Michon Bruno, Moghrabi Albert, Winikoff Rochelle, Barrette Stéphane, Bernstein Mark L, Champagne Josette, David Michèle, Duval Michel, Hume Heather A, Robitaille Nancy, Bélisle André, Champagne Martin A
Division of Hematology-Oncology, University Hospital Center Sainte-Justine, University of Montreal, 3175 chemin de la Côte Sainte-Catherine, Montreal, Quebec, Canada.
Transfusion. 2007 Oct;47(10):1837-42. doi: 10.1111/j.1537-2995.2007.01405.x.
Although the frequency of complications in adults undergoing therapeutic apheresis is low, there are little data in children.
A retrospective study of 186 children who had undergone a total of 1632 apheresis procedures between 1994 and 2002 was conducted. Adverse reactions were prospectively documented. The procedures were plasma exchange (67%), hematopoietic progenitor cell collection (18%), red blood cell exchange (6.9%), leukodepletion (0.7%), and plasma exchange with immunoadsorption (6.7%).
Adverse reactions, most minor, were reported in 55 percent of procedures in 82 percent of patients. The most frequent complications, per procedure and per patient during an entire course of therapy, were hypotension (14 and 48.4%), hypotension requiring fluid bolus (4.8 and 26.9%), symptomatic hypocalcemia (9.7 and 28.5%), allergic reactions (4.4 and 5.9%), catheter-related thrombosis (1.7 and 12.4%), catheter-related infection (2.1 and 16.1%), and severe anemia (hemoglobin [Hb] level, <7 g/dL; 2.5 and 17.2%). There were two deaths (1% of patients). Risk factors for complications by multivariate analysis were lower body weight, lower preapheresis Hb level, apheresis in a critical care unit, and number of procedures per patient. The 55 percent incidence of complications per procedure in our pediatric cohort is much higher than the 4.3 to 28 percent incidence reported in adults. The excess of adverse reactions in children are mostly related to citrate toxicity, higher relative vascular volume shifts, and the need for vascular access.
Pediatric apheresis presents unique challenges and is associated with higher complication rate compared to adults. It is recommended that this procedure be performed in specialized centers.
尽管接受治疗性血液成分单采术的成人并发症发生率较低，但关于儿童的数据却很少。
对1994年至2002年间接受了总共1632次血液成分单采术的186名儿童进行了一项回顾性研究。前瞻性记录不良反应。这些操作包括血浆置换（67%）、造血祖细胞采集（18%）、红细胞置换（6.9%）、白细胞去除术（0.7%）以及免疫吸附血浆置换（6.7%）。
82%的患者在55%的操作中报告了不良反应，大多数为轻微反应。在整个治疗过程中，每次操作和每位患者最常见的并发症是低血压（分别为14%和48.4%）、需要静脉推注液体的低血压（分别为4.8%和26.9%）、症状性低钙血症（分别为9.7%和28.5%）、过敏反应（分别为4.4%和5.9%）、导管相关血栓形成（分别为1.7%和12.4%）、导管相关感染（分别为2.1%和16.1%）以及严重贫血（血红蛋白[Hb]水平<7 g/dL；分别为2.5%和17.2%）。有两例死亡（占患者的1%）。多因素分析显示，并发症的危险因素包括体重较低、血液成分单采术前Hb水平较低、在重症监护病房进行血液成分单采以及每位患者的操作次数。我们儿科队列中每次操作55%的并发症发生率远高于成人报告的4.3%至28%的发生率。儿童不良反应过多主要与枸橼酸盐毒性、相对较高的血管容量变化以及血管通路需求有关。
与成人相比，儿科血液成分单采术面临独特挑战，且并发症发生率更高。建议在专科中心进行该操作。
