Acute mechanical hemolysis as a complication of extracorporeal photopheresis in a low-weight child

• Published in: Journal of clinical apheresis Vol. 32; no. 6; pp. 571 - 573
• Main Authors: DeSimone, Robert A, Wontakal, Sandeep N, Lyashchenko, Alexander K, Schwartz, Joseph
• Format: Report
• Language: English
• Published: 01-12-2017
• ISSN: 1098-1101
• DOI: 10.1002/jca.21520

Graft-versus-host disease (GVHD) is a complication of allogeneic hematopoietic stem cell transplantation with high morbidity and mortality. Extracorporeal photopheresis (ECP) is an effective therapy for treating medication-refractory GVHD, however, there is scant evidence of whether ECP can be safely performed in patients weighing less than 15 kg. Here, we report the implementation of a successful protocol to perform ECP in a 21-month-old, 10.6 kg female with medication-refractory GVHD. Our initial ECP treatment resulted in significant hemolysis that was most likely mechanical. After procedural adjustments that included modifying the anticoagulation dose and whole blood:anticoagulant ratio, as well as whole blood processing time, the patient tolerated future procedures safely without hemolysis or other adverse events. With appropriate technical modifications, we provide a framework for safely performing ECP in children less than 15 kg.