Certification of apheresis nurses in Indonesia

Abstract

25/31 (81%) had a diagnosis of oncological malignancy, four (13%) with immunological conditions, and two (6%) with acute leukaemia. The most common mobilisation protocol used was chemotherapy/G-CSF in 24/31 (77%) patients, supplemented with plerixafor in three cases, and G-CSF alone in 7/31 (23%), five cases with addition of plerixafor. Spectra Optia settings; total blood volumes processed – 2.5, Whole Blood:AC ratio – 12:1, maximum AC rate 0.9ml/min/L TBV, initial flush volume of 16ml, and chase volume of 4ml. Custom prime recommendation was triggered if extracorporeal volume >10% of either total blood volume or red blood cell volume. Final flush volume was increased to 26ml in all procedures. For the first 10 procedures at least 2 chamber flushes were performed, and for the subsequent 40 at least 3. For children below 25kg a blood volume of 80ml/kg was used. In very small children the procedure ran in caution mode, as the AC rate was >1.2ml/min/ /L TBV. Prophylactic calcium gluconate infusions were given throughout procedures running in caution mode. There were no patient adverse events due the apheresis procedure. Data were collected to validate the efficiency of the machine to collect CD34 cells, red cell, platelet and neutrophil contamination, and changes to patient haemoglobin, platelet count, and serum electrolyte levels. CD34 doses, median (range) 4.8×106/kg (0.54–75.1×106/kg), and collection efficiency per blood volume processed (CE2) median (range) 47.4% (24.0–88.6%) were calculated. More than 2.0×106/kg CD34 cells were obtained in 43/50 (86%) procedures, and a CD34 dose of >3.0×106/kg was obtained in 29/31 (94%) children. Changes to patient haemoglobin and platelet counts were recorded. Due to custom prime requirements in 42/50 (84%) procedures, haemoglobin increased, median (range) +11% (−4% to +24%). Platelets were reduced, median (range) −39% (−66% to +26%). No significant changes to serum electrolyte levels were noted.