RESUMO
Adequate stem cell harvesting is required for autologous hematopoietic transplantation. In deficient mobilizer patients, the collection of stem cells can be challenging because of the impossibility of achieving satisfactory CD34 cell counts with GCSF + - chemotherapy. Plerixafor is a potent and expensive drug that promotes the release of stem cells from the medullary niche to the peripheral blood and allows satisfactory harvests. We performed a retrospective analysis of 370 patients with myeloma and lymphoma harvested at our institution. 99 % of patients achieved satisfactory apheresis using Plerixafor in 45 %. Satisfactory harvests were obtained in patients mobilized with GCSF or plerixafor. In patients who used plerixafor, it was necessary to perform fewer apheresis procedures (P = 0.05). In multivariate analysis, the only factor that predicted the need for plerixafor was the presence of less than 30,000 CD34 / ul on the day of apheresis (OR 0.3. p < 0.001). Since we adopted the plerixafor protocol guided by CD34 counts, the number of patients with harvest failure has decreased. In conclusion, the rational and standardized use of plerixafor favors satisfactory harvest in patients who require autologous transplantation in South-American patients.
Assuntos
Remoção de Componentes Sanguíneos , Transplante Autólogo , Humanos , Feminino , Masculino , Remoção de Componentes Sanguíneos/métodos , Pessoa de Meia-Idade , Transplante Autólogo/métodos , Adulto , Estudos Retrospectivos , Transplante de Células-Tronco Hematopoéticas/métodos , Chile , Idoso , Ciclamos/farmacologia , Ciclamos/uso terapêutico , Mobilização de Células-Tronco Hematopoéticas/métodos , BenzilaminasRESUMO
BACKGROUND: Autologous hematopoietic stem cell transplant (HSCT), characterized by high intensity chemotherapy followed by the infusion of HSC previously collected from the peripheral blood, is a procedure used in the treatment of several malignancies. In pediatrics, the apheresis procedure represents a challenge, due to the need for insertion of a rigid central venous catheter (CVC) in small children. The CVC is usually used for stem cell collection and then removed. Later, the patient will need a new device for cell infusion. AIM: We propose the use of one single catheter for both apheresis and infusion. METHODS: We present five children between 1 and 13 years of age who underwent apheresis using a high flow PICC catheter surgically inserted. RESULTS: All patients utilized a PICC line double lumen 5Fr (PowerPICC™ 5Fr DL BARD/USA) placed in the brachiocephalic vein tunneled on the chest, inserted under 24 h prior to apheresis to assure the devices were pervious. Three of the patients were diagnosed with solid tumor and one with acute lymphoblastic leukemia (ALL) awaiting Car-T Cell therapy. The four children who underwent autologous HSCT used the same catheter for cell infusion and remained with the catheter following discharge. The child who was submitted for Car-T Cell still awaits infusion and the catheter was removed. CONCLUSIONS: High flow PICC is a viable alternative for apheresis to maintain an adequate flow of 5 ml/s and can be used as a single catheter throughout the HSCT process, reducing the risks from anesthesia and the catheter insertion procedure. TYPE OF STUDY: Clinical Research.
Assuntos
Cateteres Venosos Centrais , Transplante de Células-Tronco Hematopoéticas , Humanos , Criança , Adolescente , Pré-Escolar , Lactente , Masculino , Transplante de Células-Tronco Hematopoéticas/métodos , Feminino , Brasil , Cateteres Venosos Centrais/efeitos adversos , Remoção de Componentes Sanguíneos/métodos , Remoção de Componentes Sanguíneos/instrumentação , Cateterismo Venoso Central/métodos , Cateterismo Venoso Central/instrumentação , Cateterismo Venoso Central/efeitos adversos , Neoplasias/terapia , Institutos de Câncer , Transplante AutólogoRESUMO
Therapeutic plasma exchange (TPE) or plasmapheresis has been used in various life-threatening diseases as a primary treatment or in combination with other therapies. It was first successfully employed in the 1960s for diseases like Waldenström's disease and myeloma. Since then, TPE techniques using apheresis membranes have been introduced. Apheresis therapies separate plasma components from blood using membrane screening or centrifugation methods. TPE aims to remove substances involved in the pathophysiology of diseases. It selectively removes high-molecular-weight molecules, substances with prolonged half-life, and those associated with disease pathogenesis. TPE can be performed using membranes or centrifugation, with replacement of extracted plasma volume using albumin or fresh frozen plasma. TPE requires specific competencies in nephrology and can be prescribed and monitored by nephrologists and performed by dialysis nursing staff. TPE can be combined with adsorption-based therapies to enhance its effect, and this approach is called plasma filtration adsorption. Another variation is double plasma filtration, which selectively removes substances based on molecular size. TPE can also be combined with lipoprotein removal strategies for managing familial hypercholesterolemia. TPE is an affordable extracorporeal therapy that benefits patients with life-threatening diseases. It requires collaboration between nephrologists and other specialists, and our results demonstrate successful TPE without anticoagulation in general hospitalization or outpatient settings.
Assuntos
Remoção de Componentes Sanguíneos , Nefrologia , Humanos , Diálise Renal , Remoção de Componentes Sanguíneos/métodos , Troca Plasmática/métodos , Plasmaferese/métodosRESUMO
Introducción: Con el paso de los años, la profesión de enfermería ha ganado terreno en diferentes áreas de la medicina y su acción ha llegado a esferas que se creía exclusivas de otros profesionales del sector de la salud, como la Medicina Transfusional y Terapia celular. Objetivo: Describir las funciones de enfermería en los procederes de aféresis. Análisis y síntesis de la información: El trabajo de enfermería se basa en la aplicación de la metodología para la implementación de los cuidados que realiza. El intercambio directo con la persona permite identificar sus necesidades, facilita planear, controlar, ejecutar y evaluar las actividades que se realizan en la práctica diaria. Dentro del área de la Medicina Transfusional el accionar de enfermería es fundamental, ya que puede intervenir en diferentes fases del proceso de la donación de sangre, realiza la centrifugación del componente a obtener, transfunde o implanta componentes sanguíneos y atiende las reacciones adversas del individuo. Conclusiones: La acción de enfermería en la actividad de aféresis para diferentes procedimientos es primordial para preservar la salud del donante y el paciente, así como en la creación o modificación de protocolos de trabajo con mayor eficiencia, eficacia y efectividad en base a los conocimientos y la experiencia en este campo lo que genera una espiral de desarrollo continuo que obliga a la constante actualización en el tema.
Introduction: With the step of the years, the infirmary profession has won land in different areas of the medicine and its action has arrived to spheres that it was believed they were exclusive of other professionals of the sector of the health, as the Medicine Transfusional and cellular Therapy. Objective: to describe the nursing functions in the aphaeresis procedures. Analysis and synthesis of the information: The infirmary work is based on the application of the methodology for the implementation of the cares that he/she carries out. The direct exchange with the patient allows to identify its necessities, as well as it facilitates to drift, to control, to execute and to evaluate the activities that are carried out in the daily practice. Inside the area of the transfusion medicine working of infirmary is fundamental, since it can intervene in different phases of the process of the donation of blood, he/she carries out the centrifugation of the component to obtain, it transfuses or it implants sanguine components and he/she assists the patient's adverse reactions. Conclusions: The nurse action in the aphaeresis activity for different procedures is primordial to preserve the donor's health and the patient, as well as in the creation or modification of work protocols with bigger efficiency, effectiveness and effectiveness based on the knowledge and the experience in this field what generates a hairspring of continuous development that he/she forces to the constant bring up to date in the topic.
Assuntos
Humanos , Remoção de Componentes Sanguíneos/métodos , EnfermagemRESUMO
BACKGROUND: Although Hematopoietic Stem Cells (HSC) donation through bone marrow (BM) and peripheral blood (PB) are usually safe procedures, adverse events are expected. One of the most common events especially among BM donors (BMD) is the development of anemia. To protect the BMD and preserve the hemoglobin levels, many centers collect autologous pre-procedure blood, but the actual benefits of this procedure is controversial. METHODS AND MATERIALS: This study analyzed retrospectively data to observe what factors may influence the occurrence of post-donation anemia and also evaluate the relevance of autologous red blood cell pre procedure donation (PAD). RESULTS: The development of immediately post donation anemia (IP) was higher in BMD than in PB donors (64.2% BMD and 10.7% PBD, P < .001) and also in late post donation (LP) (28.4% BMD and 3.6% PBD, P = .007). The study demonstrated an association between PAD and anemia in IP (72.7% with anemia and 27.3% without anemia, P = .006) and an association between the volume of red blood cells in the donated hematopoietic product and the development of anemia in LP (356.3 mL and 297.8 mL, P = .037). CONCLUSION: In conclusion, collection of HSC through BM is a risk factor for anemia and PAD is a risk factor for IP anemia.
Assuntos
Anemia/etiologia , Doadores de Sangue/estatística & dados numéricos , Transplante de Medula Óssea/efeitos adversos , Transplante de Células-Tronco de Sangue Periférico/efeitos adversos , Coleta de Tecidos e Órgãos/efeitos adversos , Adulto , Anemia/diagnóstico , Remoção de Componentes Sanguíneos/métodos , Remoção de Componentes Sanguíneos/estatística & dados numéricos , Células da Medula Óssea/citologia , Células da Medula Óssea/imunologia , Transplante de Medula Óssea/estatística & dados numéricos , Eritrócitos/citologia , Feminino , Células-Tronco Hematopoéticas/citologia , Células-Tronco Hematopoéticas/imunologia , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Transplante de Células-Tronco de Sangue Periférico/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Coleta de Tecidos e Órgãos/estatística & dados numéricos , Coleta de Tecidos e Órgãos/tendênciasRESUMO
BACKGROUND: Therapeutic plasma exchange (TPE) is an extracorporeal procedure which consists of removing the patient's plasma and replacing it with an appropriate replacement fluid. Plasma and blood cells are separated by a centrifugation process. Our department has used TPE for several years, and in 2013 we introduced an institutional apheresis protocol. The main objective of this report is to describe the TPE procedures performed between 2013 and 2016 in the Peruvian population. METHODS: We analyzed the technical and clinical aspects of 864 centrifugal TPE procedures as well as the associated complications. We evaluated 230 patients treated in our institution. RESULTS: The therapeutic indications included 16 different diseases: 89.5% (N = 206/230) neurological, 7.3% (N = 17/230) hematological, 1.7% (N = 4/230) rheumatologic, 0.8% (N = 2/230) dermatological and 0.4% (N = 1/230) nephrological. 70.4% (N = 142/230) of patients were diagnosed with Guillain-Barré syndrome. Albumin 5% solution was the most frequent replacement solution, used in 65.8% (N = 569/864) of the procedures. The mean plasma volume (PV) replaced was 2451.73 ml, corresponding to 1.0 PV in all procedures. Complications occurred in 10.9% (N = 95/864) of the sessions. Allergic reactions were the most common events and cardiopulmonary arrests were recorded in two patients. CONCLUSION: This is the first report of TPE performed in the Peruvian population. The use of an institutional apheresis protocol was beneficial to improve registries in our service and our professional health attention. This study reports a low rate of complications, suggesting that TPE is safe. There is a need to create a multicenter Peruvian apheresis registry to assess the benefits and risks of TPE in Peru.