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Citrate Versus Citrate–Heparin Anticoagulation in HPC(A): Comparative Effects on Intra‐Apheresis Mobilization of CD34+ Hematopoietic Progenitor Cells

Castillo‐Aleman, Yandy Marx
; 
Villegas‐Valverde, Carlos Agustin
; 
Bencomo‐Hernandez, Antonio Alfonso
; 
Lumame, Shinnette
; 
Castelo, Charisma
; 
Rose‐Roque, Jay Mary
; 
Cato, Marlene
; 
Al‐Saadawi, Nameer
; 
Abu‐Haleeqa, Mohamed Ibrahim
; 
Alsaid, Aseel Suleiman
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Author
Castillo‐Aleman, Yandy Marx
Villegas‐Valverde, Carlos Agustin
Bencomo‐Hernandez, Antonio Alfonso
Lumame, Shinnette
Castelo, Charisma
Rose‐Roque, Jay Mary
Cato, Marlene
Al‐Saadawi, Nameer
Abu‐Haleeqa, Mohamed Ibrahim
Alsaid, Aseel Suleiman
Obeidat, Sakher Ahmad
Sachdev, Mansi
Dennison, Jayakumar David
El‐Najjar, Inas
Rivero‐Jimenez, Rene Antonio
Ventura‐Carmenate, Yendry
AlKaabi, Fatima
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Department
Personalized Medicine
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Journal article
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English
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Abstract
Successful hematopoietic stem cell transplantation relies on the collection of a sufficient number of CD34<sup>+</sup> hematopoietic progenitor cells (HPCs). While acid citrate dextrose solution A (ACD-A) is a common anticoagulant (AC) for HPC apheresis [HPC(A)], recent evidence suggests that concomitant heparin may enhance intra-apheresis recruitment (IAR) of CD34<sup>+</sup> cells and improve collection efficiency. This study aimed to compare citrate-only and citrate-heparin protocols in routine HPC(A) procedures, with a focus on their effects on IAR and efficiency outcomes. A retrospective analysis was performed on 266 HPC(As) from 193 apheresis donors in autologous and allogeneic settings. Donor demographics, procedural parameters, and collection outcomes were compared between the ACD-A-only and ACD-A plus heparin protocols. The study endpoints included apheresis yield (AY/kg), collection efficiencies (CE<sub>1</sub>, CE<sub>2</sub>, and cruCE), recruitment ratio (RR), and performance ratio (PR). Statistical analyses included Mann-Whitney U tests, effect sizes, and partial least squares (PLS) regression. Heparinized procedures demonstrated higher processed total blood volume ratios, lower AC volumes, and superior outcomes across CE<sub>1</sub> (83.8% vs. 72.5%, p = 0.00027), CE<sub>2</sub> (70.8% vs. 64.2%, p = 0.0055), cruCE (77.0% vs. 72.4%, p &lt; 0.0001), RR (2.3 vs. 1.7, p &lt; 0.0001), PR (239.3% vs. 208.2%, p &lt; 0.0001), and AY/kg (6.75 vs. 5.23 × 10<sup>6</sup> CD34<sup>+</sup> cells/kg, p = 0.0025). The effect size and PLS analyses confirmed the contribution of heparin as an adjunct AC enhancing multiple apheresis outcomes. In summary, citrate-heparin anticoagulation was found to be a feasible strategy that improved key collection efficiency and IAR metrics during HPC(A).
Citation
Y.M. Castillo‐Aleman, C.A. Villegas‐Valverde, A.A. Bencomo‐Hernandez, S. Lumame, C. Castelo, J.M. Rose‐Roque , et al., "Citrate Versus Citrate–Heparin Anticoagulation in HPC(A): Comparative Effects on Intra‐Apheresis Mobilization of CD34+ Hematopoietic Progenitor Cells," Journal of Clinical Apheresis, vol. 41, no. 2, pp. e70118-e70118, 2026, https://doi.org/10.1002/jca.70118.
Source
Journal of Clinical Apheresis
Conference
Keywords
32 Biomedical and Clinical Sciences, 3201 Cardiovascular Medicine and Haematology, Adult, Anticoagulants, Antigens, CD34, Blood Component Removal, Citric Acid, Female, Glucose, Hematopoietic Stem Cell Mobilization, Hematopoietic Stem Cell Transplantation, Hematopoietic Stem Cells, Heparin, Humans, Male, Middle Aged, Retrospective Studies
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Publisher
Wiley
DOI
10.1002/jca.70118
Additional links
https://onlinelibrary.wiley.com/doi/10.1002/jca.70118
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