1
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Howlett MS, Hicks K, Park Y, Karafin MS, Bream PR. Use of a novel configuration of ports for patients needing intermittent long-term apheresis. J Clin Apher 2024; 39:e22143. [PMID: 39105402 DOI: 10.1002/jca.22143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/01/2024] [Accepted: 07/14/2024] [Indexed: 08/07/2024]
Abstract
PURPOSE In patients with a need for frequent but intermittent apheresis, vascular access can prove challenging. We describe the migration of the use of a Vortex LP dual lumen port (Angiodynamics, Latham, NY) to one Powerflow and one ClearVUE power injectable port (Becton Dickinson, Franklin Lakes, NJ) in a series of patients undergoing intermittent apheresis. MATERIALS AND METHODS All patients had a need for long-term intermittent apheresis. Eight had double lumen Vortex port (pre) and were exchanged for one Powerflow port and one conventional subcutaneous venous port with 90° needle entry (post) while 12 did not have any port in place and received the same configuration. IRB approval was granted. We recorded the treatment time, flow rate, and tissue plasminogen activator (tPA) use for five treatment sessions after placement. When available, we compared five treatments with the Vortex port and the new configuration. RESULTS The mean treatment time is reduced with the new configuration (P = 0.0033). The predicted mean treatment time, adjusting for gender, race, BMI and age and accounting for correlations within a patient is 91.18 min pre and 77.96 min post. The flow rate is higher with the new configuration (P < 0.0001). The predicted mean flow rate in mL/min is 61.59 for the Vortex port and 71.89 for the new configuration. tPA use was eliminated in the population converted from Vortex ports and had a 48% reduction when compared to all other configurations in the study. CONCLUSION The introduction of a novel device configuration of venous access ports for intermittent apheresis resulted in higher flow rates and less total time for treatment. Use of tPA was greatly reduced. These results suggest that the new configuration could result in less expense for the hospital and better throughput in a busy pheresis practice. Clinical trial registration with ClinicalTrials.gov: NCT04846374.
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Affiliation(s)
| | - Kimani Hicks
- Medical Resident, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Yara Park
- Associate Professor of Pathology and Laboratory Medicine, Director of the Pathology Residency Training Program, UNC Department of Pathology and Laboratory Medicine, Chapel Hill, North Carolina, USA
| | - Matthew S Karafin
- Associate Professor, UNC Department of Pathology and Laboratory Medicine, Chapel Hill, North Carolina, USA
| | - Peter R Bream
- Endovascular Education and Excellence, PLLC, Chapel Hill, North Carolina, USA
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2
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Cunard R, Gopal S, Kopko PM, Dang MU, Hazle KM, Sanchez AP. Comprehensive guide to managing a chronic automated red cell exchange program in sickle cell disease. J Clin Apher 2022; 37:497-506. [PMID: 36172983 DOI: 10.1002/jca.22014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022]
Abstract
Sickle cell disease (SCD) is associated with significant morbidity and mortality, and limits both the quality and quantity of life. Transfusion therapy, specifically automated red cell exchange (aRCE), plays a key role in management of SCD and is beneficial for certain indications in the chronic, outpatient setting. The approach to maintain a successful chronic aRCE program for SCD is multifaceted. This review will highlight important considerations including indications for aRCE, patient selection, transfusion medicine pearls, vascular access needs, complications of therapy, aRCE prescription, and therapy optimization. Moreover, the importance of a multidisciplinary approach with frequent communication between the services involved cannot be overstated. Ultimately, the underlying goal of a chronic RCE program is to improve the quality of life and longevity of patients with SCD.
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Affiliation(s)
- Robyn Cunard
- Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Srila Gopal
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Patricia M Kopko
- Department of Pathology and Laboratory Medicine, University of California San Diego, La Jolla, California, USA
| | | | | | - Amber P Sanchez
- Department of Medicine, University of California San Diego, La Jolla, California, USA
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3
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Wallace LR, Thibodeaux SR. Transfusion Support for Patients with Sickle Cell Disease. Transfus Apher Sci 2022; 61:103556. [DOI: 10.1016/j.transci.2022.103556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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4
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Mukherjee S, Sahu A, Ray GK, Maiti R, Prakash S. Comparative evaluation of efficacy and safety of automated versus manual red cell exchange in sickle cell disease: A systematic review and meta‐analysis. Vox Sang 2022; 117:989-1000. [DOI: 10.1111/vox.13288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 03/15/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Somnath Mukherjee
- Department of Transfusion Medicine All India Institute of Medical Sciences Bhubaneswar India
| | - Ansuman Sahu
- Department of Transfusion Medicine All India Institute of Medical Sciences Bhubaneswar India
| | - Gopal Krushna Ray
- Department of Transfusion Medicine All India Institute of Medical Sciences Bhubaneswar India
| | - Rituparna Maiti
- Department of Pharmacology All India Institute of Medical Sciences Bhubaneswar India
| | - Satya Prakash
- Department of Transfusion Medicine All India Institute of Medical Sciences Bhubaneswar India
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5
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Peripheral Blood Smear Detection of Asymptomatic Central Line Infection in a Patient With Sickle Cell Disease. J Pediatr Hematol Oncol 2022; 44:98-99. [PMID: 35180760 DOI: 10.1097/mph.0000000000002432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 01/11/2022] [Indexed: 11/27/2022]
Abstract
Sickle cell disease is a lifelong disorder which may be managed by chronic red cell transfusion including exchange transfusion. Chronic indwelling vascular catheters including ports offer convenient and reliable access for red cell exchange but confer risk of complications including infection and thrombosis. Detection of these complications is essential for preserving vascular access and relies on both clinical and laboratory observation. Here we describe a case of asymptomatic port infection detected by manual screening of a peripheral blood smear.
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6
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Golsorkhi M, Azarfar A, Abdipour A. Vascular Access in Therapeutic Apheresis: One Size Does not Fit All. Ther Apher Dial 2022; 26:694-716. [PMID: 35043567 DOI: 10.1111/1744-9987.13799] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/19/2021] [Accepted: 01/13/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Therapeutic apheresis has been used in treating hematological and non-hematological diseases. For a successful procedure, efficient vascular access is required. Presently, peripheral venous access (PVA), central venous catheterization (CVC), implantable ports, and arteriovenous fistulas (AVFs) are used. This review aims to evaluate different type of access and their pros and cons to help physicians determine the best venous access. METHODS The electronic search included PubMed and Google Scholar up to Nov. 2020. The Mesh terms were apheresis, peripheral catheterization, central catheterization, and arteriovenous fistula. RESULTS A total of 228 studies were found through database searching. Two independent authors reviewed the articles using their titles and abstracts; 88 articles were selected and the full text was reviewed. Finally, 25 were included. The inclusion criteria were studies incorporating patients with any indication for apheresis. CONCLUSION PVA has been promoted in recent years in many centers across the United States to lower the rate of complications associated with vascular access and to make this procedure more accessible. Several factors are involved in selecting appropriate venous access, such as the procedure's duration and frequency, patient's vascular anatomy, and staff's experience. In short-term procedures, temporary vascular access like PVA or CVC is preferred. Permanent vascular access such as AVF, tunneled cuffed central lines, and implantable ports are more beneficial in prolonged treatment period but each patient has to be evaluated individually by apheresis team for the most appropriate method.
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Affiliation(s)
- Mohadese Golsorkhi
- Department of Medicine, Division of Regenerative Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Anoush Azarfar
- Kidney Transplantation Complications Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Abdipour
- Department of Medicine, Division of Nephrology, Loma Linda University, Loma Linda, CA, USA
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7
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Su L, Nizzi F, Jamshidi R, Gomez E, Perumbeti A, Mirea L, Shah S. Use of dual lumen ports for red blood cell exchange: A comparison of adults and children with sickle cell disease. J Clin Apher 2020; 35:351-357. [PMID: 32629525 DOI: 10.1002/jca.21807] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 03/05/2020] [Accepted: 06/16/2020] [Indexed: 11/08/2022]
Abstract
PURPOSE Sickle cell patients receiving chronic RBC exchange require a form of long-term central venous access if peripheral access is inadequate. In adults, dual lumen (DL) ports have been utilized but associated with greater procedure complications and duration when compared to other forms of access. In the pediatric sickle cell population, the use of DL ports for RBC exchange has not been well described. In this retrospective cohort study, RBC exchange procedures utilizing DL ports in the pediatric vs adult sickle cell population were compared. METHODS Medical records were reviewed for 685 RBC exchange procedures performed on 25 patients (11 pediatric and 14 adult) between November 2014 to November 2018. Patient-level characteristics and outcomes were compared between pediatric and adult patients using the Fisher-exact and Wilcoxon-rank sum test. Linear/logistic regression models examined procedure-level parameters and port characteristics with adjustment for clustering. RESULTS Compared to adults, pediatric patients had slower average maximum inlet speed (42 vs 53 mL/min, P < .01), but shorter procedure time (60 vs 75 minutes, P < .01) and lower rate of access alarms (1% vs 11%, P < .01). Overall, 0.29 thrombotic events per 1000 port days and 0.04 infections per 1000 port days were observed. CONCLUSION For adult and pediatric sickle cell patients, a DL port provides a viable option for RBC exchange. In comparison to adults, pediatric procedures with a DL port will typically be shorter and with less procedural complications due to smaller blood volumes and lower flow requirements.
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Affiliation(s)
- Leon Su
- Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Frank Nizzi
- Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Ramin Jamshidi
- Department of Surgery, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Esteban Gomez
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Ajay Perumbeti
- Department of Pathology and Laboratory Medicine, Phoenix Children's Hospital, Phoenix, Arizona, USA.,Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Lucia Mirea
- Clinical Research, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Sanjay Shah
- Center for Cancer and Blood Disorders, Phoenix Children's Hospital, Phoenix, Arizona, USA
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8
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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: 784] [Impact Index Per Article: 156.8] [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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9
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Hayes C, Stephens L, Fridey JL, Snyder RE, Groves JA, Stramer SL, Klapper E. Probable transfusion transmission of West Nile virus from an apheresis platelet that screened non‐reactive by individual donor‐nucleic acid testing. Transfusion 2019; 60:424-429. [DOI: 10.1111/trf.15568] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 08/12/2019] [Accepted: 09/30/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Chelsea Hayes
- Department of Pathology and Laboratory Medicine Cedars‐Sinai Medical Center Los Angeles California
| | - Laura Stephens
- Department of Pathology University of Arizona College of Medicine Tucson Arizona
| | | | | | | | | | - Ellen Klapper
- Department of Pathology and Laboratory Medicine Cedars‐Sinai Medical Center Los Angeles California
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10
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Tanhehco YC, Zantek ND, Alsammak M, Chhibber V, Li Y, Becker J, Wu DW, Foster T, Wehrli G. Vascular access practices for therapeutic apheresis: Results of a survey. J Clin Apher 2019; 34:571-578. [DOI: 10.1002/jca.21726] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/07/2019] [Accepted: 06/11/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Yvette C. Tanhehco
- Columbia University Irving Medical Center and New York‐Presbyterian Hospital, Department of Pathology and Cell BiologyColumbia University Vagelos College of Physicians and Surgeons New York New York
| | - Nicole D. Zantek
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Minneapolis Minnesota
| | - Mohamed Alsammak
- Blood Bank/Transfusion Medicine, Temple University Hospital and Department of Pathology and Laboratory MedicineLewis Katz School of Medicine at Temple University Philadelphia Pennsylvania
| | - Vishesh Chhibber
- Transfusion Medicine, Northwell Health and Pathology & Laboratory MedicineZucker School of Medicine at Hofstra/Northwell Hempstead New York
| | - Yanhua Li
- Department of PathologyNew York University School of Medicine New York New York
| | - Joanne Becker
- Department of Pathology and Laboratory Medicine; Blood Bank and Therapeutic Apheresis Unit, Roswell Park Comprehensive Cancer Center, and Pathology and Anatomical SciencesJacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo Buffalo New York
| | - Ding W. Wu
- Department of Pathology and LaboratoriesNYU‐Brooklyn, NYU Langone Medical Center New York New York
| | - Tisha Foster
- Scientific Medical Technical Department, OneBlood Lakeland Florida
| | - Gay Wehrli
- Department of PathologyUniversity of Virginia Health Charlottesville Virginia
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11
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Williams LA, Arnesen C, Gunn C, Boshell MN, Pham HP, Guillory B, Adamski J, Marques MB. New subcutaneous PowerFlow port results in cost and time‐savings in a busy outpatient apheresis clinic. J Clin Apher 2018; 34:482-486. [DOI: 10.1002/jca.21678] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/24/2018] [Accepted: 11/21/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Lance A. Williams
- Division of Laboratory Medicine, Department of PathologyThe University of Alabama at Birmingham Birmingham Alabama
| | - Christine Arnesen
- Division of Laboratory Medicine, Department of PathologyThe University of Alabama at Birmingham Birmingham Alabama
| | - Christina Gunn
- Division of Laboratory Medicine, Department of PathologyThe University of Alabama at Birmingham Birmingham Alabama
| | - Michael N. Boshell
- Division of Laboratory Medicine, Department of PathologyThe University of Alabama at Birmingham Birmingham Alabama
| | - Huy P. Pham
- Department of PathologyKeck School of Medicine of the University of Southern California Los Angeles California
| | - Bryan Guillory
- Division of Laboratory Medicine, Department of PathologyThe University of Alabama at Birmingham Birmingham Alabama
| | - Jill Adamski
- Department of Laboratory Medicine and PathologyMayo Clinic Phoenix Arizona
| | - Marisa B. Marques
- Division of Laboratory Medicine, Department of PathologyThe University of Alabama at Birmingham Birmingham Alabama
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12
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Lawicki S, Craig-Owens L, Bream PR, Eichbaum Q. Indwelling ports for prophylactic RBC exchanges in sickle cell patients: Comparison of bard and vortex ports. J Clin Apher 2018; 33:666-670. [PMID: 30387237 DOI: 10.1002/jca.21663] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/19/2018] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Red blood cell exchange (RCE) procedures are commonly used for stroke prevention in sickle cell disease (SCD) patients. We compared two different dual lumen ports used for RCE because differences between the port and catheter design may lead to functional variance. METHODS We reviewed the RCE parameters of SCD patients following implantable port placement encountered at a single institution. Five Vortex and four Bard ports were used and compared. Patients were followed for 1-24 exchange procedures over 3-26 months performed between 2013 and 2015. RESULTS Nine patients underwent 124 RCE procedures with no failures. A total of 74 exchanges used Vortex ports with a mean flow rate of 45.2 mL/min while 50 exchanges used Bard ports with a mean flow rate of 42.1 mL/min which was a significant difference (P = .002). A total of 85 exchanges with tPA administration preprocedure had a mean flow rate of 43.8 mL/min while 39 exchanges without had a mean flow rate of 45.4 mL/min which was not a significant difference (P = .19). CONCLUSION Both the Bard and Vortex ports functioned well during our study period with no treatment failures, no significant complications requiring removal or replacement, and adequate mean flow rates. While the difference in mean flow rates was statistically significant between Vortex and Bard ports, there may not be a practical difference in performance. There also does not appear to be a significant benefit in flow rates with preprocedure tPA. We conclude that both ports may be a satisfactory choice for vascular access in SCD patients expected to undergo regularly scheduled RCE.
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Affiliation(s)
- Shaun Lawicki
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Laura Craig-Owens
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Peter R Bream
- Department of Radiology and Radiologic Sciences, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Quentin Eichbaum
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee
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13
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Adamski J. Vascular access considerations for extracorporeal photopheresis. Transfusion 2018; 58 Suppl 1:590-597. [PMID: 29443405 DOI: 10.1111/trf.14500] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 12/18/2022]
Abstract
Extracorporeal photopheresis is an immunomodulatory therapy indicated for patients with cutaneous T-cell lymphoma, graft-versus-host disease, and heart or lung allograft rejection. Whole blood from the patient is drawn into the photopheresis instrument where it is separated into its components. Plasma, red blood cells, and the treated buffy coat are subsequently returned to the patient. Consistent, adequate blood flow is necessary to successfully complete the procedure. Vascular access options for photopheresis include peripheral vein cannulation, tunneled central venous catheters, and subcutaneous ports. Photopheresis is a very safe procedure; however, the complications and impact on the patient's quality of life associated with vascular access devices can be significant.
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Affiliation(s)
- Jill Adamski
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona
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14
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Szymanski J, Shah P, Dynis M, Mansfield D, Hamilton C, Despotis G. An ex vivo comparison of vascular access devices used in extracorporeal photopheresis. Transfusion 2018; 58 Suppl 1:609-613. [PMID: 29443412 DOI: 10.1111/trf.14482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Central venous access devices are commonly used in extracorporeal photopheresis, but their performance has not been systematically evaluated. The primary objective of this study was to compare pressures at various flow rates for central venous access devices in an ex vivo simulation of photopheresis. STUDY DESIGN AND METHODS Diluted, heparinized red blood cells were circulated through central access devices in series with a photopheresis system, and pressures at several flow rates were recorded. The devices tested were the Trifusion catheter (Hickman), the Vortex single-lumen and dual-lumen ports (Angiodynamics), and the TidalPort device (Norfolk). Flow rates were also compared for silicone and polyurethane catheters and for different catheter internal diameters. RESULTS The Vortex dual-lumen port generated pressure alarms above flow rates of 60 mL/minute. Throughout flow rates from 5 to 100 mL/minute, the Trifusion catheter and the TidalPort device operated at lower pressures than the Vortex ports. Within typical clinical flow rates, neither catheter material nor internal diameter substantially affected pressure. CONCLUSION Central venous access devices show large differences in pressure within flow rates used routinely in clinical settings. These differences cannot be fully attributed to catheter material composition or catheter internal diameter.
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Affiliation(s)
- Jeffrey Szymanski
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri
| | - Priyank Shah
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri
| | - Marian Dynis
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri
| | - Donna Mansfield
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri
| | - Connie Hamilton
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri
| | - George Despotis
- Department of Pathology and Immunology, Washington University in St. Louis, St. Louis, Missouri
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15
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Affiliation(s)
- Anand Padmanabhan
- Medical Sciences Institute and Blood Research Institute, BloodCenter of Wisconsin; Department of Pathology, Medical College of Wisconsin; Milwaukee Wiscosin
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16
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De Simone N, Sarode R. A tale of two ports: an in vitro comparison of flow characteristics for therapeutic plasma exchange. Transfusion 2018; 58 Suppl 1:605-608. [DOI: 10.1111/trf.14494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Nicole De Simone
- Division of Transfusion Medicine and Hemostasis, Department of Pathology; UT Southwestern Medical Center; Dallas Texas
| | - Ravi Sarode
- Division of Transfusion Medicine and Hemostasis, Department of Pathology; UT Southwestern Medical Center; Dallas Texas
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17
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Lin DMH, Wu Y. Implantable vascular access devices - past, present, and future. Transfusion 2018; 58 Suppl 1:545-548. [DOI: 10.1111/trf.14485] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Woods D, Hayashi RJ, Binkley MM, Sparks GW, Hulbert ML. Increased complications of chronic erythrocytapheresis compared with manual exchange transfusions in children and adolescents with sickle cell disease. Pediatr Blood Cancer 2017; 64. [PMID: 28544309 DOI: 10.1002/pbc.26635] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 03/30/2017] [Accepted: 04/14/2017] [Indexed: 11/09/2022]
Abstract
BACKGROUND Children and adolescents with sickle cell disease (SCD) are at high risk of strokes and are frequently treated with red blood cell (RBC) transfusions. The goal is to suppress hemoglobin (Hb) S while minimizing transfusion-induced iron overload. RBCs may be given via simple transfusion, manual exchange transfusion (MET), or erythrocytapheresis (aRBCX). Chronic transfusion practices vary among institutions. METHODS This single-institution, retrospective cohort study compares Hb S control and therapy complication rates between MET and aRBCX in a cohort of children and adolescents with SCD and stroke during a 5-year period from 2008 through 2012. Duration and mode of transfusion therapy, achievement of Hb S suppression goal, iron burden by ferritin levels, and catheter complications were evaluated. RESULTS Thirty-seven children were included in analysis. The prevalence of catheter complications was 75% in aRBCX recipients compared with 0% in MET recipients (P < 0.001). There was no significant difference between modalities in achieving Hb S suppression or ferritin goals, but those receiving aRBCX had a greater likelihood of discontinuing chelation therapy. Among aRBCX recipients, adherence to >90% of transfusion appointments was associated with achieving Hb S suppression goals. CONCLUSION aRBCX may have increased complication risks compared with MET for chronic transfusion therapy in SCD. Risks and benefits of aRBCX and MET should be considered when selecting a chronic transfusion modality. Transfusion therapy modalities should be compared in prospective studies for stroke prevention in children with SCD.
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Affiliation(s)
- Deborah Woods
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Robert J Hayashi
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Michael M Binkley
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | | | - Monica L Hulbert
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
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Willits I, Cole H, Jones R, Carter K, Arber M, Jenks M, Craig J, Sims A. Spectra Optia ® for Automated Red Blood Cell Exchange in Patients with Sickle Cell Disease: A NICE Medical Technology Guidance. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:455-468. [PMID: 28110486 PMCID: PMC5506506 DOI: 10.1007/s40258-016-0302-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The Spectra Optia® automated apheresis system, indicated for red blood cell exchange in people with sickle cell disease, underwent evaluation by the National Institute for Health and Care Excellence, which uses its Medical Technologies Advisory Committee to make recommendations. The company (Terumo Medical Corporation) produced a submission making a case for adoption of its technology, which was critiqued by the Newcastle and York external assessment centre. Thirty retrospective observational studies were identified in their clinical submission. The external assessment centre considered these were of low methodological and reporting quality. Most were single-armed studies, with only six studies providing comparative data. The available data showed that, compared with manual red blood cell exchange, Spectra Optia reduces the frequency of exchange procedures as well as their duration, but increases the requirement for donor blood. However, other clinical and patient benefits were equivocal because of an absence of robust clinical evidence. The company provided a de novo model to support the economic proposition of the technology, and reported that in most scenarios Spectra Optia was cost saving, primarily through reduced requirement of chelation therapy to manage iron overload. The external assessment centre considered that although the cost-saving potential of Spectra Optia was plausible, the model and its clinical inputs were not sufficiently robust to demonstrate this. However, taking the evidence together with expert and patient advice, the Medical Technologies Advisory Committee considered Spectra Optia was likely to save costs, provide important patient benefits, and reduce inequality, and gave the technology a positive recommendation in Medical Technology Guidance 28.
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Affiliation(s)
- Iain Willits
- Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.
- Regional Medical Physics Department, NICE External Assessment Centre, Freeman Hospital, High Heaton, NE7 7DN, UK.
| | - Helen Cole
- Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Roseanne Jones
- Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
| | - Kimberley Carter
- National Institute for Health and Care Excellence, Manchester, UK
| | - Mick Arber
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, UK
| | - Michelle Jenks
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, UK
| | - Joyce Craig
- York Health Economics Consortium, Enterprise House, Innovation Way, University of York, Heslington, York, UK
| | - Andrew Sims
- Newcastle upon Tyne Hospitals National Health Service Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK
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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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21
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Delville M, Manceau S, Ait Abdallah N, Stolba J, Awad S, Damy T, Gellen B, Sabbah L, Debbache K, Audard V, Beaumont JL, Arnaud C, Chantalat-Auger C, Driss F, Lefrère F, Cavazzana M, Franco G, Galacteros F, Ribeil JA, Gellen-Dautremer J. Arterio-venous fistula for automated red blood cells exchange in patients with sickle cell disease: Complications and outcomes. Am J Hematol 2017; 92:136-140. [PMID: 27813144 DOI: 10.1002/ajh.24600] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/31/2016] [Accepted: 11/01/2016] [Indexed: 12/11/2022]
Abstract
Erythrocytapheresis (ER) can improve outcome in patients with sickle cell disease (SCD). A good vascular access is required but frequently it can be difficult to obtain for sickle cell patients. Arterio-venous fistulas (AVFs) have been suggested for ER in SCD supported by limited evidence. We report the largest cohort of ER performed with AVFs from three French SCD reference centers. Data of SCD patients undergoing ER with AVFs in the French SCD reference center were retrospectively collected. The inclusion criteria were: SS or Sβ-Thalassemia and AVF surgery for ER. SCD-related complications, transfusion history, details about AVF surgical procedure, echocardiographic data before and after AVF, AVF-related surgical and hemodynamical complications were collected. Twenty-six patients (mean age 20.5 years, mean follow-up 68 months [11-279]) were included. Twenty-three patients (88.5%) required central vascular access before AVF. Fifteen AVFs (58%) were created on the forearm and 11 (42%) on the arm. Nineteen patients (73%) had stenotic, thrombotic or infectious AVF complications. A total of 0.36 stenosis per 1,000 AVF days, 0.37 thrombosis per 1,000 AVF days and 0.078 infections per 1.000 AVF days were observed. The mean AVF lifespan was 51 months [13-218]. One patient with severe pulmonary hypertension worsened after AVF creation and died. We report the first series of SCD patients with AVF for ER, demonstrating that AVFs could be considered as a potential vascular access for ER. Patients with increased risk for hemodynamic intolerance of AVFs must be carefully identified, so that alternative vascular accesses can be considered. Am. J. Hematol. 92:136-140, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Marianne Delville
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | - Sandra Manceau
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | - Nassim Ait Abdallah
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Jan Stolba
- Vascular surgery department; La Roseraie Clinic; Aubervilliers France
| | - Sameh Awad
- Interventional Radiology Clinique Labrouste; Paris France
| | - Thibaud Damy
- Cardiology Department; Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Barnabas Gellen
- Cardiology Department; Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
- ELSAN, Polyclinique de Poitiers; France
| | - Laurent Sabbah
- Cardiology department; Necker Enfants malades university Hospital, APHP, Université Paris 5; France
| | - Karima Debbache
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Vincent Audard
- Nephrology and Renal Transplantation Department Henri Mondor University Hospital; APHP, Université Paris-Est Créteil; France
| | - Jean-Louis Beaumont
- Etablissement français du sang, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Cécile Arnaud
- Pediatrics Department; Centre hospitalier intercommunal de Créteil; Créteil France
| | - Christelle Chantalat-Auger
- Department of Internal medicine; Bicetre University Hospital; Université Paris 11, le Kremlin-Bicêtre France
| | - Françoise Driss
- Department of Internal medicine; Bicetre University Hospital; Université Paris 11, le Kremlin-Bicêtre France
| | - François Lefrère
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | - Marina Cavazzana
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | | | - Frederic Galacteros
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
| | - Jean-Antoine Ribeil
- Biotherapy department; Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Necker-Enfants-Malades-University Hospital, APHP, Université Paris 5; Paris France
| | - Justine Gellen-Dautremer
- Centre de Référence des Syndromes Drépanocytaires Majeurs, Henri Mondor University Hospital, APHP, Université Paris-Est Créteil; France
- Internal Medicine Department; Poitiers University Hospital; Poitiers France
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Ko RH, Thornburg CD. Venous Thromboembolism in Children with Cancer and Blood Disorders. Front Pediatr 2017; 5:12. [PMID: 28220143 PMCID: PMC5292750 DOI: 10.3389/fped.2017.00012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/18/2017] [Indexed: 01/19/2023] Open
Abstract
Venous thromboembolism (VTE) in children is multifactorial and most often related to a combination of inherited and acquired thrombophilias. Children with cancer and blood disorders are often at risk for VTE due to disease-related factors such as inflammation and abnormal blood flow and treatment-related factors such as central venous catheters and surgery. We will review risk factors for VTE in children with leukemia, lymphoma, and solid tumors. We will also review risk factors for VTE in children with blood disorders with specific focus on sickle cell anemia and hemophilia. We will present the available evidence and clinical guidelines for prevention and treatment of VTE in these populations.
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Affiliation(s)
| | - Courtney D Thornburg
- Hemophilia and Thrombosis Treatment Center, Rady Children's Hospital San Diego , San Diego, CA , USA
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23
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Putensen D, Leverett D, Patel B, Rivera J. Is peripheral access for apheresis procedures underutilized in clinical practice?-A single centre experience. J Clin Apher 2016; 32:553-559. [DOI: 10.1002/jca.21508] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/23/2016] [Accepted: 08/23/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Daniel Putensen
- University College London Hospitals, Haematology-Apheresis; London United Kingdom
| | - David Leverett
- University College London Hospitals, Haematology-Apheresis; London United Kingdom
| | - Bhavika Patel
- University College London Hospitals, Haematology-Apheresis; London United Kingdom
| | - Jasmin Rivera
- University College London Hospitals, Haematology-Apheresis; London United Kingdom
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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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Putensen D, Pilcher L, Collier D, McInerney K. Ultrasound-guided peripheral deep vein cannulation to perform automated red cell exchange-A pilot study in a single centre. J Clin Apher 2015; 31:501-506. [DOI: 10.1002/jca.21440] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 10/28/2015] [Accepted: 10/30/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Daniel Putensen
- Apheresis Department; Macmillian Cancer Centre, University College London Hospitals; London
| | - Linda Pilcher
- Apheresis Department; Macmillian Cancer Centre, University College London Hospitals; London
| | - Dawn Collier
- Apheresis Department; Macmillian Cancer Centre, University College London Hospitals; London
| | - Karen McInerney
- Apheresis Department; Macmillian Cancer Centre, University College London Hospitals; London
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