The role of erythrocytapheresis in secondary erythrocytosis therapy

In chronic respiratory insufficiency secondary erythrocytosis (SPC), causin g pulmonary hypertension and dr ventricular insufficiency, is often noticed . An alternative therapy to phlebotomy for SPC is isovolemic large volume e rythrocytapheresis performed with cell separator (CSE) in order to quickly remove a large volume of red blood cells (RBC) while saving plasma proteins and clotting factors. In order to evaluate the efficiency and safety of CS E in SPC we reported a retrospective analysis of our experience with 61 SPC patients: from April 1996 to May 1998 we performed 208 CSE using Haemoneti cs MCS3P (TAE protocol). Before every apheresis procedure we verified Hb (i n median 18.8 g/dl), Ht (in median 58.4%), viscometry, coagulation test, EG A, PFR and EGG. 11 patients were treated with 1 CSE, 12 with 3, 29 with 4 a nd 9 with 5. The mean volume of RBC removed was 576 ml (range 426-800); Hb post CSE averaged 14.4 g/dl and Ht post CSE averaged 42.7%; hematic viscosi ty post CSE was significantly reduced while tissue oxygen tension increased : the improvement of symptomatology and hematochemical parameters was maint ained on the average for 6.5 months. All the procedures were well tolerated and light side effects (paresthesias citrate-depending in 27 apheresis) we re easily controlled. CSE, compared to phlebotomy, has the advantage of sel ectively removing RBC without loss of clotting factors, platelets and plasm a proteins. Although CSE has relatively high costs we noticed a decrease of hospital recurrence (about 50-65%) in SPC patients treated with apheresis.