title: Acute mechanical hemolysis as a complication of extracorporeal photopheresis in a low-weight child.
abstract: Graft-versus-host disease (GVHD) is a complication of allogeneic hematopoietic stem cell transplantation with high morbidity and mortality. Extracorporeal photopheresis (ECP) is an effective therapy for treating medication-refractory GVHD, however, there is scant evidence of whether ECP can be safely performed in patients weighing less than 15 kg. Here, we report the implementation of a successful protocol to perform ECP in a 21-month-old, 10.6 kg female with medication-refractory GVHD. Our initial ECP treatment resulted in significant hemolysis that was most likely mechanical. After procedural adjustments that included modifying the anticoagulation dose and whole blood:anticoagulant ratio, as well as whole blood processing time, the patient tolerated future procedures safely without hemolysis or other adverse events. With appropriate technical modifications, we provide a framework for safely performing ECP in children less than 15 kg.
authors.affiliation: New York-Presbyterian Hospital, New York, New York.
authors.forename: Robert A
authors.initials: RA
authors.lastname: DeSimone
authors.affiliation: New York-Presbyterian Hospital, New York, New York.
authors.forename: Sandeep N
authors.initials: SN
authors.lastname: Wontakal
authors.affiliation: New York-Presbyterian Hospital, New York, New York.
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Lyashchenko
authors.affiliation: New York-Presbyterian Hospital, New York, New York.|Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.
authors.forename: Joseph
authors.initials: J
authors.lastname: Schwartz
mesh_terms: D000925:Anticoagulants; D001835:Body Weight; D002985:Clinical Protocols; D005260:Female; D006086:Graft vs Host Disease / Q000628:therapy*; D006461:Hemolysis; D006801:Humans; D007223:Infant; D017893:Photopheresis / Q000009:adverse effects* / Q000379:methods; D016879:Salvage Therapy / Q000379:methods
chemical_list: D000925:Anticoagulants
keywords: adverse event; apheresis; graft-versus-host disease; hemolysis; pediatric intensive care unit