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Large volume leukapheresis for peripheral blood stem cell collection in children under 10 kg in weight

Bone Marrow Transplantation volume 31, pages 517–518 (2003)Cite this article

Peripheral blood stem cell (PBSC) collection in children under 10 kg in weight is certainly a technical challenge. The main concerns for apheresis in these patients are citrate toxicity, high extracorporeal volume, vascular access and patient's tolerance. This highlights the importance of a recent paper,1 which provides an alternative to apheresis, although it appears limited to very good mobilizers. As the authors point out, data regarding PBSC collection in very small children are limited.2,3,4,5 We report our technique for PBSC collection using large volume leukapheresis with the Cobe Spectra AutoPBSC procedure and the results of three such procedures.

The main problem in our opinion is vascular access. At our institution, we insert a central line under general anesthesia in the operating room. We use a 10 F double lumen catheter (PermCath, Palex SA) which is placed at the right atrium entrance through a cutdown in the internal jugular vein. The jugular vein is preserved and hemorrhage around the catheter is prevented by a vascular purse-string suture closing the vein opening around the catheter. The apheresis catheter is brought out through a separate skin incision leaving a subcutaneous tunnel. Fixation in place is accomplished by a subcutaneous foam cuff built in the catheter and a skin stitch holding the exterior end to the head skin in a comfortable position. A soft elastic head band holds the double line end from pulling during sudden head movements. This catheter is maintained after apheresis, throughout the transplantation procedure.

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References

  1. Koristek Z, Sterba J, Havranova D et al. Technique for PBSC harvesting in children of weight under 10 kg. Bone Marrow Transplant 2002; 29: 57–61.

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Authors and Affiliations

  1. Services of Hematology Hospital Sant Joan de Déu Passeig Sant Joan de Déu, Espluges, 08950, Spain

    I Martin, I Alcorta, J Estella, S Rives, T Toll & E Tuset

  2. Services of Surgery, Hospital Sant Joan de Déu, Passeig Sant Joan de Déu, Esplugues, 08950, Spain

    A Albert

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  1. I Martin
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  2. A Albert
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  3. I Alcorta
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  4. J Estella
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  5. S Rives
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  6. T Toll
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  7. E Tuset
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Martin, I., Albert, A., Alcorta, I. et al. Large volume leukapheresis for peripheral blood stem cell collection in children under 10 kg in weight. Bone Marrow Transplant 31, 517–518 (2003). https://doi.org/10.1038/sj.bmt.1703907

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  • DOI: https://doi.org/10.1038/sj.bmt.1703907

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