Witt Volker, Stegmayr Bernd, Ptak Jan, Wikström Björn, Berlin Gösta, Axelsson C G, Griskevicius A, Centoni Paolo Emilio, Liumbruno Giancarlo Maria, Molfettini Pietra, Audzijoniene Judita, Mokvist K, Sojka B Nilsson, Norda Rut, Ramlow W, Blaha Milan, Evergren M, Tomaz J
St. Anna Kinderspital, Vienna, Austria.
Transfus Apher Sci. 2008 Dec;39(3):255-60. doi: 10.1016/j.transci.2008.09.001. Epub 2008 Nov 14.
Paediatric patients are a special group in apheresis. It is general accepted to use adult indications in paediatric patients, but data in this age group are rare. In order to provide more information of apheresis practise in children and young adults (<21a) we will report of knowledge learnt by data from the registry from 2003 until 2007.
This is a web-based registry. A link is available from the WAA homepage (www.worldapheresis.org). So far data from 12,448 procedures have been included. Six hundred and twelve procedures were performed in 135 children and young adults (308 procedures<16a, 237 from 17 to 20a, and 67 with 21a) representing 5% of the total population. The median age was 14 years (range 1-21 years), 74 male and 61 female. These data were entered by 15 centres with a frequency of in median 18 aphereses in young patients per centre (range 1-287) from 2003 to 2007.
Main indications: haematological diseases and also nephrological, and neurological. The type of aphereses was mainly Leukapheresis (196, 33%), plasma exchange (149, 25%), photopheresis (127, 21%), and lipid aphereses (79, 13%). Blood access: peripheral vessels in 305 procedures (50%, compared to 73% in adults), central venous catheter in 239 (38%), and AV-fistula in 2% and 0.3%, and in 8 (1.31%) procedures an arterial line was used. Anticoagulation was mostly by ACD (71%), heparin (18% or the combination of both (3%). 39 adverse events (AE) were registered in 22 (=3.59%) of the procedures, mostly graded as mild. Treatment was interrupted in 14 procedures (2.29%). AE's were abdominal pain, anaphylactic shock, flush, hyper- and hypotension, nausea, vertigo, cephalea and need for sedation and technical problems with the device and problems with the venous access. The rate of AE's was similar for stem cell harvesting and for plasma exchange (4% and 4.7%, respectively).
The paediatric data compared to the whole registry data set are showing that aphereses are performed as safe in paediatrics as in adults. Centres are mostly handling only a few cases younger than 21. Therefore more exchange of information and experience in paediatric apheresis is warranted.
儿科患者是血液单采中的特殊群体。在儿科患者中采用成人适应证已被普遍接受，但该年龄组的数据很少。为了提供更多关于儿童及青年（<21岁）血液单采实践的信息，我们将报告从2003年至2007年登记处数据中获得的知识。
这是一个基于网络的登记处。可从世界血液单采协会（WAA）主页（www.worldapheresis.org）获取链接。到目前为止，已纳入12448例操作的数据。135名儿童及青年进行了612例操作（<16岁的有308例，17至20岁的有237例，21岁的有67例），占总人群的5%。中位年龄为14岁（范围1 - 21岁），男性74例，女性61例。这些数据由15个中心录入，2003年至2007年期间，每个中心在年轻患者中的单采频率中位数为18次（范围1 - 287次）。
主要适应证：血液系统疾病，以及肾脏和神经系统疾病。血液单采类型主要为白细胞单采（196例，33%）、血浆置换（149例，25%）、光化学疗法（127例，21%）和血脂单采（79例，13%）。血液通路：305例操作采用外周血管（50%，而成人组为73%），239例采用中心静脉导管（38%），2%采用动静脉内瘘，0.3%采用动脉内瘘，8例（1.31%）操作使用了动脉管路。抗凝主要采用ACD（71%）、肝素（18%）或两者联合（3%）。22例（=3.59%）操作记录到39例不良事件（AE），大多为轻度。14例操作（2.29%）治疗中断。不良事件包括腹痛、过敏性休克、潮红、高血压和低血压、恶心、眩晕、头痛以及需要镇静，还有设备技术问题和静脉通路问题。干细胞采集和血浆置换的不良事件发生率相似（分别为4%和4.7%）。
与整个登记数据集相比，儿科数据表明血液单采在儿科和成人中一样安全。各中心处理的21岁以下病例大多较少。因此，有必要在儿科血液单采方面加强信息和经验交流。
