Preparing for Your Apheresis Procedure: Extracorporeal Photopheresis (ECP) Treatment

ECP is a treatment on the blood that changes the activity of the immune system. ECP is used in the treatment of graft versus host disease, some types of lymphoma, and heart and lung transplant rejection. During the treatment, your child’s white blood cells are separated from the rest of their blood using an apheresis machine. The white blood cells are combined with a medicine called Uvadex or 8-MOP. This medicine becomes activated when exposed to a special light in the machine. Once the medicine is activated, the treated cells are reinfused (put back) into your child.

If your child is taking any medicines, these may need to be stopped for the procedure. Talk with your doctor.

• Starting 2 or 3 days before the procedure, have your child drink plenty of liquids – at least 6 to 8 glasses a day. This helps makes their vein easier to find if an IV is placed.
• The night before and day of the procedure, avoid fatty foods (like fried foods, cheeses and butter).
• Have your child dress in loose clothing and short sleeves that allows access to the catheter, implanted port or arms (if IV is needed). Patient gowns are available if preferred.
• Bring the UV-protective sunglasses to every ECP appointment. The medicine used in the treatment causes your child’s eyes and skin to be sensitive to sunlight.
• Please plan for you or another caregiver to be with your child during the entire day’s procedure.
• Ask your doctor about pain reducing numbing cream or other type of anesthetic placed on the skin before getting an IV needle stick or over your port. You can put this on your child’s skin at home 30 minutes before the procedure.

• A medicine may be given by the nurse right before the procedure to help your child relax and ease anxiety.
• Your child’s vital signs (temperature, heart and breathing rate and blood pressure) are checked frequently throughout procedure.
• Your child will be asked to use the bathroom right before the procedure. If they need to go pee during apheresis, a urinal or commode is provided at the bedside.
• Blood will be drawn from your child for labs before, during and after the procedure.
• The apheresis machine is loud. This is normal. Let your child know in advance and bring headphones if they are sensitive to sound.
• ECP takes 2 to 4 hours. Your child can sleep, listen to music, watch TV, play on an iPad, or eat and drink.
• If an IV is placed in an arm or leg, your child will need to limit their movement so the IV doesn’t come out.
• We cannot disconnect your child from the machine until the end of the treatment. Your child will not be able to get up and walk around during the treatment.
• Some patients may experience side effects. Alert the nurse if you notice any changes in your child’s well-being or behavior.

• Your child can start their regular activity and foods right away.
• Tiredness is common after ECP.
• It is not uncommon for your child’s temperature to rise following their ECP procedure. Report any fever per your primary team’s guidelines.
• Any medicines stopped before ECP may be taken now.
• If IV in the arm or leg was used, leave your child’s bandage on for at least 4 hours after procedure. If you see bleeding soaking through the bandage at the IV site, apply fingertip pressure for 5 minutes and keep site bandage on for an additional 4 hours.
• If Heparin (blood thinner) is used in your child’s procedure, have your child limit activity for up to 4 hours after ECP to reduce risk of bleeding.

The medicine (UVADEX) used in ECP makes your child very sensitive to sunlight for about 24-48 hours.

For the next 48 hours after the procedure, have your child:

• Stay out of direct sun.
• Wear the UVA-protective sunglasses when outdoors.
• If going outside, use a sunblock (SPF 30 or greater) and have your child wear long-sleeved clothing to cover their skin.