Ohara Yoshihiro, Ohto Hitoshi, Tasaki Tetsunori, Sano Hideki, Mochizuki Kazuhiro, Akaihata Mitsuko, Kobayashi Shogo, Waragai Tomoko, Ito Masaki, Hosoya Mitsuaki, Nollet Kenneth E, Ikeda Kazuhiko, Ogawa Chitose, Kanno Takahiro, Shikama Yayoi, Kikuta Atsushi
Department of Pediatrics, Fukushima Medical University, Fukushima, Japan; Department of Pediatric Oncology, Fukushima Medical University, Fukushima, Japan.
Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, Fukushima, Japan.
Transfus Apher Sci. 2016 Dec;55(3):338-343. doi: 10.1016/j.transci.2016.09.014. Epub 2016 Sep 30.
Pediatric apheresis for peripheral blood stem cell transplantation should be carried out with due concern for low corporeal blood volume and vulnerability to hypocalcemia-related complications, hypovolemic shock, and hypervolemic cardiac overload.
We retrospectively investigated a total of 267 apheresis procedures from 1990 to 2013 on 93 children between 0 and 10 years old, including 89 patients and 4 healthy donors, with body weights of 6.3 to 44.0 kg.
The median CD34+ cell yield per apheresis procedure was 2.3 × 10 CD34+ cells/kg (0.2-77.9 × 10 CD34+ cells/kg). Adverse events occurred in 11.6% of procedures (n = 31), including mild perivascular pain (n = 12), emesis (n = 9), hypotension (n = 3), urticaria (n = 2), numbness (n = 2), chest pain (n = 1), facial flush (n = 1), and abdominal pain (n = 1). Among hypotensive events, shock in a 9.6 kg one-year-old boy required emergency treatment in 1996. Thereafter, we adopted continuous injection of calcium gluconate, ionized calcium monitoring, central venous catheter access and circuit priming with albumin in addition to concentrated red cells. Since then we have had fewer complications: 16.4% per apheresis during 1990-1997 versus 5.8% during 1998-2013. No healthy pediatric donors suffered from any late-onset complications related to apheresis or G-CSF administration.
By employing appropriate measures, peripheral blood stem cell apheresis for small children can have an improved safety profile, even for children weighing <10 kg.
小儿外周血干细胞移植的单采术应充分考虑到小儿血容量低以及易发生与低钙血症相关的并发症、低血容量休克和高血容量性心脏负荷过重等情况。
我们回顾性调查了1990年至2013年间对93名0至10岁儿童进行的总共267次单采术，其中包括89例患者和4名健康供者，体重为6.3至44.0千克。
每次单采术CD34+细胞产量的中位数为2.3×10个CD34+细胞/千克（0.2至77.9×10个CD34+细胞/千克）。11.6%的单采术（n = 31）发生了不良事件，包括轻度血管周围疼痛（n = 12）、呕吐（n = 9）、低血压（n = 3）、荨麻疹（n = 2）、麻木（n = 2）、胸痛（n = 1）、面部潮红（n = 1）和腹痛（n = 1）。在低血压事件中，1996年一名体重9.6千克的1岁男孩发生休克，需要进行紧急治疗。此后，我们除了使用浓缩红细胞外，还采用了葡萄糖酸钙持续注射、监测离子钙、中心静脉置管以及用白蛋白预充管路。自那时以来，我们的并发症减少了：1990 - 1997年期间每次单采术的并发症发生率为16.4%，而1998 - 2013年期间为5.8%。没有健康的小儿供者发生任何与单采术或粒细胞集落刺激因子给药相关的迟发性并发症。
通过采取适当措施，即使对于体重<10千克的小儿，小儿外周血干细胞单采术的安全性也可得到改善。
