Phlebotomy and therapeutic apheresis in the treatment of polyglobulia

Česká verze

Authors: M. Bohoněk; J. Hrabánek; M. Kořánová; D. Kutáč
Authors place of work: Oddělení hematologie a krevní transfuze, Ústřední vojenská nemocnice – Vojenská fakultní nemocnice Praha
Published in the journal: Transfuze Hematol. dnes,19, 2013, No. 4, p. 216-222.
Category: Souhrnné práce, původní práce, kazuistiky

Summary

The efficiency and suitability of two cyto-reduction methods in the treatment of polyglobulia –⁠ phlebotomy and double erythrocytapheresis –⁠ were evaluated by retrospective analysis. This study evaluated the treatment of 44 patients (33 male, 11 female) in the years from 2001 to 2013. Total number of procedures was 364, number of double erythrocytapheresis was 284 (median age 64.4 years), number of phlebotomies series was 80 with an average of 2.13 phlebotomies per series (median age 69 years). The most frequent diagnosis was polycythaemia vera (n = 26), followed by secondary polycythaemia (n = 17) and 1 patient had familiar erythrocytosis. Treatment in polycythaemia vera and familiar polycythaemia was indicated at Ht > 0.50, with a therapeutic goal of Ht < 0.45. Treatment in secondary polycythaemia was indicated at Ht > 0.55, achieved Ht value should not drop below 0.50 or 0.55, respectively. In most cases, the treatment of choice consisted of double erythrocytapheresis using Haemonetics MCS+, while phlebotomy was indicated mainly with patients with poor venous access or with poor toleration of apheresis. Median of collected blood during a single series of phlebotomy was 914.6 ml. Median of initial Ht was 0.54, final Ht 0.50 and decrease of Ht 0.048. With median frequency 112 days, median number of phlebotomies was 7 per year. In double erythrocytapheresis, median collected RBCs was 415 ml. Median initial Ht was 0.54, final Ht 0.47 and decrease of Ht 0.07. Median frequency was 98 days, median procedures was 3.7 per year. Double erythrocytapheresis is sufficient to achieve the Ht target values in most patients with polycythaemia vera as well as secondary polycythaemia. For a majority of patients, the method is more comfortable than phlebotomy, brings faster relief and decreases the number of hospital visits. Double erythrocytapheresis has been shown to be a suitable cyto-reduction method that rapidly and safely corrects increased haematocrit values at an acceptable cost.

Key words:
polyglobulia, phlebotomy, therapeutic apheresis, double apheresis

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