Journal of Clinical Apheresis最新文献

{"title":"Toward Better Estimation of Total Blood Volume in Obese Patients Undergoing Apheresis","authors":"Caitlin Raymond,&nbsp;Sinaii Ninet,&nbsp;Kamille West-Mitchell","doi":"10.1002/jca.70049","DOIUrl":"https://doi.org/10.1002/jca.70049","url":null,"abstract":"<div>\u0000 \u0000 <p>Estimating total blood volume (TBV) in obese individuals remains a critical yet unresolved challenge in apheresis medicine. Our prior work demonstrated that commonly used TBV formulas exhibit significant variability, particularly at higher BMI ranges. This study builds on those findings to test modified algorithms that produce mid-spectrum apheresis parameters and mitigate extreme over- or underestimation. Using a standardized artificial dataset and retrospective clinical data from obese patients, we evaluated the performance of modified versions of the Lemmens-Bernstein formula and Gilcher's Rule. We assessed output consistency, alignment with empirically defined expected ranges, and potential clinical impact on apheresis parameters. A modified Lemmens-Bernstein formula (LB-60) yielded TBV estimates within an expected range for obese women and resolved extreme overshooting of an empiric expected range at higher BMIs. For obese men, both the LB-60 and a modified Gilcher's Rule (Gilchers-65) performed comparably. These formulas produced mid-spectrum apheresis parameters and mitigated extreme over- or underestimation. We recommend using a modified Lemmens-Bernstein formula for obese women, and either it or a modified Gilcher's Rule for obese men. These represent practical interim solutions while the field moves toward direct TBV measurement.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144740482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unexpected Seizure Complication Post-Apheresis in a Young Adult With Sickle Cell Disease: A Case Report","authors":"Joshua Glass,&nbsp;HyoJeong Han,&nbsp;Jennifer Webb","doi":"10.1002/jca.70044","DOIUrl":"https://doi.org/10.1002/jca.70044","url":null,"abstract":"<div>\u0000 \u0000 <p>This case report presents a previously unreported grade 4 adverse event in a 23-year-old male with sickle cell disease (SCD) undergoing autologous stem cell collection for gene therapy. About 8 h after the collection of stem cells, the patient experienced a generalized tonic–clonic seizure. Imaging revealed a right temporal infarct, newly identified but determined to be subacute. Common causes such as electrolyte imbalance, a thromboembolic event, and posterior reversible encephalopathy syndrome (PRES) were excluded. Given the temporal relation of seizure occurrence after the apheresis procedure, an adverse event due to apheresis cannot be excluded. Seizure due to apheresis has not been reported before and would be categorized as grade 4 according to the common terminology criteria for adverse events (CTCAE). This case highlights the need to report and collect all adverse events that occur during or after apheresis procedures in SCD patients undergoing gene therapy to better counsel patients on the potential risks and prevention strategies.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144695780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Day Two Advantage: A Retrospective Paired Analysis of Consecutive HPC(A) Collections","authors":"Yandy Marx Castillo-Aleman,&nbsp;Carlos Agustin Villegas-Valverde,&nbsp;Antonio Alfonso Bencomo-Hernandez,&nbsp;Shinnette Lumame,&nbsp;Charisma Castelo,&nbsp;Jay Mary Rose-Roque,&nbsp;Marlene Cato,&nbsp;Nameer Al-Saadawi,&nbsp;Mohamed Ibrahim Abu-Haleeqa,&nbsp;Inas El-Najjar,&nbsp;Yendry Ventura-Carmenate,&nbsp;Fatema Mohammed Al-Kaabi","doi":"10.1002/jca.70046","DOIUrl":"https://doi.org/10.1002/jca.70046","url":null,"abstract":"<div>\u0000 \u0000 <p>The hematopoietic progenitor cell apheresis [HPC(A)] is a cornerstone of stem cell transplantation. While multiple apheresis sessions are common in clinical practice, few studies have examined the procedural variability within the same donor across consecutive collections. This study aims to compare changes in the efficiency metrics between the first and second HPC(A) procedures. A retrospective analysis was conducted on paired HPC(A) procedures performed on the same donor between January 2023 and May 2025 at the Abu Dhabi Stem Cells Center. The predefined parameters, including the collection efficiencies (CE₁, CE₂, cruCE), performance ratio (PR), and total volume processed (TVP), were compared using the Wilcoxon signed-rank tests. Effect sizes were calculated using Cohen's <i>r</i>, and associations between variables were assessed using the Spearman correlation. Of the 215 procedures screened, 90 met the inclusion criteria. Despite similar preapheresis CD34⁺ cell counts and flow rates, second-day procedures demonstrated significantly improved CE₁, CE₂, and PR, with lower TVP. A large effect size was observed for the TVP/total blood volume (TBV) ratio (<i>r</i> = 0.63), and moderate-to-large effect sizes for CE₂ (<i>r</i> = 0.41), PR (<i>r</i> = 0.47), and CE₁ (<i>r</i> = 0.47). CE₁ and CE₂ correlated strongly with PR across both sessions, while CE₂ correlated positively with TVP/TBV on day 1 (<i>ρ</i> = 0.47) and negatively on day 2 (<i>ρ</i> = −0.40). Second-day HPC(A) sessions yielded superior efficiency despite reduced volume, supporting the value of individualized collection planning. These “<i>day two advantages</i>” may inform refinements in yield prediction and highlight the need for prospective studies to optimize apheresis strategies.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144666454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Report of the ASFA Apheresis Registry Study on Focal Segmental Glomerulosclerosis","authors":"Poyyapakkam Srivaths,&nbsp;Grace F. Monis,&nbsp;Leonor P. Fernando,&nbsp;Jeanne E. Hendrickson,&nbsp;Jay S. Raval,&nbsp;Cyril Jacquot,&nbsp;Keefe Davis,&nbsp;Edward Wong,&nbsp;Chisa Yamada","doi":"10.1002/jca.70041","DOIUrl":"https://doi.org/10.1002/jca.70041","url":null,"abstract":"<div>\u0000 \u0000 <p>Focal segmental glomerulosclerosis (FSGS) is one of the causes of end-stage kidney disease. The etiology is not fully understood, and standardized treatments are not established. We created a registry on apheresis for post-transplant FSGS through the Renal Subcommittee in the Research Committee in the American Society for Apheresis (ASFA), and here is our first report. Members of the renal subcommittee from seven centers in the United States contributed data collection on demographic, clinical course, and overall outcomes of patients with post-transplant recurrence of FSGS treated with therapeutic plasma exchange (TPE) between 2015 and 2020. The TPE data, including frequency and replacement fluid for TPE, are also investigated. The median age at diagnosis of FSGS and first transplantation among 26 patients was 12.7 and 21 years, respectively. The FSGS recurred at a median of 1 day after transplantation, and TPE was performed daily or every other day in the first month and continued at some frequency beyond a year in some cases. Most procedures used albumin as a replacement fluid and citrate anticoagulation, with 1–1.5 plasma volumes exchange. Twelve patients had complete/partial remission by 6 months. The median urine protein/creatinine ratio improved from 4.47 to 1.4 mg/mg within 3 months, and eGFR improved from 26 to 78 mL/min/1.73 m² in a year after TPE started. The study revealed some uniformity in the prescription of TPE, primarily using albumin as replacement fluid and performing 1–1.5 plasma volume exchanges. Observed complication rates were minimal. TPE can be one of the treatments to consider in this condition.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144598428","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Green Plasma in Extracorporeal Photopheresis: A Case Report in Overlap Chronic GvHD","authors":"Yandy Marx Castillo-Aleman,&nbsp;Aseel Suleiman Alsaid,&nbsp;Shinnette Lumame,&nbsp;Charisma Castelo,&nbsp;Jay Mary Rose Roque,&nbsp;Marlene Cato,&nbsp;Yara Khaled Afifi,&nbsp;Sheima Ali,&nbsp;Mohamed Ibrahim Abu-Haleeqa,&nbsp;Inas El-Najjar,&nbsp;Nameer Al-Saadawi","doi":"10.1002/jca.70045","DOIUrl":"https://doi.org/10.1002/jca.70045","url":null,"abstract":"<div>\u0000 \u0000 <p>We report the case of a 50-year-old male with peripheral T-cell lymphoma who underwent allogeneic hematopoietic stem cell transplantation and developed overlap chronic graft-versus-host disease (ocGvHD) requiring extracorporeal photopheresis (ECP). His clinical presentation included a maculopapular rash with jaundice, hepatosplenomegaly, hyperbilirubinemia, and elevated liver enzymes. Liver biopsy findings were not consistent with GvHD or lymphoma but were suggestive of drug-induced hepatitis. ECP was initiated using the Therakos CellEx Photopheresis System. During the initial sessions, dark green plasma discoloration was observed, accompanied by multiple plasma/red blood cell interface-related procedural alarms. These challenges were managed through various operator adjustments, and the procedures remained safe and effective. Over four ECP sessions, both the discoloration and opacity of the plasma progressively improved, in parallel with declining liver enzyme levels and a reduction in procedural alarms. This temporal association between hepatic recovery and improved interface stability during ECP has not been previously described in the context of ocGvHD. Although dark green plasma is an uncommon finding in this setting, it should prompt evaluation for underlying hepatic dysfunction and timely management of plasma/red blood cell interface issues to ensure safe and effective ECP delivery.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144598225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Response to a Letter to the Editor on Our Recent Publication “Performance of Total Blood Volume Algorithms in Obesity and Severe Obesity”","authors":"Caitlin Raymond","doi":"10.1002/jca.70043","DOIUrl":"https://doi.org/10.1002/jca.70043","url":null,"abstract":"","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Constructive Reflections on Total Blood Volume Estimation in Obesity: Comment on Raymond et al.","authors":"Radheshyam Meher","doi":"10.1002/jca.70042","DOIUrl":"https://doi.org/10.1002/jca.70042","url":null,"abstract":"","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144589663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Extracorporeal Photopheresis and Heart Transplantation; A Comprehensive Review of Current Evidence","authors":"Mehrbod Vakhshoori,&nbsp;Andreas Zuckermann,&nbsp;Amir Abdipour","doi":"10.1002/jca.70039","DOIUrl":"https://doi.org/10.1002/jca.70039","url":null,"abstract":"<div>\u0000 \u0000 <p>Despite significant advancements in heart transplantation (HTx) techniques and the development of immunosuppressive (IS) medications, rejection remains a persistent challenge. Additionally, IS medications are associated with various complications, highlighting the need for alternative therapeutic interventions. Extracorporeal photopheresis (ECP) has emerged as a promising adjunctive therapy. Initially approved for the treatment of cutaneous T-cell lymphoma, ECP has expanded its applications to include both the prophylaxis and treatment of HTx rejection. However, the available data remain limited, necessitating a comprehensive review to better understand its role. This article aims to evaluate the existing literature on ECP, focusing on its mechanisms and its potential in both the preventive and therapeutic management of HTx rejection. This comprehensive evaluation is intended to guide future research efforts, which could include well-designed clinical trials and real-world studies to address the limitations of current data. Ultimately, our goal is to provide a robust framework for integrating ECP into HTx management protocols, ensuring that its potential benefits are fully realized for both prophylactic and therapeutic applications.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144573561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transient Wavy Collection Trend in Hematopoietic Stem Cell Apheresis: A Rare and Underreported Occurrence","authors":"Dibyajyoti Sahoo,&nbsp;Aparna Krishna,&nbsp;Abhishekh Basavarajegowda","doi":"10.1002/jca.70040","DOIUrl":"https://doi.org/10.1002/jca.70040","url":null,"abstract":"<div>\u0000 \u0000 <p>Hematopoietic stem cell transplantation is a key therapeutic approach for various malignancies in recent years. Peripheral blood hematopoietic stem cells are typically collected using the apheresis technique following mobilization. However, during the collection process various challenges may arise. Here we report a rare occurrence during stem cell collection, where the collection trend graph exhibited a persistent wavy pattern throughout most of the procedure. The patient was found to be dehydrated on examination and was hydrated with normal saline IV, after which the wavy pattern resolved. The cells started collecting from the same collection preference that was set by the operator and the green diamonds, which depict cells aligned in a straight line. This is the first documented report of a wavy interface pattern during stem cell collection. This report contributes to the existing literature and may provide valuable insights for troubleshooting similar occurrences in future cases.</p>\u0000 </div>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144482050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of Total Blood Volume Algorithms in Obesity and Severe Obesity","authors":"Caitlin Raymond,&nbsp;Ninet Sinaii,&nbsp;Kamille West-Mitchell","doi":"10.1002/jca.70038","DOIUrl":"https://doi.org/10.1002/jca.70038","url":null,"abstract":"<p>Amid the ongoing obesity epidemic, the estimation of total blood volume (TBV) in obese people remains hotly contested without common agreement among apheresis practitioners. We compare the results of estimated TBV from different formulas across a spectrum of obese BMIs from a cohort of 155 individual patients. We also plot the difference between the resulting TBVs, assigning a threshold of functional significance of 500 mL, at which the choice of formula might make an impact on patient care. We compare the mean TBV estimated in non-severe versus severe obesity for all the above algorithms and determine the impact of algorithm choice on various apheresis procedures. The choice of algorithm has a significant impact on apheresis procedures; for example, we found differences of up to ~3–4 plasma units for a therapeutic plasma exchange depending on the choice of algorithm applied. We additionally find that algorithm performance varies widely in both men and women, particularly in morbid obesity, and often produces values that fall outside an empirically chosen expected range. We do not find a clinically significant difference in mean estimated TBV between non-severe and severe obesity in any algorithm tested, suggesting that physiological changes in obesity may fail to be captured by these algorithms. We hope these results are useful to other apheresis practitioners and help them make an informed choice of algorithm to estimate TBV in their obese patients. However, our current algorithms for estimating TBV may be flawed, and the field may wish to move toward measurement of TBV using recently available commercial options.</p>","PeriodicalId":15390,"journal":{"name":"Journal of Clinical Apheresis","volume":"40 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jca.70038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144273396","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}