Comparative evaluation of a heparin-citrate anticoagulation for LDL-apheresis in two primary apheresis systems.
BACKGROUND
As COBE Spectra has been replaced in many parts of the world, we describe a new protocol for low-density lipoprotein (LDL)-apheresis performed on familial hypercholesterolemia patients for the Spectra Optia platform.


METHODS
For all procedures, after administering a bolus of heparin of 2,500 U, 10,000 U of heparin added to a 600 ml ACD-A bag was used as anticoagulant (AC). In a first phase (A), 16 apheresis procedures with COBE Spectra using an inlet:AC ratio of 25:1 were compared to 18 LDL-apheresis treatments with Spectra Optia at split Inlet:AC ratios of 16:1/18:1 or 20:1/25:1. Platelet activation and coagulation markers were assessed. In a follow-up phase (B), 20 procedures on Spectra Optia using an inlet:AC ratio of 20:1 were performed.


RESULTS
Although coagulation markers and platelet activation analyzed were similar in both apheresis devices used, COBE Spectra procedures did not show any visual clumping in the sets. Visual analysis of clumping was highest in the Spectra Optia's 20:1/25:1 AC regimen (5/8 procedures). For the lowest Spectra Optia, AC regimen and during the follow-up phase reversible clump formation in the disposable set was similar (1/10 procedures). Clumping was successfully reversed in all cases by temporarily lowering the inlet:AC ratio to 18:1. Blood cell counts (WBC, Plt, Hct) were similar for both COBE Spectra and Spectra Optia procedures. Spectra Optia had a significantly higher plasma removal efficiency versus COBE Spectra (84% vs.75%, P < .05). No serious adverse events were observed.


CONCLUSIONS
Apheresis procedures on the Spectra Optia system with low-dose heparin-citrate anticoagulation are feasible and safe.
German Haemapheresis Centre, Cologne, Germany.
Doris
D
Handschel
Department of Scientific Services and Support, Terumo BCT, Zaventem, Belgium.
Michiel
M
Etienne Janssens
Department of Scientific Services and Support, Terumo BCT, Zaventem, Belgium.
Marion
M
Gericke
Department of Scientific Services and Support, Terumo BCT, Zaventem, Belgium.
Stef
S
De Reys
German Haemapheresis Centre, Cologne, Germany.
Helmut
H
Borberg
D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects; D001777:Blood Coagulation; D001781:Blood Component Removal / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D002784:Cholesterol / Q000097:blood; D019343:Citric Acid / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000097:blood / Q000628:therapy; D008077:Lipoproteins, LDL / Q000097:blood* / Q000302:isolation & purification*; D008297:Male; D010951:Plasma Exchange / Q000379:methods
D000925:Anticoagulants; D008077:Lipoproteins, LDL; D019343:Citric Acid; D006493:Heparin; D002784:Cholesterol
LDL-apheresis; Spectra Optia; anticoagulation; citrate; heparin