World apheresis registry: report of 2004 data

Centers from 9 countries have applied for a login code to the WAA apheresis registry. Of these 9 centers from 4 countries have been actively entering data during 2004. Registered are at the moment a total of 347 patients (55% women, mean age 54 y, and 45% men, mean age 52 y). Main indications were neurological (33%), vasculitis (9%), and lipid apheresis (8%). In 92% of the patients therapeutic apheresis was performed while in 8% retrieval of components was the reason. A total of 1808 procedures were registered. More than 88% of the patients had acute indications. Access was mainly by peripheral vessels (65%), central dialysis catheter through jugular route (11%) or subclavian (9.4%) while femoral vein and AV fistula were used in 4.3 versus 0.5% of occasions. Anticoagulation was performed by ACD (80.5%), CPD citrate (2.5%), ACD and heparin (7%), ACD and LMW heparin (4%) and only heparin (5.8%). Replacement fluids for therapeutic apheresis removing plasma was mainly by albumin (85%) while plasma (22%) and cryoprecipitate poor plasma (5%) was used to less extent. Adverse events (AE) were registered in 6% of procedures. Distribution was for mild AE (1.4%), moderate (3.4%) and severe (0.6%) In 21 treatments there were 2 AEs while in 2 patients there were 3 AEs. Most frequent AEs were hypotension (35%), tingling around the mouth (24%), chill and fever (5.5%) and urticaria (5.5%). There were significant differences between the centers. The incidence of hypotension varied between 0.36–3.23% between centres. There was no significant difference in severe AEs between the centres. Main procedure used was centrifugation technique for conventional plasma exchange by centrifugation or filtration, while other modes were leukapheresis, erythrapheresis, platelet apheresis, LDL-apheresis, photopheresis and adsorption. Conclusion: Data from the registry show that centres have various approaches to apheresis. One can learn from each others experience to reduce side effects and improve efficacy.