Erythrocyte-exchange with the OPTIA™ cell separator in patients with sickle-cell disease.

Erythrocyte-exchange (EEX) has proven to be a very useful tool in sickle-cell disease (SCD) patients either during acute painful crisis unresponsive to hydration and/or analgesia or as a prophylactic treatment in high risk patients in those who do not tolerate hydroxyurea (HU), with the aim of lowering HbS levels. EEX may be performed either by using continuous- or discontinuous flow devices, the former being of choice in children or in low-weight patients. Thus, a low extracorporeal blood volume (EBV) could allow for a better and safer procedure management. In this study we compared EEX procedure performed with the recently released OPTIA device with EEX procedures performed using the COBE Spectra device (EBV 185 vs 270 mL, respectively). Twenty-one EEX (4 as emergency treatment) were performed in 12 patients with the Spectra device and 25 (9 as emergency treatment) in 15 patients with the OPTIA device. All the procedures were well tolerated and uneventful. We did not observe significant differences between the two devices as to pre- and post-EEX parameters, namely in target hematocrit and in HbS reduction. Noteworthy, due to the lowest EBV allowed by the OPTIA device, an EEX procedure performed in a 13 Kg- child did not require a preliminary priming of the circuit. In conclusion, the OPTIA device proved to be as effective as the Spectra device in treating SCD patients either during sickling crisis or as prophylactic therapy. The OPTIA device can be safely used in the pediatric setting since it allows a lower EBV.

Mononuclear cell collection in patients treated with extracorporeal photochemotherapy by using the off-line method: a comparison between COBE Spectra AutoPbsc version 6.1 and Amicus cell separators.

BACKGROUND: The first step (MNC collection) during extracorporeal photochemotherapy by using the off-line method is of paramount importance, since the product should be highly MNC-enriched with low RBC count to avoid UV-A intercepting by erythrocytes. MATERIAL AND METHODS: 10 patients (nine with chronic GvHD and one with bullous pemphigoid) underwent MNC collection on subsequent days either with the COBE Spectra AutoPbsc version 6.1 or the Amicus Crescendo cell separator. Total and differential WBC count were performed on peripheral blood samples before procedure and on the yields. The procedure parameters were recorded for comparison between the two devices. Analysis included descriptive statistics and paired t-test. RESULTS: No clinically relevant side effect with the exception of mild paresthesias was observed during the 20 MNC collections. Furthermore, no difference were observed as to pre-collection hematological parameters. The mean total nucleated cell count in the yield was 6.99 ± 2.39 × 10(9) with a MNC content of 5.9 ± 2.19 × 10(9) in the Spectra group and 6.15 ± 2.02 × 10(9) with 5.29 ± 2.39 × 10(9) in the Amicus group (P = 0.407 and P = 0.540, respectively). PLT content was higher in the yield from the Spectra group when compared to the Amicus group (1.54 × 10(11) ± 0.74 vs. 0.53 × 10(11) ± 0.34, P = 0.001). Moreover, no difference were observed in the RBC content in the product : 3.38 mL ± 1.91 vs. 4.59 mL ± 2.09, P = 0.191, when COBE Spectra and Amicus were compared, respectively. CONCLUSIONS: Both devices provide a satisfactory MNC collection for further UV-A treatment.

Brief Report: Peripheral Monocyte/Macrophage Phenotypes Associated With the Evolution of Cognitive Performance in HIV-Infected Patients.

BACKGROUND: The contribution of monocyte activation in the development of HIV-associated neurocognitive disorders is not completely understood. This study aimed to explore the predictive value of peripheral monocyte/macrophage (M/M) phenotypes on the evolution of cognitive performance in a population of virologically suppressed HIV-infected patients. SETTING: Prospective, observational, longitudinal study. METHODS: HIV-1-infected patients with HIV-RNA <50copies/mL for >12 months underwent neuropsychological examination at baseline and after 1 year. Cognitive performance was evaluated using Z-transformed scores, and neurocognitive impairment (NCI) was defined according to Frascati criteria. Peripheral M/M phenotypes (classic CD14CD16, intermediate CD14CD16, and nonclassic CD14CD16) and specific surface activation markers (eg, CD163, CD11b, and CD38) were evaluated using flow cytometry at baseline. Predictive value of peripheral M/M phenotypes on the evolution of cognitive performance over 1-year follow-up was also evaluated. RESULTS: Overall, 54 patients [85.2% men, median age 50 years (range 27-60 years), 27.8% hepatitis C virus coinfected, 48.1% with past AIDS-defining events, median nadir CD4 83 cells/µL (range 1-334), median baseline CD4 547 cells/µL (range 136-1652)] were enrolled. Proportion of patients with NCI was low, accounting for 13% at baseline and 16.5% after 1 year (P = 0.687). Memory was the only single domain in which decreased performance after 1 year was observed (-0.25 Z-score, P = 0.025). In patients with significant decrease (≥0.5 SD) in memory performance (n = 20), significantly lower CD14CD16CD163 (% CD14CD16) (P = 0.038) and higher CD14CD38 (% CD14) (P = 0.030) levels were observed. CONCLUSIONS: In virologically suppressed HIV-infected patients, the evolution of memory performance could be linked to the expression of certain peripheral activated M/M phenotypes. Such associations should be verified in larger populations over the long term.