Regional anticoagulation with acid citrate dextrose-A for extracorporeal photoimmunochemotherapy.

ABSTRACT

BACKGROUND AND OBJECTIVES: During photopheresis, intravenous heparin is used to prevent clotting in the extracorporeal circuit. Regional citrate anticoagulation could lower the risks associated with heparin treatment. MATERIALS AND METHODS: Four-hundred and six photophereses procedures that were anticoagulated by acid citrate dextrose-A (ACD-A) (of which 343 were performed in patients at risk for haemorrhage) were analysed together with 278 heparin-anticoagulated treatments. RESULTS: Four-hundred and four of 406 citrate treatments were completed. Seven transient paresthesias (1.73%), five of which occurred in the first 50 treatments, were observed. Bleeding complications were noted during heparin anticoagulation (1.07%), but not during citrate anticoagulation. During photopheresis, haemoglobin values and platelet counts decreased by 11.4% and 14.6%, respectively (P < 0.0001). Twenty-four hours after treatment, haemoglobin values, and platelet and leucocyte counts were still lower than at baseline (P < 0.0001). The changes of haemoglobin, platelet and leucocyte values did not differ for citrate and heparin. CONCLUSIONS: In patients with contraindications against heparin use, ACD-A citrate anticoagulation during photopheresis is a safe and efficient alternative. Photopheresis induces profound changes of the blood count, irrespective of the anticoagulation method.