Serap KARAMAN, İnci YILDIZ, Traje CELKAN, Leman YANTRİ, Hilmi APAK, Aylin CANPOLAT, Alp ÖZKAN

Akut lösemili hastalarda hiperlökositoz tedavisinde basit ve etkili kan değişimi yöntemi (ön sonuçlar)

Amaç: Akut lösemi çok yüksek lökosit değerleri ile karşımıza çıkabilir. Lökoferez birçok hastada yüksek blast sayısını etkin olarak azaltmaktadır ve erişkin hastalarda lökosit sayısını hızla azaltmak için kullanılmaktadır. Ancak bu işlem pahalıdır ve kan merkezi görevlilerinin sürekli ilgilenmelerini gerektirir. Ayrıca küçük hastalarda vücut dışı dolaşımın hesaplanması ve sisteme ayrıca eklenmesi gibi önlemlerin alınması gerekmektedir. Bu çalışmada hiperlökositozu olan lösemili çocuk hastalarda lineer peristaltik enfüzyon pompası ile kan değişimi kullanılmıştır.Gereç ve Yöntem: Pompanın yardımı ile hastadan çekilen kan miktarı kadar kan ürünü diğer bir pompa yardımıyla geri verilerek hastanın “izovolümetrik” durumu sağlanmış olur.Bulgular: Çalışmaya yaşları 3 ay ile 12 yaş arasında değişen 11 hasta alındı. İki hasta iki yaşından küçüktü, altı hasta 20 kg’ın altında idi. Ortalama kan değişim süresi 33 saat, ortalama kan değişim miktarı 2 382 ml idi. Hastaların başlangıç lökosit düzeyleri ortalama 393 600/mm3 işlem sonu lökosit sayıları 67 982/mm3 idi. Hiçbir hastada yan etki gözlenmedi.Çıkarımlar: Hiperlökositozlu hastalarda lineer peristaltik enfüzyon pompası yardımıyla kan değişimi yöntemi, kullanım kolay, ucuz ve etkili bir yöntemdir

A simple and effective exchange transfusion method for the treatment of hyperleucocytosis in patients with acute leukemia (preliminary results)

Aim: Acute leukemia may present with extremely high blast counts (>100 000 /mm3). Leukapheresis effectively reduces the blast count in many patients and is routinely used for immediate leukocytoreduction in adult patients. But this procedure is expensive, requires prompt readiness of specialized blood bank personal. Additional measures such as extracorporeal fluid calculation and priming is required in young patients. In this study linear peristaltic infusion pump was used for exchange transfusion in pediatric leukemia patients with hyperleukocytosis.Material and Method: The blood withdrawn by the pump from the patient was replaced with the same amount of appropriate blood product in order to maintain the isovolumetric state of the patient.Results: Eleven patients ranging in age 3 months to 12 years with high blast counts were enrolled into the study. Two patients were smaller than 2 years of age, sipatients were under 20 kg. The mean exchange time was 33 hours and mean amount of transfused blood was 2382 ml. Their mean initial leukocyte count was 393 000/mm3. Their mean end-leukocyte count was 67 982/mm3. No side effects were observed in any of the patients.Conclusion: Exchange transfusion of patients with hyperleukocytosis with the use of linear peristaltic pump, is a safe and cheap method for this group of patients.

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