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Objective: Chronic myelogenous leukemia (CML) is a disease, that in cases with high leukocyte numbers, is treated with hydration and cytoreductive therapy. Materials and Methods:A 20-year-old female patient, during a routine examination for pregnancy, presented with elevated white blood cells (WBC) count (over 275x109/L) and splenomegaly without any complaints. The diagnosis of Ph-positive CML was confirmed by cytology and PCR [presence of p210 type BCR::ABL1 [e13a2 (b2a2)] transcripts. Since she was in her 6th month of pregnancy, abortion or conventional treatment (tyrosine kinase inhibitors (TKI), chemotherapy and/or allogeneic haematopoietic stem cell transplant) were contraindicated due to the high risk for both the mother and the fetus. The patient was treated with two consecutive leukaphereses followed by weekly apheresis for about 3,5 months until the day of the delivery. Each procedure included the processing of 1000-1200 ml of whole blood with the separation of around 600 ml white blood cell concentrate and plasma. Results:The patient's WBC count was kept between 170 and 270 x 109/L until childbirth, and immediately after delivery, imatinib mesylate therapy was initiated.A healthy male child with a weight of 2250 kg and height of 46 сm was born. The mother achieved hematologic, cytogenetic and molecular remission within the next 6-9 months after initiation of tyrosine kinase inhibitor therapy. Discussion: The classical treatment for CML includes tyrosine kinase inhibitors, chemotherapy and/or allogeneic haematopoietic stem cell transplantation. All of these approaches have teratogenic potential, and therapeutic schemes should involve contraception. In cases with existing advanced pregnancy, therapeutic leukapheresis is a valid option for controlling WBC counts until the delivery date. Despite the later initiation of TKI therapy, the deep molecular response is still present thirteen years after the initiation of therapy.

Ulcerative colitis is a chronic inflammatory disease that affects the colon and rectum. Its pathogenesis is probably multifactorial including the influx of certain cytokines into the colonic mucosa, causing disease activity and relapse. The hypothesis of removing such cytokines from the circulation by leukocytapheresis was implemented to reduce disease activity, maintain remission, and prevent relapse. Many recent reports not only in Japan, but also in the West, have highlighted its beneficial effects in both adult and pediatric patients. Large placebo-controlled studies are needed to confirm the available data in this regard. In this article, we shed some light on the use of leukocyte apheresis in the management of autoimmune diseases, especially ulcerative colitis.

Abstract Background Severe falciparum malaria is associated with considerable rates of mortality, despite the administration of appropriate anti-malarial treatment. Since overall survival is associated with total parasite biomass, blood exchange transfusion has been proposed as a potential method to rapidly reduce peripheral parasitaemia. However, current evidence suggests that this treatment modality may not improve outcome. Automated red blood cell exchange (also referred to as “erythrocytapheresis”) has been advocated as an alternative method to rapidly remove parasites from circulating blood without affecting patients’ volume and electrolyte status. However, only limited evidence from case reports and case series is available for this adjunctive treatment. This retrospective cohort study describes the use of automated red blood cell exchange for the treatment of severe malaria at the Medical University of Vienna. Methods Epidemiologic data for imported malaria cases in Austria are reported and data of patients treated for malaria at the General Hospital/Medical University of Vienna were extracted from electronic hospital records. Results Between 2000 and 2010, 146 patients were hospitalized at the Medical University of Vienna due to malaria and 16 of those were classified as severe malaria cases. Eleven patients of this cohort were potentially eligible for an adjunctive treatment with automated red blood cell exchange. Five patients eventually underwent this procedure within a period of seven hours (range: 3–19 hours) after hospital admission. Six patients did not undergo this adjunctive treatment following the decision of the treating physician. The procedure was well tolerated in all cases and rapid reduction in parasite counts was achieved without occurrence of haemodynamic complications. One patient died within seven days, whereas four patients survived without any sequelae. Discussion and conclusion Automated red blood cell exchange was a safe and efficient procedure to rapidly clear peripheral parasitaemia. Whether the fast reduction in parasite biomass may ultimately improve patient survival remains however unclear. Randomized controlled trials are needed to conclusively appreciate the value of this adjunctive treatment.