Evaluation of a scoring system for vein suitability in platelet apheresis donors.

INTRODUCTION: Donor vein assessment for the selection of good quality veins is crucial for a successful apheresis procedure. This study intends to find out the effectiveness of a vein assessment scoring tool (VST) used and found to be effective in selecting whole blood donors to reduce the difficulty in identifying good quality veins for the plateletpheresis procedure. MATERIALS AND METHODS: This was a prospective observational study on platelet apheresis donors with the application of a VST consisting of three vein descriptor parameters (vein visibility, vein palpability, and vein size) with 5 Likert-type responses constituting a score of 0-12 for each arm. Two vein assessors independently evaluated the vein in both arms and marked their responses blinded from each other as well from the principal investigator. The scores were then calculated and analyzed at the end of the study for their association with phlebotomy and procedural outcomes. RESULTS: A total of 190 donors were recruited. The mean scores for the arms with successful and failed phlebotomy were 9.1 and 9.4 (SD 2.3), respectively. The intra-class correlation Alpha Cronbach value was 0.834 and 0.837 for total scoring in the left arm and right arm, respectively, between the two assessors. Scores neither showed a correlation with other outcomes like low flow alarms, hematoma formation, number of phlebotomy attempts, and procedure completion. CONCLUSION: The study showed that the vein score tool did not truly predict the phlebotomy outcome in apheresis donors, though there was a good degree of inter-assessor reliability.

Feasibility of high-yield plateletpheresis in routine practice: Experience from tertiary health center from South India.

BACKGROUND AND OBJECTIVES: High-yield plateletpheresis donations can reduce donor exposure and be economically beneficial as well. However, obtaining a high-yield plateletpheresis from a maximum number of donors with low basal platelet count and its effect on postdonation platelet count of donors undergoing high-yield plateletpheresis has been a matter of concern. This study aimed to assess the feasibility of making high-yield platelet donation as a routine practice. METHODS: It was a retrospective observational study to determine the effect of high-yield plateletpheresis on donor reactions, efficacy, and quality parameters. It was conducted from January 1, 2019 to June 30, 2021, at the Department of Transfusion Medicine in a tertiary care hospital of South India. RESULTS: Out of the 669 procedures, 564 (84.3%) of the collection had a platelet yield of ≥5 × 1011, 468 (70%) of the collection had a platelet yield of 5.5 × 1011, whereas 284 (42.5%) met the target of 6 × 1011 by coulter. The mean drops in platelet count were 95 ± 16 × 103/µl (77,600-113,000/µl), mean platelet recruitment was 1.31 ± 0.51. The mean collection efficiency of the procedure for the 669 cases was shown to be 80.21 ± 15.34, and the mean collection rate was 0.07 × 1011 ± 0.02 per minute. Only forty donors (5.5%) experienced adverse donor reactions. CONCLUSIONS: High-yield plateletpheresis can be done in routine practice with no added adverse donor reaction with effective quality products.

Optimising platelet usage during the induction therapy of acute myeloid leukaemia: Impact of physician education.

INTRODUCTION: Platelet products are scarce and expensive resources to be used judiciously. However, inappropriate usage is common. Lack of physician awareness is an important issue. We implemented a physician education program (PEP) along with repeated WhatsApp reminders at our centre. We audited the platelet usage practise before and after the intervention. METHODS: Charts of patients with acute myeloid leukaemia (AML) treated between January 2020 and August 2020 was reviewed, and the mean platelet usage per patient per day was calculated. Physician education was implemented between September 2020 and December 2020 (2 PowerPoint lectures of 20 min each and weekly WhatsApp messages containing the guidelines). Data of patients treated between Jan 2021 and August 2021 was prospectively audited to understand platelet usage and the indications for transfusions. The British Committee for the Standards in Haematology (BCSH) platelet transfusion guidelines were used as the adjudication tool to evaluate compliance. The mean platelet usage per day per kg body weight of a patient before and after the PEP was compared using the t-test. RESULTS: Group A (before physician education) consisted of 22 patients, and group B (after physician education) consisted of 23 patients. The mean number of platelet transfusions for each patient in a day per kg body weight was 125.7 × 108 in group A whereas, after the PEP, it had reduced to 73.9 × 108 amounting to an absolute reduction of 51 × 108 (58.8%) from the baseline with a statistical significance of P = 0.001. After implementing the PEP, the mean number of random donor platelets used reduced by 10.25 units (34% reduction), and the mean single donor platelets used reduced by 0.83 units (19% reduction). The 190 requests for platelet transfusion received during this period were classified as appropriate (157/190), which constituted 82.63% of the requests, or inappropriate (33/190), which accounted for 17.36%. CONCLUSIONS: A short-duration education programme supplemented with weekly WhatsApp messages and an active feedback mechanism on the rationale of platelet transfusion by the treating physician and transfusion specialist could significantly reduce platelet consumption during the therapy of acute myeloid leukaemia patients. This is a measure that can be considered by all high-volume haematology centres, which can improve patient safety and reduce costs.

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.

Effect of leukapheresis on pain reduction in leukemic priapism.

Priapism is a rare presentation of Chronic Myeloid Leukaemia (CML). It is also considered a medical emergency as delay in treatment may lead to impotence. Prompt medical and surgical interventions such as hydroxyurea, analgesia, phenylephrine injection and aspiration, open surgical shunting, and local radiation therapy are essential. Leukapheresis effectively reduces leukocyte count rapidly and effectively, thereby an important therapy along with other standard of care in CML-induced priapism. In the present case, priapism was the presenting symptom of CML. The same was managed with various modalities such as hydroxyurea, allopurinol, antibiotics, analgesics, sedatives, phenylephrine injection, and aspiration but failed to reduce priapism pain. With a single cycle of leukapheresis, priapism pain could be reduced significantly.

Management of Bombay Rh negative with clinically significant anti-S for CABG surgery.

The Bombay Rh D negative is the rarest of the rare in blood groups. A 65-year-old male patient with coronary artery disease was admitted for CABG. During grouping, forward showed no agglutination in A, B, D, and H, and reverse showed agglutination in A, B, and O cell. The blood group was confirmed as Bombay Rh D negative. Four units of PRBC was requested for the surgery as it was cardiothoracic surgery. We checked our inventory and rare donor list for Bombay-negative blood. Acute normovolemic hemodilution was done for 2 units preoperatively with saline replacement. Autologous platelet apheresis was done for this patient. During routine cross-match, one unit was incompatible. The patient had naturally occurring anti-S, which was reactive at 37°C and clinically significant. A total of 4 PRBC (Packed Red Blood Cell), 1 Single Donor Platelet (SDP), 12 Fresh Frozen Plasma (FFP), and 9 cryoprecipitate were transfused throughout the hospital stay. The patient was Bombay Rh negative with anti-S with major surgery, which was re-explored twice; the patient was managed successfully in spite of all these difficulties with cooperation from different blood banks from all over India.