Adverse events associated with therapeutic apheresis procedures carried out on adult hematological disorders

Aim: Apheresis is a procedure in which target cell or component is separated from the blood through a cell separator while rest of the blood is given back to the person. Although apheresis procedures are considered to be quite safe, some adverse reactions may occur due to the technique, the procedure itself, indication or anticoagulant solution and vascular access used during the treatment. In this study, we aimed to determine the frequency and severity of apheresis complications in procedures performed on adult patients with hematological indications in Cukurova University Hemapheresis Unit. Detailed analysis of these side effects may help taking necessary precautions and provide information about rapid and effective interventions when side effects are observed. Material and Methods: This study includes totally 1783 therapeutic apheresis procedures carried out in Cukurova University hemapheresis unit on adult patients with hematological disorders between 2005-2014. We retrospectively analysed the data related to the apheresis procedures and collected from patient files and complications reporting forms. Findings: Procedures were performed in 447 patients (mean age 42.1 ± 17.6); 193 (42.3%) were women and 254 (56.8%) were men. Totally 1,239 TPE (69.5%), 428 RBCX (24%), 60 leukocytapheresis (3.4%), 56 plasma filtration (3.1%) were done. Total number of adverse events related to therapeutic apheresis was 836 and majority of complications was seen in TPE procedures. At least one adverse reaction occurred in 642 (36%) and more than one complication (min: 2, max: 7) was observed in 142 (8%) of procedures. In addition, only mild complications were detected in 348 (19.5%) procedures, while moderate adverse effects were identified in 243 (13.6%). Termination of the procedure due to severe complications was observed in 51 procedures (2.9%). No fatal complications were detected in our study. Patient-related adverse events were observed in 490 procedures (27.5%). The complications associated with vascular access and technical malfunctions were reported in 151 (8.5%) and in 62 (3.5%) procedures respectively. TTP, SCD and Hyperviscosity syndrome were the most common indications encountered. And the majority of complications was seen in the same disorders at the same time. In our study, the top three signs and symptoms of adverse events were hypotension (14.3%), dizziness (5.6%), and allergic skin reactions (3.3%). Conclusion: Considering that significant number of complications was mild or moderate and mortality rate was extremely low, apheresis procedures can be generally recognized as safe. Planning the procedure in coordination with Hemapheresis Unit, a detailed examination of the patient before apheresis treatment, taking into account possible adverse effects before the procedure and close monitoring of the patients during and after the procedure may significantly reduce the overall rate of complications, especially in the case of severe adverse reactions which led to termination of the procedures. Key words: Therapeutic apheresis, adverse events, plasma exchange, plasma filtration, leukapheresis, red blood cell exchange.