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Infanti L, Leitner G, Moe M, Pehlic V, Cattaneo M, Benkert P, Holbro A, Passweg J, Worel N, Buser A. Blood donation for iron removal in individuals with HFE mutations: study of efficacy and safety and short review on hemochromatosis and blood donation. Front Med (Lausanne) 2024; 11:1362941. [PMID: 38566922 PMCID: PMC10986032 DOI: 10.3389/fmed.2024.1362941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Background Elevated serum ferritin with/without HFE variants in asymptomatic persons leads frequently to referral for blood donation. Hemochromatosis (p.C282Y/p.C282Y) only requires treatment. We evaluated safety and feasibility of iron removal in healthy persons with elevated ferritin and HFE variants using blood donation procedures. Materials and methods Thirty subjects with ferritin >200 ng/mL (women) or >300 ng/mL (men) with p.C282Y/p.C282Y, p.C282Y/p.H63D or p.H63D/p.H63D were randomized to weekly phlebotomy (removal of 450 mL whole blood) or erythrapheresis (removal of 360 mL red blood cells) every 14 days. The ferritin target was <100 ng/mL. A full blood count and ferritin were measured at each visit. Hemoglobin (Hb) ≥140 g/L was required at inclusion. If Hb dropped to <120 g/L (women) or <130 g/L (men), procedures were postponed (7 or 14 days). Primary endpoint was the number of procedures needed to the ferritin target; secondary objectives were duration of treatment and compliance. The treatment effect was tested with Poisson regression; number of procedures and treatment duration were compared between study arms with the Kruskal-Wallis test. Results Twenty-five of 30 participants were men (83%); mean age was 47 years (SD 10.5), mean BMI 26.6 kg/m2 (SD 3.6); 17 had p.C282Y/p.C282Y, nine p.C282Y/p.H63D, four p.H63D/p.H63D. Median baseline Hb was 150 g/L (IQR 144, 1,559), median ferritin 504 ng/mL (IQR 406,620). Twenty-seven subjects completed the study. Treatment arm (p < 0.001) and HFE variant (p = 0.007) influenced the primary endpoint significantly. To ferritin levels <100 ng/mL, a median number of 7.5 (IQR 6.2, 9.8) phlebotomies and 4.0 (IQR 3.0, 5.8) erythraphereses (p = 0.001) was needed during a median of 66.5 days (IQR 49,103) and 78.5 days (IQR 46139), respectively (p = 0.448). Low Hb was the principal reason for protocol violation; anemia occurred in 13 participants (48%). Immediate complications were infrequent; fatigue was reported after 25% of phlebotomies and 45% of erythraphereses. Thirty-five procedures were postponed because of low Hb and 15 for non-medical reasons. The median interval was 7.0 (IQR 7.7) and 14.0 (IQR 14, 20) days between phlebotomies and erythraphereses, respectively. Conclusion Blood donation procedures remove iron effectively in HC, but frequent treatments cause Hb decrease and fatigue that can impair feasibility.
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Affiliation(s)
- Laura Infanti
- Regional Blood Transfusion Centre Swiss Red Cross Basel, Basel, Switzerland
- Division of Hematology, University Hospital, University of Basel, Basel, Switzerland
| | | | - Morten Moe
- Unit of Medical Biochemistry, Division of Diagnostics and Technology, Akershus University Hospital, Akershus, Norway
| | - Vildana Pehlic
- Regional Blood Transfusion Centre Swiss Red Cross Basel, Basel, Switzerland
| | - Marco Cattaneo
- Clinical Trial Unit, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University and University Hospital Basel, Basel, Switzerland
| | - Andreas Holbro
- Regional Blood Transfusion Centre Swiss Red Cross Basel, Basel, Switzerland
- Division of Hematology, University Hospital, University of Basel, Basel, Switzerland
| | - Jakob Passweg
- Division of Hematology, University Hospital, University of Basel, Basel, Switzerland
| | - Nina Worel
- Department for Transfusion Medicine and Cell Therapy, Medical University Vienna, Vienna, Austria
| | - Andreas Buser
- Regional Blood Transfusion Centre Swiss Red Cross Basel, Basel, Switzerland
- Division of Hematology, University Hospital, University of Basel, Basel, Switzerland
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2
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Rombout-Sestrienkova E, Winkens B, van Kraaij M, van Deursen CTBM, Janssen MCH, Rennings AMJ, Evers D, Kerkhoffs JL, Masclee A, Koek GH. A predictive model for estimating the number of erythrocytapheresis or phlebotomy treatments for patients with naïve hereditary hemochromatosis. J Clin Apher 2020; 36:340-347. [PMID: 33368569 PMCID: PMC8247321 DOI: 10.1002/jca.21867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023]
Abstract
Background and Aims Standard treatment for naïve hereditary hemochromatosis patients consists of phlebotomy or a personalized erythrocytapheresis. Erythrocytapheresis is more efficient, but infrequently used because of perceived costs and specialized equipment being needed. The main aim of our study was to develop a model that predicts the number of initial treatment procedures for both treatment methods. This information may help the clinician to select the optimal treatment modality for the individual patient. Methods We analyzed retrospective data of 125 newly diagnosed patients (C282Y homozygous), treated either with phlebotomy (n = 54) or erythrocytapheresis (n = 71) until serum ferritin (SF) reached levels ≤100 μg/L. To estimate the required number of treatment procedures multiple linear regression analysis was used for each treatment method separately. Results The linear regression model with the best predictive quality (R2 = 0.74 and 0.73 for erythrocytapheresis and phlebotomy respectively) included initial SF, initial hemoglobin (Hb) level, age, and BMI, where initial SF was independently related to the total number of treatment procedures for both treatment methods. The prediction error expressed in RMSPE and RMSDR was lower for erythrocytapheresis than for phlebotomy (3.8 and 4.1 vs 7.0 and 8.0 respectively), Conclusions Although the prediction error of the developed model was relatively large, the model may help the clinician to choose the most optimal treatment method for an individual patient. Generally erythrocytapheresis halves the number of treatment procedures for all patients, where the largest reduction (between 55% and 64%) is reached in patients with an initial Hb level ≥ 9 mmol/L (14.5 g/dL). ClinicalTrials.gov number NCT00202436.
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Affiliation(s)
- Eva Rombout-Sestrienkova
- Department of Transfusion Medicine, Sanquin Blood Supply, Blood Bank Division, Amsterdam, The Netherlands.,Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and statistics, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Marian van Kraaij
- Department of Transfusion Medicine, Sanquin Blood Supply, Blood Bank Division, Amsterdam, The Netherlands
| | | | - Mirian C H Janssen
- Department of General Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.,Department of Pediatrics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Alexander M J Rennings
- Department of General Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Dorothea Evers
- Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Jean-Louis Kerkhoffs
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Hematology, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Ad Masclee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ger H Koek
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
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3
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Padmanabhan A, Connelly-Smith L, Aqui N, Balogun RA, Klingel R, Meyer E, Pham HP, Schneiderman J, Witt V, Wu Y, Zantek ND, Dunbar NM, Schwartz GEJ. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice - Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Eighth Special Issue. J Clin Apher 2019; 34:171-354. [PMID: 31180581 DOI: 10.1002/jca.21705] [Citation(s) in RCA: 760] [Impact Index Per Article: 152.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating and categorizing indications for the evidence-based use of therapeutic apheresis (TA) in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Eighth Edition of the JCA Special Issue continues to maintain this methodology and rigor in order to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Eighth Edition, like its predecessor, continues to apply the category and grading system definitions in fact sheets. The general layout and concept of a fact sheet that was introduced in the Fourth Edition, has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of TA in a specific disease entity or medical condition. The Eighth Edition comprises 84 fact sheets for relevant diseases and medical conditions, with 157 graded and categorized indications and/or TA modalities. The Eighth Edition of the JCA Special Issue seeks to continue to serve as a key resource that guides the utilization of TA in the treatment of human disease.
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Affiliation(s)
- Anand Padmanabhan
- Medical Sciences Institute & Blood Research Institute, Versiti & Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance & University of Washington, Seattle, Washington
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Department of Medicine, University of Virginia, Charlottesville, Virginia
| | - Reinhard Klingel
- Apheresis Research Institute, Cologne, Germany & First Department of Internal Medicine, University of Mainz, Mainz, Germany
| | - Erin Meyer
- Department of Hematology/Oncology/BMT/Pathology, Nationwide Children's Hospital, Columbus, Ohio
| | - Huy P Pham
- Department of Pathology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Jennifer Schneiderman
- Department of Pediatric Hematology/Oncology/Neuro-oncology/Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, Illinois
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks NW & Department of Laboratory Medicine, University of Washington, Seattle, Washington, Yale University School of Medicine, New Haven, Connecticut
| | - Nicole D Zantek
- Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Abstract
Iron-overload syndromes may be hereditary or acquired. Patients may be asymptomatic early in the disease. Once heart failure develops, there is rapid deterioration. Cardiac hemochromatosis is characterized by a dilated cardiomyopathy with dilated ventricles, reduced ejection fraction, and reduced fractional shortening. Deposition of iron may occur in the entire cardiac conduction system, especially the atrioventricular node. Cardiac hemochromatosis should be considered in any patient with unexplained heart failure. Screening for systemic iron overload with serum ferritin and transferin saturation should be performed. If these tests are consistent with iron overload, further noninvasive and histologic confirmation is indicated to confirm organ involvement with iron overload. Cardiac magnetic resonance imaging is superior to other diagnostic tests since it can quantitatively assess myocardial iron load. Therapeutic phlebotomy is the therapy of choice in nonanemic patients with cardiac hemochromatosis. Therapeutic phlebotomy should be started in men with serum ferritin levels of 300 μg/l or more and in women with serum ferritin levels of 200 μg/l or more. Therapeutic phlebotomy consists of removing 1 unit of blood (450 to 500 ml) weekly until the serum ferritin level is 10 to 20 μg/l and maintenance of the serum ferritin level at 50 μg/l or lower thereafter by periodic removal of blood. Phlebotomy is not a treatment option in patients with anemia (secondary iron-overload disorders) nor in patients with severe congestive heart failure. In these patients, the treatment of choice is iron chelation therapy.
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Affiliation(s)
- Wilbert S Aronow
- Cardiology Division, Department of Medicine, Westchester Medical Center/New York Medical College, Valhalla, NY, USA
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5
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Schwartz J, Padmanabhan A, Aqui N, Balogun RA, Connelly-Smith L, Delaney M, Dunbar NM, Witt V, Wu Y, Shaz BH. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach from the Writing Committee of the American Society for Apheresis: The Seventh Special Issue. J Clin Apher 2017; 31:149-62. [PMID: 27322218 DOI: 10.1002/jca.21470] [Citation(s) in RCA: 276] [Impact Index Per Article: 39.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The American Society for Apheresis (ASFA) Journal of Clinical Apheresis (JCA) Special Issue Writing Committee is charged with reviewing, updating, and categorizing indications for the evidence-based use of therapeutic apheresis in human disease. Since the 2007 JCA Special Issue (Fourth Edition), the Committee has incorporated systematic review and evidence-based approaches in the grading and categorization of apheresis indications. This Seventh Edition of the JCA Special Issue continues to maintain this methodology and rigor to make recommendations on the use of apheresis in a wide variety of diseases/conditions. The JCA Seventh Edition, like its predecessor, has consistently applied the category and grading system definitions in the fact sheets. The general layout and concept of a fact sheet that was used since the fourth edition has largely been maintained in this edition. Each fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis in a specific disease entity. The Seventh Edition discusses 87 fact sheets (14 new fact sheets since the Sixth Edition) for therapeutic apheresis diseases and medical conditions, with 179 indications, which are separately graded and categorized within the listed fact sheets. Several diseases that are Category IV which have been described in detail in previous editions and do not have significant new evidence since the last publication are summarized in a separate table. The Seventh Edition of the JCA Special Issue serves as a key resource that guides the utilization of therapeutic apheresis in the treatment of human disease. J. Clin. Apheresis 31:149-162, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York
| | - Anand Padmanabhan
- Blood Center of Wisconsin, Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Nicole Aqui
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rasheed A Balogun
- Division of Nephrology, University of Virginia, Charlottesville, Virginia
| | - Laura Connelly-Smith
- Department of Medicine, Seattle Cancer Care Alliance and University of Washington, Seattle, Washington
| | - Meghan Delaney
- Bloodworks Northwest, Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Volker Witt
- Department for Pediatrics, St. Anna Kinderspital, Medical University of Vienna, Vienna, Austria
| | - Yanyun Wu
- Bloodworks Northwest, Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Beth H Shaz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York.,New York Blood Center, Department of Pathology.,Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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6
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Rombout-Sestrienkova E, van Kraaij MGJ, Koek GH. How we manage patients with hereditary haemochromatosis. Br J Haematol 2016; 175:759-770. [PMID: 27723100 DOI: 10.1111/bjh.14376] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A number of disorders cause iron overload: some are of genetic origin, such as hereditary haemochromatosis, while others are acquired, for instance due to repeated transfusions. This article reviews the treatment options for hereditary haemochromatosis, with special attention to the use of erythrocytapheresis. In general, therapy is based on the removal of excess body iron, for which ferritin levels are used to monitor the effectiveness of treatment. For many decades phlebotomy has been widely accepted as the standard treatment. Recent publications suggest that erythrocytapheresis, as a more individualized treatment, can provide a good balance between effectiveness, tolerability and costs. Other treatments like oral chelators and proton pomp inhibitors, which are used in selected patients, create the possibility to further individualize treatment of hereditary haemochromatosis. In the future, hepcidin-targeted therapy could provide a more fundamental approach to treatment.
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Affiliation(s)
- Eva Rombout-Sestrienkova
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands.,Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, the Netherlands
| | - Marian G J van Kraaij
- Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, the Netherlands
| | - Ger H Koek
- Division of Gastroenterology & Hepatology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
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7
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Acute Disseminated Encephalomyelitis. J Clin Apher 2016; 31:163-202. [PMID: 27322219 DOI: 10.1002/jca.21474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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8
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Rombout-Sestrienkova E, Koek GH, Neslo R, van Kraaij M, Menheere PP, Masclee A, Swinkels DW. Course of iron parameters in HFE-hemochromatosis patients during initial treatment with erythrocytapheresis compared to phlebotomy. J Clin Apher 2016; 31:564-570. [PMID: 26878994 DOI: 10.1002/jca.21451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/21/2015] [Accepted: 01/25/2016] [Indexed: 12/19/2022]
Abstract
Current treatment for newly diagnosed patients with hereditary hemochromatosis (HH) and iron overload consist of weekly phlebotomy or less frequent and more personalized erythrocytapheresis. Previous observations during phlebotomy suggest an increase in intestinal iron uptake caused by lowering of hepcidin as a result of intensive bloodletting. It is not known whether such an effect is present or even more pronounced using erythrocytapheresis since a larger amount of iron is extracted per procedure. In this study we aimed to assess the effect of erythrocytapheresis on the course of iron parameters, with special focus on serum hepcidin. We performed a retrospective proof-of-principle observational study, comparing serum iron parameters in 12 males during the depletion phase using either phlebotomy (n = 6) or erythrocytapheresis (n = 6). Decreases in serum ferritin over time were similar for both treatments but more pronounced using erythrocytapheresis when expressed per treatment procedure. Hemoglobin did not change during erythrocytapheresis, whereas during phlebotomy decreased with 10%. Increase of erythropoietin and soluble transferrin receptor and decrease in transferrin saturation were similar for both treatments. Reduction in serum hepcidin was higher (50% versus 25% of initial value) and occurred more early using phlebotomy (10 versus 20 weeks after start). In aggregate, compared to phlebotomy, the less frequent and more personalized erythrocytapheresis leads to a more pronounced decrease in serum ferritin per treatment procedure, without a larger decrease in serum hepcidin. This may be clinically relevant and may prevent an increase in intestinal iron uptake and an ensuing vicious circle of more frequent treatment procedures. J. Clin. Apheresis 31:564-570, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Eva Rombout-Sestrienkova
- Blood Bank Division, Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands.,Division of Gastroenterology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ger H Koek
- Division of Gastroenterology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rabin Neslo
- Sanquin Blood Supply, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Transfusion Technology Assessment Department, Utrecht, The Netherlands
| | - Marian van Kraaij
- Blood Bank Division, Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands.,Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul P Menheere
- Department of Clinical Chemistry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ad Masclee
- Division of Gastroenterology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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9
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Řeháček V, Bláha M, Jiroušová H, Černohorská J, Papoušek P. Therapeutic Erythrocytapheresis in the Initial Treatment of Hereditary Hemochromatosis. ACTA MEDICA (HRADEC KRÁLOVÉ) 2015; 55:180-5. [DOI: 10.14712/18059694.2015.43] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: The current treatment of hereditary hemochromatosis (HH) consists of performing periodic whole blood phlebotomies. Erythrocytapheresis (EA) can remove up to three times more red blood cells per single procedure and could thus have a clinical benefit. A prospective study of 30 consecutive cases of HH were included in a periodic EA program. Methods and patients: EA were performed using a discontinuous flow cell separators. The protocol consisted of a bimonthly EA until normalization of the serum ferritin was reached. The aim was to reduce the total erythrocyte volume by 25–35%, eventually, to adjust the amount so that hematocrit would not drop below 0.25. Results: 530 ± 101 ml of erythrocytes were removed (median 517, range 116–761 ml). Iron depletion (ferritin < 20 μg/l) was achieved in all patients after a mean 6.9 ± 7.6 months, median 5 months, range 1–36 months and a mean 14 EA sessions. The procedures were well tolerated and there were no severe side-effects. Conclusions: We conclude that HH patients treated with EA achieved iron depletion quickly under good conditions of tolerance. The efficacy, speed, tolerability, and more favorable schedule of an EA program facilitate treatment of HH.
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10
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de Graaff B, Neil A, Sanderson K, Si L, Yee KC, Palmer AJ. A Systematic Review and Narrative Synthesis of Health Economic Studies Conducted for Hereditary Haemochromatosis. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2015; 13:469-483. [PMID: 26255179 DOI: 10.1007/s40258-015-0189-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Hereditary haemochromatosis (HH) is a common genetic condition amongst people of northern European heritage. HH is associated with increased iron absorption leading to parenchymal organ damage and multiple arthropathies. Early diagnosis and treatment prevents complications. Population screening may increase early diagnosis, but no programmes have been introduced internationally: a paucity of health economic data is often cited as a barrier. OBJECTIVE To conduct a systematic review of all health economic studies in HH. METHODS Studies were identified through electronic searching of economic/biomedical databases. Any study on HH with original economic component was included. Study quality was formally assessed. Health economic data were extracted and analysed through narrative synthesis. RESULTS Thirty-eight studies met the inclusion criteria. The majority of papers reported on costs or cost effectiveness of screening programmes. Whilst most concluded screening was cost effective compared with no screening, methodological flaws limit the quality of these findings. Assumptions regarding clinical penetrance, effectiveness of screening, health-state utility values (HSUVs), exclusion of early symptomatology (such as fatigue, lethargy and multiple arthropathies) and quantification of costs associated with HH were identified as key limitations. Treatment studies concluded therapeutic venepuncture was the most cost-effective intervention. CONCLUSIONS There is a paucity of high-quality health economic studies relating to HH. The development of a comprehensive HH cost-effectiveness model utilising HSUVs is required to determine whether screening is worthwhile.
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Affiliation(s)
- Barbara de Graaff
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia
| | - Amanda Neil
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia
| | - Kristy Sanderson
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia
| | - Lei Si
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia
| | - Kwang Chien Yee
- School of Medicine, University of Tasmania, Medical Science 1 Building, 17 Liverpool St, Private Bag 68, Hobart, TAS, 7000, Australia
| | - Andrew J Palmer
- Menzies Institute for Medical Research, University of Tasmania, Medical Science Building 2, 17 Liverpool St (Private Bag 23), Hobart, Tasmania, 7000, Australia.
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11
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Rombout-Sestrienkova E, Winkens B, Essers BA, Nieman FH, Noord PA, Janssen MC, van Deursen CT, Boonen A, Reuser-Kaasenbrood EP, Heeremans J, van Kraaij M, Masclee A, Koek GH. Erythrocytapheresis versus phlebotomy in the maintenance treatment of HFE hemochromatosis patients: results from a randomized crossover trial. Transfusion 2015; 56:261-70. [DOI: 10.1111/trf.13328] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Revised: 07/30/2015] [Accepted: 08/05/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Eva Rombout-Sestrienkova
- Department of Transfusion Medicine; Sanquin Blood Supply; Amsterdam, the Netherlands
- Department of Internal Medicine, Division of Gastroenterology; Maastricht University Medical Centre; Maastricht, the Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistic; School for Public Health and Primary Care (CAPHRI), Maastricht University
| | | | - Fred H.M. Nieman
- Department of Clinical Epidemiology and Medical Technology Assessment
| | | | - Mirian C.H. Janssen
- Department of Internal Medicine; Radboud University Nijmegen Medical Centre; Nijmegen, the Netherlands
| | - Cees Th.B.M. van Deursen
- Department of Internal Medicine; Zuyderland Medical Center; Heerlen/Brunssum/Sittard the Netherlands
| | | | | | - Judith Heeremans
- Department of Transfusion Medicine; Sanquin Blood Supply; Amsterdam, the Netherlands
| | - Marian van Kraaij
- Department of Transfusion Medicine; Sanquin Blood Supply; Amsterdam, the Netherlands
| | - Ad Masclee
- Department of Internal Medicine, Division of Gastroenterology; Maastricht University Medical Centre; Maastricht, the Netherlands
| | - Ger H. Koek
- Department of Internal Medicine, Division of Gastroenterology; Maastricht University Medical Centre; Maastricht, the Netherlands
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12
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Rombout-Sestrienkova E, De Jonge N, Martinakova K, Klöpping C, van Galen KPM, Vink A, Wajon EMCJ, Smit WM, van Bree C, Koek GH. End-stage cardiomyopathy because of hereditary hemochromatosis successfully treated with erythrocytapheresis in combination with left ventricular assist device support. Circ Heart Fail 2014; 7:541-3. [PMID: 24847131 DOI: 10.1161/circheartfailure.114.001198] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Eva Rombout-Sestrienkova
- From the Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Maastricht, The Netherlands (E.R.-S.); Department of Cardiology (N.D.J., C.K.), Department of Hematology (K.P.M.v.G.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, The Netherlands (E.R.-S., G.H.K.); Faculty of Medicine, Masaryk University, Brno, Czech Republic (K.M.); Department of Cardiology (E.M.C.J.W.) and Department of Internal Medicine (W.M.S.), Medical Spectrum Twente, Enschede, The Netherlands; and Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Groningen, The Netherlands (C.v.B.).
| | - Nicolaas De Jonge
- From the Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Maastricht, The Netherlands (E.R.-S.); Department of Cardiology (N.D.J., C.K.), Department of Hematology (K.P.M.v.G.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, The Netherlands (E.R.-S., G.H.K.); Faculty of Medicine, Masaryk University, Brno, Czech Republic (K.M.); Department of Cardiology (E.M.C.J.W.) and Department of Internal Medicine (W.M.S.), Medical Spectrum Twente, Enschede, The Netherlands; and Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Groningen, The Netherlands (C.v.B.)
| | - Kateřina Martinakova
- From the Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Maastricht, The Netherlands (E.R.-S.); Department of Cardiology (N.D.J., C.K.), Department of Hematology (K.P.M.v.G.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, The Netherlands (E.R.-S., G.H.K.); Faculty of Medicine, Masaryk University, Brno, Czech Republic (K.M.); Department of Cardiology (E.M.C.J.W.) and Department of Internal Medicine (W.M.S.), Medical Spectrum Twente, Enschede, The Netherlands; and Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Groningen, The Netherlands (C.v.B.)
| | - Corinne Klöpping
- From the Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Maastricht, The Netherlands (E.R.-S.); Department of Cardiology (N.D.J., C.K.), Department of Hematology (K.P.M.v.G.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, The Netherlands (E.R.-S., G.H.K.); Faculty of Medicine, Masaryk University, Brno, Czech Republic (K.M.); Department of Cardiology (E.M.C.J.W.) and Department of Internal Medicine (W.M.S.), Medical Spectrum Twente, Enschede, The Netherlands; and Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Groningen, The Netherlands (C.v.B.)
| | - Karin P M van Galen
- From the Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Maastricht, The Netherlands (E.R.-S.); Department of Cardiology (N.D.J., C.K.), Department of Hematology (K.P.M.v.G.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, The Netherlands (E.R.-S., G.H.K.); Faculty of Medicine, Masaryk University, Brno, Czech Republic (K.M.); Department of Cardiology (E.M.C.J.W.) and Department of Internal Medicine (W.M.S.), Medical Spectrum Twente, Enschede, The Netherlands; and Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Groningen, The Netherlands (C.v.B.)
| | - Aryan Vink
- From the Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Maastricht, The Netherlands (E.R.-S.); Department of Cardiology (N.D.J., C.K.), Department of Hematology (K.P.M.v.G.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, The Netherlands (E.R.-S., G.H.K.); Faculty of Medicine, Masaryk University, Brno, Czech Republic (K.M.); Department of Cardiology (E.M.C.J.W.) and Department of Internal Medicine (W.M.S.), Medical Spectrum Twente, Enschede, The Netherlands; and Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Groningen, The Netherlands (C.v.B.)
| | - Elly M C J Wajon
- From the Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Maastricht, The Netherlands (E.R.-S.); Department of Cardiology (N.D.J., C.K.), Department of Hematology (K.P.M.v.G.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, The Netherlands (E.R.-S., G.H.K.); Faculty of Medicine, Masaryk University, Brno, Czech Republic (K.M.); Department of Cardiology (E.M.C.J.W.) and Department of Internal Medicine (W.M.S.), Medical Spectrum Twente, Enschede, The Netherlands; and Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Groningen, The Netherlands (C.v.B.)
| | - Wim M Smit
- From the Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Maastricht, The Netherlands (E.R.-S.); Department of Cardiology (N.D.J., C.K.), Department of Hematology (K.P.M.v.G.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, The Netherlands (E.R.-S., G.H.K.); Faculty of Medicine, Masaryk University, Brno, Czech Republic (K.M.); Department of Cardiology (E.M.C.J.W.) and Department of Internal Medicine (W.M.S.), Medical Spectrum Twente, Enschede, The Netherlands; and Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Groningen, The Netherlands (C.v.B.)
| | - Cor van Bree
- From the Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Maastricht, The Netherlands (E.R.-S.); Department of Cardiology (N.D.J., C.K.), Department of Hematology (K.P.M.v.G.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, The Netherlands (E.R.-S., G.H.K.); Faculty of Medicine, Masaryk University, Brno, Czech Republic (K.M.); Department of Cardiology (E.M.C.J.W.) and Department of Internal Medicine (W.M.S.), Medical Spectrum Twente, Enschede, The Netherlands; and Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Groningen, The Netherlands (C.v.B.)
| | - Ger H Koek
- From the Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Maastricht, The Netherlands (E.R.-S.); Department of Cardiology (N.D.J., C.K.), Department of Hematology (K.P.M.v.G.), and Department of Pathology (A.V.), University Medical Center Utrecht, Utrecht, The Netherlands; Department of Internal Medicine, Division of Gastroenterology and Hepatology, University Medical Center Maastricht, Maastricht, The Netherlands (E.R.-S., G.H.K.); Faculty of Medicine, Masaryk University, Brno, Czech Republic (K.M.); Department of Cardiology (E.M.C.J.W.) and Department of Internal Medicine (W.M.S.), Medical Spectrum Twente, Enschede, The Netherlands; and Blood Bank Division, Unit Transfusion Medicine, Sanquin Blood Supply, Groningen, The Netherlands (C.v.B.)
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Parra Salinas I, Montes Limon A, Recasens Flores V, Fernandez-Mosteirin N, Garcia-Erce JA. [Predictive factors of response to erytrhocytapheresis in patients with biochemical iron overload with or without hereditary hemochromatosis type 1]. Med Clin (Barc) 2014; 142:187-91. [PMID: 24041941 DOI: 10.1016/j.medcli.2013.05.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 05/04/2013] [Accepted: 05/09/2013] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVE Progressive increase of iron stores leads to the development of varied diseases, some of them irreversible. Until now, phlebotomy has been the cornerstone in the treatment of iron overload. Nevertheless, each erytrhocytapheresis procedure removes more than twice the volume of red cells and iron than phlebotomy, allowing to achieve iron depletion in shorter time. Our aim was to describe clinical features and analytical tests parameters of patients with iron overload, to analyze global and subsets results, to suggest predictive factors of response and to evaluate security of the procedure. PATIENTS AND METHOD Descriptive, longitudinal and prospective study of 663 procedures corresponding to 35 patients (December 2002 to October 2011). Response was defined as a serum ferritine value lower than 50 ng/mL during two months. Statistical analysis was done with SPSS(®) v 17.0 and the minimum level of statistical significance was defined as p-value < 0,05. RESULTS Seventy-seven percent of patients reached response with 11 (interquartile range 1-42) erytrhocytapheresis procedures and at 11 (1-108) months. Eighty-seven point five percent of patients who did not achieve response had their ferritine values reduced in more than 50%. The decrease of all iron metabolism parameters was statistically significant. Statistically significant predictive factors of response to erytrhocytapheresis were: patients younger than 60 years-old, hereditary hemochromatosis cases, and patients who had received treatment with phlebotomies prior to erytrhocytapheresis. CONCLUSIONS Erytrhocytapheresis is a secure and effective procedure for iron depletion in patients with iron overload, especially in high risk hereditary hemochromatosis cases that do not respond to phlebotomies.
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Affiliation(s)
- Ingrid Parra Salinas
- Servicio de Transfusión, Hospital Universitario Cruces, Baracaldo, Vizcaya, España.
| | - Anel Montes Limon
- Servicio de Transfusión, Hospital Universitario Miguel Servet, Zaragoza, España
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15
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Alternativas al tratamiento habitual de la hemocromatosis hereditaria. Med Clin (Barc) 2014; 142:205-7. [DOI: 10.1016/j.medcli.2013.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 06/20/2013] [Indexed: 11/21/2022]
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16
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Erythrocytapheresis compared with whole blood phlebotomy for the treatment of hereditary haemochromatosis. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 12 Suppl 1:s84-9. [PMID: 24333062 DOI: 10.2450/2013.0128-13] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 07/11/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND Hereditary haemochromatosis may result in severe organ damage which can be prevented by therapy. We studied the possible advantages and disadvantages of erythrocytapheresis as compared with phlebotomy in patients with hereditary haemochromatosis. MATERIALS AND METHODS In a prospective, randomised, open-label study, patients with hereditary haemochromatosis were randomised to bi-weekly apheresis or weekly whole blood phlebotomy. Primary end-points were decrease in ferritin levels and transferrin saturation. Secondary endpoints were decrease in haemoglobin levels, discomfort during the therapeutic procedure, costs and technicians' working time. RESULTS Sixty-two patients were included. Thirty patients were randomised to apheresis and 32 to whole blood phlebotomy. Initially, ferritin levels declined more rapidly in the apheresis group, and the difference became statistically highly significant at 11 weeks; however, time to normalisation of ferritin level was equal in the two groups. We observed no significant differences in decline of transferrin saturation, haemoglobin levels or discomfort. The mean cumulative technician time consumption until the ferritin level reached 50 μg/L was longer in the apheresis group, but the difference was not statistically significant. The cumulative costs for materials until achievement of the desired ferritin levels were three-fold higher in the apheresis group. CONCLUSION Treatment of hereditary haemochromatosis with erythrocytapheresis instead of whole blood phlebotomy results in a more rapid initial decline in ferritin levels and a reduced number of procedures per patient, but not in earlier achievement of target ferritin level. The frequency of discomfort was equally low with the two methods. The costs and, probably, technician time consumption were higher in the apheresis group.
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Evers D, Kerkhoffs JL, Van Egmond L, Schipperus MR, Wijermans PW. The efficiency of therapeutic erythrocytapheresis compared to phlebotomy: A mathematical tool for predicting response in hereditary hemochromatosis, polycythemia vera, and secondary erythrocytosis. J Clin Apher 2013; 29:133-8. [DOI: 10.1002/jca.21303] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/22/2013] [Accepted: 09/10/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Dorothea Evers
- Department of Haematology; Hagaziekenhuis; Leyweg 275 The Hague The Netherlands
| | | | - Liane Van Egmond
- Department of Haematology; Hagaziekenhuis; Leyweg 275 The Hague The Netherlands
| | | | - Pierre W. Wijermans
- Department of Haematology; Hagaziekenhuis; Leyweg 275 The Hague The Netherlands
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18
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Choe WH, Park BG, Lee KH, Lee JH, Lee JH, Kwon SW. Automated double red-cell phlebotomy for the treatment of erythrocytosis. J Clin Apher 2012; 27:255-9. [DOI: 10.1002/jca.21241] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Accepted: 06/14/2012] [Indexed: 01/19/2023]
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19
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Jhang JS, Schwartz J. Phlebotomy or bloodletting: from tradition to evidence-based medicine. Transfusion 2012; 52:460-2. [DOI: 10.1111/j.1537-2995.2012.03548.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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20
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Poullin P, Lefèvre PA. Intérêt des érythraphérèses à la phase initiale du traitement des hémochromatoses génétiques de type 1 : expérience à propos de 30 cas. Transfus Clin Biol 2011; 18:553-8. [DOI: 10.1016/j.tracli.2011.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 04/06/2011] [Indexed: 11/27/2022]
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Rombout-Sestrienkova E, Nieman FH, Essers BA, van Noord PA, Janssen MC, van Deursen CT, Bos LP, Rombout F, van den Braak R, de Leeuw PW, Koek GH. Erythrocytapheresis versus phlebotomy in the initial treatment of HFE hemochromatosis patients: results from a randomized trial. Transfusion 2011; 52:470-7. [DOI: 10.1111/j.1537-2995.2011.03292.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Szczepiorkowski ZM, Winters JL, Bandarenko N, Kim HC, Linenberger ML, Marques MB, Sarode R, Schwartz J, Weinstein R, Shaz BH. Guidelines on the use of therapeutic apheresis in clinical practice--evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 2010; 25:83-177. [PMID: 20568098 DOI: 10.1002/jca.20240] [Citation(s) in RCA: 412] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The American Society for Apheresis (ASFA) Apheresis Applications Committee is charged with a review and categorization of indications for therapeutic apheresis. Beginning with the 2007 ASFA Special Issue (fourth edition), the subcommittee has incorporated systematic review and evidence-based approach in the grading and categorization of indications. This Fifth ASFA Special Issue has further improved the process of using evidence-based medicine in the recommendations by refining the category definitions and by adding a grade of recommendation based on widely accepted GRADE system. The concept of a fact sheet was introduced in the Fourth edition and is only slightly modified in this current edition. The fact sheet succinctly summarizes the evidence for the use of therapeutic apheresis. The article consists of 59 fact sheets devoted to each disease entity currently categorized by the ASFA as category I through III. Category IV indications are also listed.
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Affiliation(s)
- Zbigniew M Szczepiorkowski
- Transfusion Medicine Service, Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire 03756, USA.
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Abstract
Haemochromatosis should currently refer to hereditary iron overload disorders presenting with a definite and common phenotype characterised by normal erythropoiesis, increased transferrin saturation and ferritin and primarily parenchymal iron deposition related to innate low (but normally regulated) production of the hepatic peptide hormone hepcidin. Since the discovery of the haemochromatosis gene (HFE) in 1996, several novel gene defects have been detected, explaining the mechanism and diversity of iron overload diseases. Overall, at least four main types of hereditary haemochromatosis (HH) have been identified. This review describes the systematic diagnostic and therapeutic strategy and pitfalls for patients suspected for HH and their relatives.
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Affiliation(s)
- M C H Janssen
- Radboud University Medical Centre, Department of General Internal Medicine 463, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
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Poullin P, Lefèvre P. [Therapeutic erythrocytapheresis: technical aspects and clinical applications]. Rev Med Interne 2007; 29:290-6. [PMID: 18280010 DOI: 10.1016/j.revmed.2007.10.406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 06/21/2007] [Accepted: 10/13/2007] [Indexed: 11/28/2022]
Abstract
PURPOSE Therapeutic erythrocytapheresis is a selective red cell-depletion aphaeresis technique. CURRENT KNOWLEDGE AND KEY POINT Using a discontinuous or continuous flow blood cell separator, the technique safely allows quickly and automatically collecting a large volume of red cells. The main obstacle of implementation is a poor peripheral venous access. The procedure is well-tolerated. Polycythemia vera, hereditary hemochromatosis, complicated sickle-cell-disease and retinal venous occlusion are the main clinical applications. PROSPECT AND PROJECT Therapeutic erythrocytapheresis is a more modern and more effective method than the classic patient-bleeding. It has to be preferred in the early treatment of patients with polycythemia vera and hereditary hemochromatosis.
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Affiliation(s)
- P Poullin
- Service d'hémaphérèse et d'autotransfusion, hôpital de la Conception, 13385 Marseille cedex 05, France.
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Fernández-Mosteirín N, Salvador-Osuna C, García-Erce JA, Orna E, Pérez-Lungmus G, Giralt M. Comparación de la flebotomía con eritrocitaféresis en la sobrecarga de hierro en portadores de mutaciones del gen HFE. Med Clin (Barc) 2006; 127:409-12. [PMID: 17020684 DOI: 10.1157/13092766] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Large-volume erythrocytapheresis (EA) is an useful and speedy method to treat iron overload (IO). We assesed the efficacy of EA in patients with HFE gene mutations and IO compared to the classical phlebotomies. PATIENTS AND METHOD Data from 9 patients with IO treated with EA, using a discontinuous flow cell separator as a single needle procedure, for a period of 2 years, were compared to 9 matched patients who underwent conventional phlebotomies. RESULTS The mean volume of red blood cells removed in each EA was 275 ml, with a median reduction of 23 g/l for haemoglobin and 55 microg/l for serum ferritin levels (vs. 17 microg/l between phlebotomies). The liver function test returned to normal values in 4 out of 5 patients undergoing EA, but none of the phlebotomies. The time required to achieve iron depletion was 3 times shorter in EA group. CONCLUSIONS EA is an effective and safe procedure that achieves iron depletion more quickly than manual phlebotomies. Nevertheless, to determine its cost-effectiveness, economical, prospective, randomized studies are warranted.
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Borberg H. Quo vadis haemapheresis. Current developments in haemapheresis. Transfus Apher Sci 2006; 34:51-73. [PMID: 16412691 DOI: 10.1016/j.transci.2005.11.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Accepted: 11/08/2005] [Indexed: 01/13/2023]
Abstract
The techniques of haemapheresis originated in the development of centrifugal devices separating cells from plasma and later on plasma from cells. Subsequently membrane filtration was developed allowing for plasma-cell separation. The unspecificity of therapeutic plasma exchange led to the development of secondary plasma separation technologies being specific, semi-selective or selective such as adsorption, filtration or precipitation. In contrast on-line differential separation of cells is still under development. Whereas erythrocytapheresis, granulocytapheresis, lymphocytapheresis and stem cell apheresis are technically advanced, monocytapheresis may need further improvement. Also, indications such as erythrocytapheresis for the treatment of polycythaemia vera or photopheresis though being clinically effective and of considerable importance for an appropriate disease control are to some extent under debate as being either too costly or without sufficient understanding of the mechanism. Other forms of cell therapy are under development. Rheohaemapheresis as the most advanced technology of extracorporeal haemorheotherapy is a rapidly developing approach contributing to the treatment of microcirculatory diseases and tissue repair. Whereas the control of a considerable number of (auto-) antibody mediated diseases is beyond discussion, the indication of apheresis therapy for immune complex mediated diseases is quite often still under debate. Detoxification for artificial liver support advanced considerably during the last years, whereas conclusions on the efficacy of septicaemia treatment are debatable indeed. LDL-apheresis initiated in 1981 as immune apheresis is well established since 24 years, other semi-selective or unspecific procedures, allowing for the elimination of LDL-cholesterol among other plasma components are also being used. Correspondingly Lp(a) apheresis is available as a specific, highly efficient elimination procedure superior to techniques which also eliminate Lp(a). Quality control systems, more economical technologies as for instance by increasing automation, influencing the over-interpretation of evidence based medicine especially in patients with rare diseases without treatment alternative, more insight into the need of controlled clinical trials or alternatively improved diagnostic procedures are among others tools ways to expand the application of haemapheresis so far applied in cardiology, dermatology, haematology, immunology, nephrology, neurology, ophthalmology, otology, paediatrics, rheumatology, surgery and transfusion medicine.
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Affiliation(s)
- Helmut Borberg
- German Haemapheresis Centre, Deutsches Haemapherese Zentrum, Maarweg 165, D-50 825 Köln, Germany.
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