Changes in hematological parameters post plateletpheresis: Single center study from North India.

INTRODUCTION: Increasing demand for platelet transfusion implies the need to recruit greater numbers of donors. We planned this study to evaluate donor safety issues with regards to changes in hematological values after plateletpheresis to improve donor safety and satisfaction. MATERIALS & METHODS: The study was conducted on 1000 healthy plateletpheresis donors over a period of 24 months. Pre- and post-apheresis hematological parameters of donors were analyzed. Recovery of platelet was also observed in plateletpheresis donor who returned to after 48 h. RESULT: We observed that the Platelet counts decreased significantly in the plateletpheresis donors (p=<0.001) after each procedure and there was a non-significant decline in Hb (p = 0.34), Hct (p = 0.44) and RBCs (p = 0.08). The hematological changes were within the normal limits with no clinical evidence of anemia or thrombocytopenia. Recovery of platelets in plateletpheresis donors after 48 h was observed in 30 donors (0.03 %). CONCLUSION: A significant immediate post procedure decrease in platelet count was observed in our study but the recovery of platelets was adequate suggesting next platelet collection from the donor can be safely done after a period of 48 h.

Frequent plateletpheresis donations & its effect on haematological parameters: An observational study.

Background & objectives: The well-being of donors undergoing frequent plateletpheresis has been a matter of concern. The aim of this study was to analyze the effect of frequent plateletpheresis on the haematological parameters (HP) of repeat donors. Methods: The study was conducted during February 2016 to March 2017 on all the repeat plateletpheresis donors undergoing the 2nd plateletpheresis within a month of the first in a tertiary care centre. Donors repeating plateletpheresis 3rd and 4th times were also studied. The values of the HP observed on follow up after plateletpheresis done on three different separators were compared. Results: HPs of the 98 donors were similar at follow up except mean platelet volume (P <0.05). Of the 98 donors, 35 were followed up within a week and 63 were followed up within 8-30 days. No significant alteration was found in the HPs except a significant difference in the variation of platelet counts of the two groups (P=0.025). In 34 donors who presented 3rd time for plateletpheresis (mean gap between 1st and 3rd plateletpheresis=31 days), no significant differences in the HPs were found except the platelet distribution width (P <0.05). Minimal difference in the HP was found in the baseline and the follow up of 3rd plateletpheresis i.e., at 4th plateletpheresis donation. Plateletpheresis through all the three cell separators used had similar effects on the follow up HPs. Interpretation & conclusions: Repeated plateletpheresis can be done without any detrimental effects on the cell counts of the plateletpheresis donors. The three cell separators yielded similar post-donation follow up haematological parameters.

Are Buffy-coat Pooled Platelet Concentrates an Effective Alternative to Apheresis Platelet Concentrates? An In vitro Analysis at a Tertiary Care Center in Northern India.

Background: There is a need for platelet products to have the best quality. Apheresis platelet concentrates (PCs) obtained from single-donors PCs (SD-PCs) are considered best but have issues such as feasibility and cost. Buffy-coat pooled PCs (BCP-PCs) are considered an alternative to SD-PCs. This study compares BCP-PCs and SD-PCs for in vitro quality parameters and their changes during storage. Materials and Methods: Fifteen units of BCP-PCs and 15 units of SD-PCs were prepared. In this study, a pool of five buffy coats was prepared. Fifteen units of BCP-PCs were analyzed on day 1 and day 5 of storage, while 15 SD-PCs were analyzed on day 1 while ten units on day 5. The parameters analyzed were volume, hematological parameters, pH, swirling, and sterility. Results: The mean platelets count of SD-PCs was found to be significantly higher as compared to BCP-PCs. White blood cells (WBCs) contamination was significantly lower in BCP-PCs as compared to SD-PCs. The mean pH and mean platelet volume of SD-PCs were significantly lower than BCP-PCs. During storage, the mean platelets count of BCP-PCs was decreased significantly while that of SD-PCs nonsignificantly. The mean WBCs count and pH decreased in both BCP-PCs and SD-PCs significantly. All units in both types of PCs were sterile. Conclusion: Platelet yield was significantly better in SD-PCs, while mean WBCs contamination was significantly lower in BCP-PCs. BCP-PCs may be preferred in place of SD-PCs in case of nonavailability of apheresis, difficulty in finding a willing donor, or when the cost is of consideration.

Quality assessment of platelet concentrates prepared by platelet-rich plasma, buffy-coat, and apheresis methods in a tertiary care hospital in South India: A cross-sectional study.

INTRODUCTION: In blood banking and transfusion medicine, it is of paramount importance to improve transfusion safety and provide a higher quality of product to maximize the therapeutic outcomes and minimize the risk of developing transfusion-associated complications for patients receiving a blood transfusion. MATERIALS AND METHODS: This was a cross-sectional study conducted at the department of transfusion medicine in a tertiary care hospital of South India from February 2019 to December 2020. The primary objective of the study was to assess the quality of platelet concentrates (PC) prepared by platelet-rich plasma (PRP), buffy-coat (BC), and apheresis method. A total of 760 PCs were subjected to quality assessment, among which 124 were PRP-PC, 176 were BC-PC, and 460 were single donor platelet (SDP). RESULTS: The total percentage of platelets meeting all the six quality control parameters in PRP, BC and SDP was 78.23%, 81.81%, and 89.96%, respectively. Apheresis PCs showed a significantly higher platelet concentration per µL on comparison with whole-blood-derived platelets. BC-PCs were found to be better than PRP-PC with regard to lower white blood cell (WBC) contamination (P < 0.05) and red blood cell (RBC) contamination (P < 0.01). No statistically significant difference was found with regard to platelet yield, volume, swirling, and pH. CONCLUSION: Ex vivo quality of PCs prepared by BC-PC, PRP-PC, and apheresis-PC fulfilled the desired quality control parameters. BC-PC was better than PRP-PC in terms of lesser WBC and RBC contamination and comparable in terms of volume, platelet yield, swirling, and pH. Apheresis PCs showed a higher platelet concentration per microliter on comparison with whole-blood-derived platelets; hence in a blood center where facilities for collection of apheresis product are available, SDPs should be the choice of platelet transfusion.

Factors Influencing Corrected Count Increment After Platelet Transfusion in Thrombocytopenic Patients.

Background Platelet transfusion is a life-saving procedure for thrombocytopenic patients. Platelet transfusions can be either prophylactic or therapeutic. Prophylactic platelet transfusion reduces the risk of bleeding before any specific procedure, whereas therapeutic platelet transfusion helps to control active bleeding. Evaluation of the response to platelet transfusion by calculating the corrected count increment (CCI) is important to determine the success of platelet transfusion and to plan subsequent patient management. Methods We conducted a prospective observational study in patients who received at least one unit of platelet concentrate (random donor platelet (RDP) or single donor platelet (SDP)) admitted under or seen by General Medicine. Patients over 60 years, multiparous females, and chemotherapy patients were excluded. The patient's pre-transfusion and post-transfusion platelet counts at one hour and 24 hours were taken, and CCI was calculated. Results We studied 60 patients during the study period, out of which 35 were males (58.33%) and 25 were females (41.67%). The mean age was 36.2 years, and the age range was from 15 to 60 years. The majority of patients were O-Rh positive (41.67%), followed by B-Rh positive (40%), A-Rh positive (11.67%), and least by AB-Rh positive (5%) and only one patient with O-Rh negative (1.67%). The logistic regression analysis showed that sepsis (p=0.025), splenomegaly (p=0.004), COVID-19 (p=0.016), dengue (p=0.028), systemic lupus erythematosus (SLE) (p=0.045), immune thrombocytopenic purpura (ITP) (p=0.003) and fever (p=0.007) significantly contributed to unsuccessful CCI. However, acute leukemia (p=0.238), active bleeding (p=0.147), disseminated intravascular coagulopathy (DIC) (p=0.952), aplastic anemia (AA) (p=0.114), and sickle cell disease (SCD) (p=0.739) did not show any statistical significance. Conclusion Unsuccessful CCI at 24 hours is attributed to non-immunological clinical factors like sepsis, splenomegaly, COVID-19, and fever, whereas immunological clinical factors like SLE, dengue, and ITP resulted in unsuccessful CCI at one hour, as evident by this study.

Plateletpheresis in the Era of Automation: Optimizing Donor Safety and Product Quality Using Modern Apheresis Instruments.

The increases in major surgeries, transplantations and speciality clinics have significantly increased the utilization of platelet concentrates including single donor platelets (SDP). The advantages of SDP or apheresis platelet have been discussed elaborately by previous authors as compared to random donor platelets. Here we share our experiences of plateletpheresis procedures using the modern apheresis machines with regards to product quality and donor safety. This study included 3016 procedures of plateletpheresis (1397 on Amicus and 1619 on Trima accel cell separators) on eligible donors using recommended apheresis kits. A target yield of 3 × 1011 was set as the end point of each procedure. Donor details, procedure details and donor adverse reactions if any were documented. Statistical analysis was done using the SPSS statistical package (version 13, USA). Of the total 6276 donors screened 2049 (32.6%) were deferred due to various reasons. Out of remaining 4227 eligible donors; 3016 (71.4%) underwent plateletphereis procedures based on the requirement of SDP by the patients. Mean pre-procedure platelet count and hematocrit in donors were 188.3 × 106/mL and 41.7% respectively. Mean procedure time in Amicus (76.6 min) was significantly more than the Trima accel (64.3 min) (p = 0.02). Platelet yield by Trima accel and Amicus was 2.96 × 1011 and 3.08 × 1011 respectively (p = 0.061). A total of 40 donors (1.33%) suffered adverse effect during or after apheresis procedures. While the modern plateletpheresis devices are both donor and user friendly at the same time they provide quality product consistently in lesser time.

Regulated upon activation, normal T cells expressed and secreted (CCL5) in platelet concentrate: Role of mode of preparation and duration of storage.

BACKGROUND AND OBJECTIVES: Platelet concentrates (PCs) can be prepared in several different ways, and they can be stored over few days before the use. Regulated on activation, normal T cells expressed and secreted (RANTES) levels in these concentrates may vary depending on the type of preparation and duration of storage of this component. We measured RANTES levels in platelet supernatants in different preparations and with different storage duration. MATERIALS AND METHODS: Fifteen PCs were prepared by platelet-rich plasma (PRP) and buffy coat (BC) method each. Forty-two single donor platelets (SDPs) were prepared using cell separators Cobe Spectra, Trima Accel, and Amicus. Filtered PCs were prepared using labside and bedside filters. The supernatants were collected after 1, 18, 65, and 112 h of preparation. SDP samples were taken on the 0 day, 3rd day, and 5th day. In filtered PC, pre- and post-filtration samples were taken, and aliquots were frozen at - 56°C for the measurement of RANTES. RESULTS: RANTES at 1 h was 1210 ± 560 pg/ml in PRP-PC, 1384 ± 463 pg/ml in BC-PC. At 112 h, 1617 ± 451 pg/ml and 1949 ± 134 pg/ml, respectively. In SDP, 0-day level was 1850 ± 278 pg/ml and >2000 pg/ml on 5th day. In prestorage, filtered PC RANTES was 1035 ± 496 pg/ml, and in the poststorage sample, it was 310 ± 508 pg/ml. With bedside filters, presample showed 1243 ± 832 pg/ml and postsample showed 556 ± 748 pg/ml. CONCLUSION: The concentration of RANTES increased continuously from 1 h to 5 days of storage in all PCs. After 65 h, BC-PC showed higher levels of RANTES compared to PRP-PC. Filtered PRP-PCs appear to be the best in terms of low RANTES to prevent allergic reactions and cultures negative.

Prevalence and predictors of adverse reactions in plateletpheresis donors with the perspective of donor safety in a tertiary care hospital of Northern India.

BACKGROUND: Plateletpheresis procedures are generally safe and associated with low adverse reactions. Although donor reactions and injuries are self-limited events, they may discourage donors from future platelet donations. AIM: The purpose of this study was to determine the prevalence and predictors of adverse donor reactions in plateletpheresis donors, which could serve as targets for interventions to reduce reactions. MATERIALS AND METHODS: The study included 106 platelet donors over a period of 2 years. The demographic, biometric, and clinical parameters were noted. The data were analyzed for predictors of adverse donor reactions. STATISTICAL ANALYSIS USED: The data were analyzed using independent sample t-test to correlate donor variables such as gender. To correlate other variables such as age, weight, and whole blood processed, Chi-square test was used. RESULTS: A total of 106 plateletpheresis donations were performed and 13.2% of vasovagal reactions were observed. The significant predictive factors for reactions were young female donors with low body weight in which more than 2.5 L volume of whole blood was processed and more than 250 ml of acid, citrate, and dextrose-A was infused and with single venous access procedures. CONCLUSIONS: The results of this study are encouraging and helpful in identifying donors at risk for developing adverse reactions during plateletpheresis so that proper and close observation during and after donation as well as timely intervention can prevent most of the unpleasant events of plateletpheresis donors.

Study of Single Donor Platelet (SDP) Preparation by Baxter CS 3000 plus and Haemonetics MCS plus.

BACKGROUND: In plateletpheresis blood is withdrawn from a donor in anticoagulant solution and separated into components. Platelets are retained and the remaining components are returned to the individual. METHODS: The present study was aimed to compare the platelet yield and collection efficiency of Baxter CS 3000 plus and Haemonetics MCS plus cell separators and to study adverse donor reactions. Donors were selected as per the set criteria for single donor platelet (SDP) preparation. Donors' samples for pre donation and post donation platelet count were collected in EDTA and for product counts in the sample pouch attached with apheresis kits. The results were obtained by haematology analyzer. Platelet yield and collection efficiency were calculated. RESULT: Results were tabulated for both the cell separators and analyzed. Platelet yield was marginally better with Baxter CS 3000 plus but collection efficiency was better with the Haemonetics MCS plus. Residual white cells were more in single donor platelet concentrate preparation by MCS plus. Adverse donor reactions were similar with both cell separators, in form of mild citrate toxicity and mild to moderate pain at phlebotomy site. CONCLUSION: Findings of the present study along with other factors such as less priming time for kit, portability of cell separator, better patient comfort owing to single arm venous access and lesser cost suggest that Haemonetics MCS plus is a better choice as compared to Baxter CS 3000 plus cell separator.

Adding to platelet safety and life: Platelet additive solutions.

BACKGROUND: Platelet additive solutions (PAS) are crystalloid nutrient media used in place of plasma for platelet storage. They replace 60%-70% of plasma in platelet components, so the amount of storage plasma can be decreased. Platelets in PAS have lower risk for allergic transfusion reactions with equivalent clinical efficacy for controlling bleeding. AIM: The aim of this study is to evaluate the clinical and laboratory efficacy of PAS-platelets. MATERIALS AND METHODS: A total of 1674 single donor platelet (SDP) were collected in PAS in the month of June to September 2016 by different apheresis systems. The quality control tests were done on 356 units in 4 months. Total number of SDP were processed with Amicus device (n = 232), Trima Accel (n = 84), and MCS+ (n = 40). The parameters analyzed were antibody titer of anti-A and anti-B, volume, platelet count, pH, bacterial contamination, and reporting of adverse transfusion reaction. Antibody titers were checked by tube technique, and platelet counts were checked by hematology analyzer Sysmex poch 100i. The swirling was checked manually, and pH was checked with pH strips. RESULTS: Out of 356, 164 units were O group, 113 units were B group, 68 units were of A group, and the remaining 11 units were of AB Group. Anti-A and anti-B titer was significantly reduced in PAS-SDP and found 1:32 or less for all the units. All the units found negative for bacterial contamination. No transfusion reaction was reported of the units transfused. All other quality parameters for platelets also found satisfactory after implementing the additive solution. CONCLUSION: The ABO antibody titers were significantly reduced after addition of PAS. This facilitates the ABO incompatible SDP transfusion and helps in inventory management. The risk of allergic transfusion reaction decreases after reducing the amount of plasma from SDP units. Using PAS-SDP certainly improve the inventory management for platelets with no compromise on clinical and laboratory efficacy.