Summary
Excess red blood cells (RBC) in patients with polycythemia vera (PV) are usually removed by repeated phlebotomy. In order to improve the efficacy of this treatment, we used isovolemic large-volume erythrocytapheresis (EA) by a cell separator. A retrospective analysis of our experience with 69 PV patients (206 EA procedures) is reported. EA induced a rapid, well-tolerated, and long-lasting reduction of Hct, Hb, and RBC counts, as well as an immediate disappearance or reduction of clinical symptoms of PV, while tissue oxygen tension — as measured in 8 patients — increased. Hct was reduced by EA from 56.8% ±5.6% to 41.9% ±6.6%, Hb from 17.5±2.3 to 12.7±2.4 g%, RBC counts from 7.±0.9 to 5.4±0.9×106/mm3. The mean volume of the apherisate was 1410±418 ml, (mean Hct 79.7%±9.3%), and the actual RBC volume removed 1113±367 ml. The isovolemic procedure was well tolerated and the acceptance by patients seemed to be better than with repeated phlebotomy. In 21 patients whose Hct values (Hct before and after EA 58%±5.7% and 41.5%±4.9%) were regularly followed after EA the mean period with Hct<50% after a single EA procedure was 6.1±4.1 months (median, 6); in 14 out of these 21 patients a Hct of <43% after EA was reached and their mean period with Hct<50% after EA was 7.6±4.0 months (median, 7.5). For three patients this period was 11, 13, and 15 months, respectively. In our experience large-volume isovolemic EA is a feasible, very effective, and welltolerated alternative treatment modality for PV patients. It may be superior to repeated phlebotomy, especially for patients with excessively increased RBC mass. Only a controlled prospective trial can answer the question, whether EA, due to its rapid effect and due to the long-lasting lower RBC mass, leads to a lower rate of thromboembolic events, and whether EA may delay the necessity for treatment of PV by cytotoxic drugs or P32.
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Abbreviations
- EA:
-
Erythrocytapheresis
- Hb:
-
Hemoglobin
- Hct:
-
Hematocrit
- PV:
-
Polycythemia vera
- RBC:
-
Red blood cells
References
Arrago JP, Rain JD, Dresch C, Najean Y (1987) Polyglobulie primitive — Difficultés et complications du traitement par saignées. La Presse Médical 16/6:291–294
Berk PD (1988) Erythrocytosis and polycythemia. In: Wyngaarden JB, Smith LH (eds) Cecil textbook of medicine, 18th edn. Saunders, Philadelphia, p 983
Berk PD, Goldberg JD, Silverstein MN et al. (1981) Increased incidence of acute leukemia in polycythemia vera associated with chlorambucil therapy. N Engl J Med 304:442–447
Berk PD, Goldberg JD, Donovan PB, Fruchtmann SM, Berlin NI, Wasserman LR (1986) Therapeutic recommendations in polycythemia vera based on Polycythemia Vera Study Group Protocols. Semin Hematol 23:132–143
Boughton BJ (1978) Chronic myeloproliferative disorders: improved platelet aggregation following venesection. Br J Haematol 39:589–598
Chievitz E, Thiede T (1962) Complications and causes of death in polycythemia vera. Acta Med Scand 172:513–523
Egli F, Wieczorek A, Niemöller M, Rhyner K (1988) Polycythaemia vera: Klinik und Verlauf bei 86 Patienten. Schweiz Med Wochenschr 118:1969–1975
European Organization for Research and Treatment of Cancer. Leukemia and Haematosarcoma Cooperative Group (1981) Treatment of polycythemia vera by radiophosphorus or busulphan: a randomized trial. Br J Cancer 44:75–80
Fleckenstein W, Weiss Ch, Schomerus HR, Kersting Th (1984) A new method for the bed-side recording of tissue pO2-histograms. Verh Dtsch Ges Inn Med 90:439–443
Geigy-Tabellen (1979) Basel, 8. Auflage, S. 66–68
Gunzer U, Klink M, Klinker E et al. (1987) Cytapheresis plus cytostatics: a successful therapeutical approach in myeloproliferative disorders. 5th Annual Meeting of the European Society for Haemapheresis, Cologne, Abstract
Heath CW (1933) Oral administration of iron in hypochromic anemia. Arch Int Med 51:459–482
Heilmeyer L (1970) Die akute Blutungsanämie. In: Handbuch der inneren Medizin, vol II/2, 5th Edn. Springer, Berlin Heidelberg New York, pp 7–13
Heimpel H (1968) Erythropoese und Erythrozytenumsatz. In: Handbuch der inneren Medizin, vol II/1, 5th edn. Springer, Berlin Heidelberg New York, p 550
Hutton RD (1979) The effect of iron deficiency on whole blood viscosity in polycythaemic patients. Br J Haematol 43:191–199
Kaboth U, Rumpf KW, Lipp T, Bigge J, Beyer JH, Kaboth W (1987) Treatment of polycythemia vera by erythrapheresis (EA). 5th Annual Meeting of the European Society of Haemapheresis, Cologne, Abstract
Kaboth U, Rumpf KW, Lipp T, Bigge J, Beyer JH, Seyde W, Schuff-Werner P, Kaboth W (1988) Großvolumige Erythrapherese bei Patienten mit Polycythaemia vera. Klin Wochenschr 66 [Suppl XIII]:110–111
Kaboth U, Rumpf KW, Lipp T, Bigge J, Kaboth W (1988) Treatment of polycythemia vera (PV) by large-volume erythrapheresis (EA). World Apheresis Association, 2nd International Congress, Ottawa, Abstract 0-8-1, p 180
Kaboth U, Rumpf KW, Lipp T, Bigge J, Kaboth W (1988) Treatment of polycythemia vera (PV) by large-volume erythrapheresis (EA). Proceedings of ASCO, 24th Annual Meeting, New Orleans, Abstract 737, 7:190
Kaplan ME, Mack K, Goldberg JD, Donovan PB, Berk PD, Wassermann LR (1986) Long term management of polycythemia vera with hydroxyurea. A progress report. Semin Hematol 23:167–171
Kovaleva LG, Skachilova NN, Sedova GT, et al. (1983) Efficacy of intensive erythrocytapheresis in polycythemia vera. Gematol-Transfuziol 28:17–20
Landaw SA (1976) Acute leukemia in polycythemia vera. Semin Hematol 13:33–48
Milligan DW, MacNamee R, Roberts DE, Davies JA (1982) The influence of iron-deficient indices on whole blood viscosity in polycythaemia. Br J Haematol 50:467–473
Newland AC, Wedzicha JA (1984) Isovolaemic haemodilution (erythrapheresis) in polycythaemia. Apheresis Bulletin 2:24–33
Pearson TC, Wetherley-Mein G (1978) Vascular occlusive episodes and venous haematocrit in primary proliferative polycythaemia. Lancet II:1219–1222
Pearson TC, Guthrie DL, Slater NGP, Wetherley-Mein G (1982) Method of PCV measurement and the effect of iron deficiency on whole blood viscosity in polycythaemia. Br J Haematol 52:166–169
Rector WG jr, Fortuin NJ, Conley CL (1982) Non-hematologic effects of chronic iron deficiency. A study of patients with polycythemia vera treated solely with venesections. Medicine 61:382–389
Robertson OH, Bock AV (1919) Blood volume in wounded soldiers. J Exp Med 29:139–172
Schiodt E (1938) Observations on blood regeneration in man. III. The rise in reticulocytes in patients with hematemesis or melena from peptic ulcer. Am J Med Sci 196:632–641
Stecher G, Reinhardt G (1970) Polyglobulie und Polycythaemia vera. In: Handbuch der inneren Medizin, vol II/2, 5th edn. Springer, Berlin Heidelberg New York, p 878
Stodtmeister R (1937) Blutkrankheiten. Die Bedeutung der Sternalpunktion für die Beurteilung Kranker mit sekundären Anämien. Dtsch Med Wochenschr 63:1681–1686
Sybesma JPhHB, van Dongen WJJ (1988) Erythrocytapheresis in polycythemia vera. World Apheresis Association, 2nd International Congress, Ottawa, Abstract P-5-5, p 83
Wedzicha JA, Rudd RM, Apps MCP, Cotter FE, Newland AC, Empey DW (1983) Erythrapheresis in patients with polycythaemia secondary to hypoxic lung disease. Br Med J 186:511–514
Wintrobe MM (1981) Thrombocytosis. In: Clinical hematology, 8th edn. Lea and Febinger, Philadelphia, p 1128
Zoller WG, Kellner H, Spengel FA (1988) Erythrocytapheresis. A method for rapid extracorporeal elimination of erythrocytes. Results in 65 patients. Klin Wochenschr 66:404–409
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Kaboth, U., Rumpf, K.W., Lipp, T. et al. Treatment of polycythemia vera by isovolemic large-volume erythrocytapheresis. Klin Wochenschr 68, 18–25 (1990). https://doi.org/10.1007/BF01648884
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DOI: https://doi.org/10.1007/BF01648884