A prospective, randomized, sequential crossover trial of large-volume versus normal-volume leukapheresis procedures: effects on serum electrolytes, platelet counts, and other coagulation measures

BACKGROUND: LVL procedures with the administration of heparin as an additio nal anticoagulant are increasingly performed because of the potentially hig her yield of autologous peripheral blood HPCs. A prospective, randomized cr ossover trial was performed to evaluate the influence of leukapheresis volu me-that is, large versus normal-on serum electrolytes, platelet count, and other coagulation measures in 25 patients with breast cancer and 14 patient s with non-Hodgkin's lymphoma. STUDY DESIGN AND METHODS: Patients were randomly assigned to start either w ith an LVL on Day 1 followed by a normal-volume leukapheresis (NVL) on Day 2 or vice versa. In LVL, heparin was administered in addition to ACD-A. Ble eding complications, transfusion support, whole-blood counts, and several c oagulation measures as well as plasma heparin levels were evaluated. RESULTS: Although the duration, the infused amount of ACD-A, the flow rate, the drop in platelet count, and the drop in potassium were significantly g reater in LVL, and although LVL patients also received heparin, there was n o significant difference in clinical tolerance or bleeding complications. A fter LVL, patients exhibited a significantly longer activated partial throm boplastin time (APTT), with a median of 70 seconds (range, 44-100 sec), and a median anti-factor Xa activity of 0.69 IU per mt (range, 0.10-1.29 IU/mL ). The value of the APTT after LVL correlated with anti-factor Xa activity (r = 0.37, p<0.05), but not with platelet count or heparin infusion rate. M arkers for coagulation activation did not increase during NVL or LVL. CONCLUSION: LVL with heparin as an additional anticoagulant seems to be a s afe procedure in patients with low preleukapheresis platelet counts. No act ivation of coagulation occurred after NVL or LVL procedures.