In this paper the authors reviewed more than 50.000 extracorporeal procedures in 7.142 patients regarding incidence and severity of apheresis related adverse events.
Adverse events were graded in mild, moderate, severe and leading to death. First of all, no death occurred, but in 168 (0.4%) procedures severe side effects (hypotension, bronchospasm, arrhythmia and asystole) led to interruption of the treatment.
The authors compared diagnoses, gender, apheresis techniques (filtration or centrifugation), replacement fluids, anticoagulation and venous access.
In general extracorporeal treatment techniques are safe and are related with a small number of overall side effects. Taken together 2907 events occurred in 50.846 procedures (5.7%), most of them were mild to moderate and occurred during the 1st procedure. The main recorded side effect was tingling given in n/10.000 procedures = 174/10.000. Access problems occurred in 130cases/10.000 procedures. A central venous catheter caused more severe events than the peripheral venous access.
The authors found a clear relationship to the technique and the replacement fluid. Filtration was associated with more side effects than centrifugation. Albumin as exchange medium was associated with more hypotension and plasma with more allergic reactions, HES caused no adverse events. The matter of anticoagulation is difficult to answer. Here it seems that the citrate containing anticoagulation medium is responsible for more moderate and heparin for more mild reactions.
Interestingly calcium prophylaxis seemed to result in an increase of adverse events and thus having a negative effect. The reason for this could not be clarified in this study because of the data entered, which do not discriminate between continuous and on demand Ca++ administration. And it might be that the patients already presenting some adverse effects were given then Ca++
A multivariance analysis revealed that patients who were older, a female, received plasma as replacement and calcium as prophylaxis were at higher risk to experience severe adverse events.
The authors suggest that a careful monitoring of vital signs and an emergency equipment near by would be necessary counteract life threating side effects, although they are really less frequent (0.4%).
The question of anticoagulation and calcium prophylaxis has to be clarified in further studies.
M. Mörtzell Henriksson, E. Newman, V. Witt, K. Derfler, G. Leitner, S. Eloo , A. Dhondt, D. Deeren, G. Rock, J. Ptak, M. Blaha, M. Lanska, Z. Gasova, R. Hrdlickova,W. Ramlow, H. Prophet, G. Liumbruno, E. Mori, A. Griskevicius, J. Audzijoniene, H. Vrielink, S. Rombout, A. Aandahl, A. Sikole, J. Tomaz, K. Lalic, S. Mazic, V. Strineholm, B. Brink, G. Berlin, J. Dykes, F. Toss, C.G. Axelsson, B. Stegmayr, T. Nilsson, R. Norda, F. Knutson, B. Ramsauer, A.Wahlström
Published recently in Transfusion and Apheresis Science http://dx.doi.org/10.1016/j.transci.2016.01.003
1473-0502/© 2016 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).