title: Comprehensive technical and patient-care optimization in the management of pediatric apheresis for peripheral blood stem cell harvesting.
abstract: BACKGROUND
  Pediatric apheresis for peripheral blood stem cell transplantation should be carried out with due concern for low corporeal blood volume and vulnerability to hypocalcemia-related complications, hypovolemic shock, and hypervolemic cardiac overload.
  
  
  METHODS
  We retrospectively investigated a total of 267 apheresis procedures from 1990 to 2013 on 93 children between 0 and 10 years old, including 89 patients and 4 healthy donors, with body weights of 6.3 to 44.0 kg.
  
  
  RESULTS
  The median CD34+ cell yield per apheresis procedure was 2.3 × 106CD34+ cells/kg (0.2-77.9 × 106CD34+ cells/kg). Adverse events occurred in 11.6% of procedures (n = 31), including mild perivascular pain (n = 12), emesis (n = 9), hypotension (n = 3), urticaria (n = 2), numbness (n = 2), chest pain (n = 1), facial flush (n = 1), and abdominal pain (n = 1). Among hypotensive events, shock in a 9.6 kg one-year-old boy required emergency treatment in 1996. Thereafter, we adopted continuous injection of calcium gluconate, ionized calcium monitoring, central venous catheter access and circuit priming with albumin in addition to concentrated red cells. Since then we have had fewer complications: 16.4% per apheresis during 1990-1997 versus 5.8% during 1998-2013. No healthy pediatric donors suffered from any late-onset complications related to apheresis or G-CSF administration.
  
  
  CONCLUSIONS
  By employing appropriate measures, peripheral blood stem cell apheresis for small children can have an improved safety profile, even for children weighing <10 kg.
authors.affiliation: Department of Pediatrics, Fukushima Medical University, Fukushima, Japan; Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Ohara
authors.affiliation: Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan. Electronic address: hit-ohto@fmu.ac.jp.
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ohto
authors.affiliation: Department of Transfusion Medicine, The Jikei University School of Medicine, Tokyo, Japan.
authors.forename: Tetsunori
authors.initials: T
authors.lastname: Tasaki
authors.affiliation: Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Sano
authors.affiliation: Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Mochizuki
authors.affiliation: Department of Pediatrics, Fukushima Medical University, Fukushima, Japan; Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Mitsuko
authors.initials: M
authors.lastname: Akaihata
authors.affiliation: Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Department of Pediatrics, Fukushima Medical University, Fukushima, Japan; Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Tomoko
authors.initials: T
authors.lastname: Waragai
authors.affiliation: Department of Pediatrics, Fukushima Medical University, Fukushima, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Ito
authors.affiliation: Department of Pediatrics, Fukushima Medical University, Fukushima, Japan.
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Hosoya
authors.affiliation: Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Nollet
authors.affiliation: Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Division of Pediatric Oncology, The National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Chitose
authors.initials: C
authors.lastname: Ogawa
authors.affiliation: Japanese Red Cross Fukushima Blood Center, Fukushima, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kanno
authors.affiliation: Center for Medical Education and Career Development, Fukushima Medical University, Fukushima, Japan.
authors.forename: Yayoi
authors.initials: Y
authors.lastname: Shikama
authors.affiliation: Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan.
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kikuta
mesh_terms: D018952:Antigens, CD34 / Q000378:metabolism; D001781:Blood Component Removal / Q000009:adverse effects / Q000379:methods*; D001782:Blood Donors; D001794:Blood Pressure; D001835:Body Weight / Q000187:drug effects; D002118:Calcium / Q000008:administration & dosage / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D019587:Dietary Supplements; D005260:Female; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010146:Pain / Q000209:etiology; D005791:Patient Care / Q000379:methods*; D000072916:Peripheral Blood Stem Cells / Q000166:cytology* / Q000187:drug effects
chemical_list: D018952:Antigens, CD34; D002118:Calcium
keywords: Apheresis; CD34+ cell; Peripheral blood stem cell; Stem cell; Transplantation