Belizaire Roger, Sykes David B, Chen Yi-Bin A, Spitzer Thomas R, Makar Robert S
Department of Pathology, Brigham and Women's Hospital; Massachusetts General Hospital, Boston, Massachusetts.
Division of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts.
Transfusion. 2015 Sep;55(9):2142-8. doi: 10.1111/trf.13125. Epub 2015 Apr 24.
Collection of hematopoietic progenitor cells by apheresis (HPC-A) requires separation of cells by density. Previous studies highlighted the challenges of HPC-A collection from patients with abnormal red blood cells (RBCs). TEMPI syndrome is a recently described condition defined by teleangiectasias, elevated erythropoietin and erythrocytosis, monoclonal gammopathy, perinephric fluid collections, and intrapulmonary shunting. Patients with TEMPI syndrome have responded to therapies used to treat plasma cell dyscrasias and may benefit from autologous HPC transplantation. We report HPC-A collection from a patient with TEMPI syndrome that was complicated by severe iron deficiency.
The patient received granulocyte-colony-stimulating factor (G-CSF) and plerixafor for HPC mobilization and underwent 3 days of HPC-A collection.
The patient presented for collection with a microcytic erythrocytosis. Over 3 days, approximately 50 L of whole blood was processed, and 2 × 10(8) CD34+ cells were collected (2.8 × 10(6) CD34+ cells/kg). The mean collection efficiency (CE), percentage of mononuclear cells, hematocrit (Hct), and RBC count were 18%, 90%, 14%, and 9 × 10(11) , respectively. Altering collection variables to avoid RBC contamination reduced CE. Ficoll preparations of the products after freeze-thaw showed RBC contamination and hemolysis. Postthaw viability exceeded 95%. The products were not RBC reduced or washed. There were no adverse reactions during or after infusion.
HPC-A collection from a patient with TEMPI syndrome was complicated by microcytic erythrocytosis, leading to RBC contamination and hemolysis in the product. Adequate HPCs were collected and the patient tolerated infusion without RBC depletion or washing. Our report highlights difficulties of HPC-A collection from iron-deficient patients.
通过单采术采集造血祖细胞（HPC-A）需要根据密度分离细胞。既往研究强调了从红细胞（RBC）异常的患者中采集HPC-A的挑战。TEMPI综合征是一种最近描述的疾病，其特征为毛细血管扩张、促红细胞生成素升高和红细胞增多、单克隆丙种球蛋白病、肾周积液和肺内分流。TEMPI综合征患者对用于治疗浆细胞发育异常的疗法有反应，可能从自体HPC移植中获益。我们报告了1例患有TEMPI综合征且并发严重缺铁的患者的HPC-A采集情况。
该患者接受粒细胞集落刺激因子（G-CSF）和普乐沙福进行HPC动员，并进行了3天的HPC-A采集。
该患者采集时表现为小细胞性红细胞增多。在3天内，处理了约50L全血，采集到2×10⁸个CD34⁺细胞（2.8×10⁶个CD34⁺细胞/kg）。平均采集效率（CE）、单核细胞百分比、血细胞比容（Hct）和RBC计数分别为18%、90%、14%和9×10¹¹。改变采集变量以避免RBC污染会降低CE。冻融后产品的Ficoll制备显示有RBC污染和溶血。解冻后活力超过95%。产品未进行RBC减少或洗涤处理。输注期间及之后均未出现不良反应。
从1例TEMPI综合征患者采集HPC-A时因小细胞性红细胞增多而变得复杂，导致产品中有RBC污染和溶血。采集到了足够的HPC，患者耐受输注，无需进行RBC去除或洗涤。我们的报告强调了从缺铁患者中采集HPC-A的困难。
