What is white blood cell removal?

White blood cell removal, also known as leukocytapheresis, is a nonsurgical treatment to reduce the quantity of white blood cells in your child’s bloodstream. Leukocytapheresis may be used alone or in conjunction with other treatments.

White blood cells are part of the immune system. They help the body fight infection. If your child has an unusual buildup of white blood cells — or if they are not functioning properly — these cells can affect your child’s overall health.

If your child has leukemia and her white blood cells are becoming too numerous or attacking healthy cells, your child’s doctor may recommend leukocytapheresis as part of her care plan.

If your child has graph versus host disease or other cancers, leukocytapheresis may be included as part of other apheresis treatments such as extracorporeal photopheresis, stem cell collection and T-cell collection.

White blood cell removal is repeated as needed.

Why might your child need white blood cell removal?

White blood cell removal can be performed on babies, children and adults. It is used to treat:

• Leukemia: For children with leukemia, leukocytapheresis is a way to reduce the number of white blood cells to less harmful levels before full treatment starts. White blood cell removal produces short-term benefits that can serve as a “bridge” before more definitive treatments, such as chemotherapy, can be performed or its benefits felt. For children younger than 1 year old, whole blood exchange is generally recommended instead of white blood cell removal.
• Graph versus Host Disease: For children who have this side effect from bone marrow transplant, white cells are treated with light therapy and returned to the patient. For more information, see Extracorporeal Photopheresis.
• Other cancers: Some childhood cancers can be treated with stem cell or T-cell infusions which are part of the white cell components. For more information about these procedures and who may benefit, see Stem Cell Collection and T-cell Collection.

At The Children’s Hospital of Philadelphia, our pediatric Apheresis Program performs more than 1,800 apheresis procedures each year, including more than 200 white blood cell removals.

What to expect

If your child is referred to the Apheresis Program for white blood cell removal, she will have an initial evaluation by an apheresis physician-nurse team. The apheresis team will already know about your child and her condition from your child’s treating physician.

On the day of your child’s procedure, our team will greet you and your child when you arrive. You will be directed to a patient area that includes:

• A reclining chair or bed for your child
• A high-tech apheresis machine that will be customized for your child’s size and procedure
• Room for you to sit with your child
• A television to distract and entertain your child

Your child’s procedure will be overseen by board-certified physicians, and experienced apheresis nurses and child life staff. One or more team members will be with your child at all times to provide comfort, answer questions, and ensure the procedure goes smoothly.

How is white blood cell removal performed?

For a white blood cell removal, your child’s blood will be withdrawn by a needle or catheter. In most cases, clinicians insert a needle into both of your child’s arms to withdraw and return the blood. Some children do not have very good veins in their arms. In that case, an implanted port can be placed to withdraw and return the blood.

Another way to withdraw your child’s blood is by a small tube (catheter) inserted into a vein in the groin or chest area. To place the catheter, a physician will make a small cut and insert the catheter. The skin will be numb, so your child should not have any pain during catheter placement.

The blood that’s withdrawn from your child will be circulated through a centrifuge in a blood cell separator machine. The centrifuge separates the white blood cells from the other parts of the blood (red blood cells, plasma and platelets). The separated white blood cells are collected.

These collected cells may be discarded or, in some situations, these cells may be used again. Two examples include:

• White blood cells that are treated with light therapy (therapeutic photopheresis) and reinfused into the same child to treat graft-versus-host disease and other conditions. See therapeutic photopheresis for details.
• White blood cells that are frozen before chemotherapy or radiation therapy — to protect the cells during treatment for leukemia — then reinfused into the same child afterwards to help her immune system. See stem cell collection and T-cell collection for details.

Your child’s remaining blood cells may be mixed with replacement fluids (such as saline or albumin) or blood components (such as red blood cells or fresh frozen plasma), and returned to your child. Blood and fluids are slowly removed and returned to your child at the same time, so your child is never missing more than a few ounces at a time.

In addition, your child will receive a small amount of citrate, an anticoagulant that will prevent your child’s blood from clotting during the procedure. If your child is small or anemic, donor blood (red blood cells) will be used to prime the blood cell separator machine before transfusion.

A white blood cell removal may take two to five hours to complete, depending on how much blood is removed. Depending on your child’s condition, white blood cell removal may be performed repeatedly as ordered by your child’s treating physician.

Risks

White blood cell removal is a safe procedure, but side effects can occur.

Your child may experience:

• Symptoms similar to regular blood donation, such as nausea, vomiting, dizziness or fainting
• Problems related to the anticoagulant, including chills, sour taste in the mouth, tingling around the lips, muscle cramping, irregular heartbeats, or prolonged bleeding
• Bruising, numbness, pain or infection at the site of the needle stick or catheter insertion
• Low or fluctuating blood pressure

If your child experiences any of these symptoms, please tell your child’s medical team.