Safe and Efficient Extracorporeal Photopheresis in Patients with Pre-Procedure Hematocrit below 26%

Abstract Background Extracorporeal photopheresis (ECP) is widely used for graft-versus-host disease (GVHD), but manufacturer recommendations suggest maintaining a pre-procedure hematocrit (Hct) above 27%. This study evaluates the safety and efficacy of ECP performed at lower Hct levels. Methods We retrospectively analyzed 13 ECP procedures in three male patients with GVHD, comparing sessions performed at Hct < 26% to those at Hct > 27%. Procedural parameters, hemodynamic stability, and adverse events were assessed. Results All procedures at Hct < 26% were successfully completed without adverse reactions, vascular access issues, or significant hemodynamic changes. Average procedure duration was 97 min at Hct < 26% and 95 min at Hct > 27%, showing no significant impact on efficiency. Conclusion ECP at Hct < 26% is safe and effective, reducing the need for transfusion while maintaining procedural integrity. These findings challenge current Hct thresholds and support more flexible patient selection criteria.