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Discordant CD 34+ cell results in peripheral blood and hematopoietic progenitor cell–apheresis product: implications for clinical decisions and impact on patient treatment
Author(s) -
Liwski Courtney J.,
Padley Douglas J.,
Gustafson Michael P.,
Winters Jeffrey L.,
Gastineau Dennis A.,
Jacob Eapen K.
Publication year - 2014
Publication title -
transfusion
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.045
H-Index - 132
eISSN - 1537-2995
pISSN - 0041-1132
DOI - 10.1111/trf.12324
Subject(s) - apheresis , progenitor cell , hematopoietic cell , cd34 , medicine , haematopoiesis , blood product , peripheral blood , blood cell , cell , intensive care medicine , immunology , stem cell , surgery , platelet , biology , genetics
Case Report A 50‐year‐old male with T ‐cell lymphoma presented for autologous peripheral blood stem cell transplantation. After granulocyte–colony‐stimulating factor ( G‐CSF ) mobilization, his peripheral blood CD 34+ cell count was 166 × 10 6 /L on the day before collection, which predicted a high yield of CD 34+ cells in the apheresis product. The first two collections had yields much lower than expected, triggering an investigation and changes to the apheresis collection methods since mobilization appeared adequate from the peripheral CD 34+ values. Results Changes to the apheresis collection variables and instrumentation did not improve the yields in the next three collections. The laboratory investigation demonstrated that there was an interfering substance in the patient's plasma that was causing falsely high peripheral blood CD 34+ cell values and that the low CD 34+ cell yields in the collections were consistent with the actual peripheral blood CD 34+ cell value. Based on this finding and after discussion with the clinical service, the patient then received plerixafor to increase the number of circulating CD 34+ cells before Collections 6 and 7. The patient went on to achieve the target CD 34+ cell dose and subsequently underwent a successful autologous transplant with full hematopoietic engraftment. Conclusion This case demonstrates the importance of timely and critical review of laboratory results in the context of the specific patient. This case exemplifies how diligent review of laboratory results and open communication among the various teams can positively affect patient outcomes.