Adverse reactions associated with mobile therapeutic apheresis: analysis of 17,940 procedures.

In order to evaluate the nature and frequency of adverse reactions associated with Therapeutic Apheresis (TA), database information from two large mobile apheresis services was analyzed. A total of 17,940 procedures performed on 3,583 patients were studied using an Access Database. Seventy percent (12,558) of the procedures were performed on a Fresenius AS104 blood cell separator and 30% (5,382) were performed on a COBE Spectra. The five most commonly treated diseases were Guillain-Barre Syndrome (25%), thrombotic thrombocytopenic purpura (20%), myasthenia gravis (18%), the hyperviscosity syndrome (12%), and chronic inflammatory demyelinating polyneuropathy (9%). All patients received calcium gluconate supplement during the procedures. Cardiac monitoring was used during 80% of the procedures and blood pressure monitoring was used during all procedures. All procedures were supervised by a physician. Both apheresis services fully comply with the ASFA Guidelines for Therapeutic Apheresis Providers. Adverse reactions occurred in 3.9% of all procedures. The following adverse reactions were documented: reactions related to ACD toxicity (3%), vasovagal reactions (0.5%), vascular access related complications (0.15%), reactions related to FFP (0.12%), hepatitis B from FFP (0.06%), arrhythmias (0.01%), hemolysis due to inappropriate dilution of 25% albumin (0.01%), and one death (from underlying disease) during a TA procedure (0.006%). These data demonstrate that therapeutic apheresis is associated with a low rate of side effects when performed by well-trained and certified nurses under the direction of experienced physicians, even in the diverse setting of large mobile therapeutic apheresis programs.

Biokinetics and dosimetry analysis in healthy volunteers for a two-injection (rest-stress) protocol of the myocardial perfusion imaging agent technetium 99m-labeled Q3.

BACKGROUND: Trans (N,N'-ethylene bis(acetylacetoneimine)) bis(tris(3-methoxy-1-propyl) phosphine) 99mTc(III) (99mTc-Q3) has been developed for myocardial perfusion imaging. Biokinetic studies and dosimetry analysis have been completed for six healthy volunteers. METHODS AND RESULTS: The same-day two-injection protocol involved (1) an average rest injection of 241 MBq of 99mTc-Q3 followed by myocardial single-photon emission computed tomography (SPECT) at 15.0 minutes and a whole body (WB) scan at 1.5 hours; and (2) an average stress injection during treadmill exercise of 744 MBq of 99mTc-Q3 at 2.4 hours (postrest injection) followed by myocardial SPECT and additional WB scans at 1.5, 3.5, 6.5, and 21 hours poststress injection. Total urine was collected over 24 hours. Absolute organ activities were determined by conjugate counting methods. The two-injection data were simplified to a one-injection equivalent data set to facilitate dosimetry analysis. Decay corrected average percentage uptake values, plus or minus one standard deviation, for the myocardium were 1.4% +/- 0.2% at approximately 1.5 hours for both the postrest and poststress injections. The average biologic half-time for the myocardium was 26.4 hours. The highest organ uptake values included the gallbladder with 5.5% +/- 1.9% and the liver with 4.1% +/- 1.0% at the 1.5 hours poststress scan time. The sum of all gastrointestinal (GI) tract components was 18.8% +/- 9.4% at approximately 6.5 hours poststress injection (before any fecal elimination). The total 24 hour urine clearance was 17.1% +/- 2.4%. The gallbladder wall and upper large intestine wall received the highest doses at 0.024 and 0.023 mGy/MBq, respectively. CONCLUSION: The effective dose equivalent is estimated to be 0.01 mSv/MBq, which for an administration of 1110 MBq (30 mCi) is less than half that of a standard imaging protocol using 111 MBq (3 mCi) of 201Tl, and comparable to the published estimates for 99mTc-labeled sestamibi and 99mTc-labeled tetrofosmin (also normalized to 1110 MBq of administered activity). The 99mTc-Q3 exhibits myocardium uptake similar to that for these other two 99mTc agents.

Comparison of technetium 99m Q12 and thallium 201 for detection of angiographically documented coronary artery disease in humans.

BACKGROUND: 99mTc-labeled Q12 (99mTc-Q12) is a new imaging agent that produces myocardial visualization in humans. This study examined the hypothesis that a 100-minute rest-exercise tomographic imaging protocol after injection of 99mTc-Q12 can be used to detect the presence or absence of coronary artery stenoses. METHODS AND RESULTS: Imaging with 201Tl and 99mTc-Q12 was performed in 20 patients with angiographically documented coronary artery disease and 10 "normal" subjects including two patients with chest pain and normal coronary arteriograms and eight subjects with a very low likelihood of occlusive coronary disease. 99mTc-Q12 was imaged beginning 15 minutes after injection at rest and with exercise. In the 20 patients, a corresponding myocardial defect was detected in blinded fashion in 18 with 201Tl and 17 with 99mTc-Q12 (difference not significant). Of 10 patients without evidence of coronary disease, nine had a normal 201Tl scan and eight had a normal 99mTc-Q12 scan (difference not significant). Agreement of 99mTc-Q12 and 201Tl imaging for detection of regional myocardial perfusion defects was excellent (kappa = 0.88). Identification of the presence or absence of angiographically documented coronary disease in individual coronary artery distributions was 80% and 82% for 201Tl imaging and 73% and 87% for 99mTc-Q12 (difference not significant). CONCLUSION: 99mTc-Q12, used in a rest-exercise sequence that can be completed in 100 minutes, provided identification of regional myocardial perfusion defects similar to that of 201Tl.