kg body weight) were collected with one LVL in 46 (92%) patients, while four (8%) patients needed another procedure. All our LVL were well tolerated. Side effects were observed in five (9.2%) patients and one procedure had to be discontinued because of catheter-related haemorrhage. The platelet count decreased significantly (p<0.001) after each procedure but without bleeding or need for transfusion support.
  
  
  CONCLUSIONS
  Our experience confirms that LVL is efficient and safe even in small children, if the procedure is adjusted considering the weight and age of child. The most important factors are good venous access, adequate preparation of the child's electrolyte status, and surroundings in which the small child as well as parents feel comfortable, and can tolerate the procedure better. Although a median platelet loss of 50% can be expected, LVL is safe and reduces the overall number of procedures required. It can be recommended for peripheral blood stem cell collection even in small body weight children with malignant diseases, particularly those who mobilise low numbers of CD34+ cells.
authors.affiliation: Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre, Zagreb, Croatia.
authors.forename: Ines
authors.initials: I
authors.lastname: Bojanic
authors.affiliation: Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre, Zagreb, Croatia.
authors.forename: Sanja
authors.initials: S
authors.lastname: Mazic
authors.affiliation: Department of Paediatrics, University Hospital Centre, Zagreb, Croatia.
authors.forename: Ljubica
authors.initials: L
authors.lastname: Rajic
authors.affiliation: Department of Oncology, Children's Hospital Zagreb, Zagreb, Croatia.
authors.forename: Gordana
authors.initials: G
authors.lastname: Jakovljevic
authors.affiliation: Department of Oncology, Children's Hospital Zagreb, Zagreb, Croatia.
authors.forename: Jasminka
authors.initials: J
authors.lastname: Stepan
authors.affiliation: Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre, Zagreb, Croatia.
authors.forename: Branka Golubic
authors.initials: BG
authors.lastname: Cepulic
mesh_terms: D000925:Anticoagulants / Q000627:therapeutic use; D001835:Body Weight; D002675:Child, Preschool; D019343:Citric Acid / Q000627:therapeutic use; D005260:Female; D005947:Glucose / Q000031:analogs & derivatives / Q000627:therapeutic use; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007223:Infant; D007937:Leukapheresis / Q000379:methods*; D008297:Male
chemical_list: D000925:Anticoagulants; C002113:acid citrate dextrose; D019343:Citric Acid; D006493:Heparin; D005947:Glucose