Effect of double dose plateletpheresis on target yield and donor platelet recovery

Abstract Introduction The demand for apheresis platelets has increased in the recent past and the shrinking donor pool has shifted the trend to collection of double-dose or higher yield of platelets. Objective The present study aimed to determine the effect of double-dose plateletpheresis on the target yield and donor platelet recovery. Methods The study was conducted on 100 healthy plateletpheresis donors, 50 of whom were in the study group, which underwent double-dose plateletpheresis (DDP), and 50 of whom were in the control group for single-donor plateletpheresis. Pre- and post-procedure samples of donors were subjected to a complete blood count. The DDP product was sampled for platelet yield and then split into two parts. Platelet yield, collection efficiency, collection rate, recruitment factor and donor platelet loss were calculated. Results The mean platelet yield in the SDP was 4.09 ± 1.15 × 1011 and in the DDP, 5.93 ± 1.04 × 1011. There was a significant correlation between the pre-donation platelet count and platelet yield. The total of platelets processed for the SDP were 5.42 ± 1.08 × 1011 and for the DDP, 7.94 ± 0.77 × 1011. The collection efficiency was 71.93 ± 25.14% in the SDP and 72.94 ± 16.28% in the DDP, while the collection rates were 0.78 × 1011 and 0.94 × 1011 per minute, respectively. The average recruitment factor observed was 0.98 in the SDP, while it was 0.99 in the DDP. The mean platelet loss observed in the SDP was 35.55 ± 8.53% and in the DDP, 37.76 ± 8.65%. Conclusion The double-dose plateletpheresis supplements the platelet inventory in developing countries where the apheresis donor pool is limited. It is prudent to ensure stringent donor selection criteria for donors donating high-yield platelet products, thus enhancing donor safety and retention.

Effect of double dose plateletpheresis on target yield and donor platelet recovery.

INTRODUCTION: The demand for apheresis platelets has increased in the recent past and the shrinking donor pool has shifted the trend to collection of double-dose or higher yield of platelets. OBJECTIVE: The present study aimed to determine the effect of double-dose plateletpheresis on the target yield and donor platelet recovery. METHODS: The study was conducted on 100 healthy plateletpheresis donors, 50 of whom were in the study group, which underwent double-dose plateletpheresis (DDP), and 50 of whom were in the control group for single-donor plateletpheresis. Pre- and post-procedure samples of donors were subjected to a complete blood count. The DDP product was sampled for platelet yield and then split into two parts. Platelet yield, collection efficiency, collection rate, recruitment factor and donor platelet loss were calculated. RESULTS: The mean platelet yield in the SDP was 4.09 ±â€¯1.15 × 1011 and in the DDP, 5.93 ±â€¯1.04 × 1011. There was a significant correlation between the pre-donation platelet count and platelet yield. The total of platelets processed for the SDP were 5.42 ±â€¯1.08 × 1011 and for the DDP, 7.94 ±â€¯0.77 × 1011. The collection efficiency was 71.93 ±â€¯25.14% in the SDP and 72.94 ±â€¯16.28% in the DDP, while the collection rates were 0.78 × 1011 and 0.94 × 1011 per minute, respectively. The average recruitment factor observed was 0.98 in the SDP, while it was 0.99 in the DDP. The mean platelet loss observed in the SDP was 35.55 ± 8.53% and in the DDP, 37.76 ± 8.65%. CONCLUSION: The double-dose plateletpheresis supplements the platelet inventory in developing countries where the apheresis donor pool is limited. It is prudent to ensure stringent donor selection criteria for donors donating high-yield platelet products, thus enhancing donor safety and retention.

Exploring the unseen effect of COVID 19 pandemic on blood transfusion services in a tertiary care centre.

BACKGROUND: The coronavirus pandemic confronted blood transfusion services with major challenges. The present study was conducted to explore the effect of the COVID-19 pandemic on blood transfusion services including seroprevalence of transfusion-transmitted infections. MATERIAL AND METHODS: A retrospective cross-sectional study was conducted and data on blood donation, utilization, camps, plateletpheresis and seroprevalence of transfusion-transmitted infections (TTI) was retrieved from software from March to September 2020 and 2021 and compared with corresponding time periods of three preceding non-pandemic years. RESULTS: There was a decline of 53.79% and 34.4% in blood donations in 2020 and 2021 respectively with a significant reduction in voluntary donations from 91.8% in the pre-pandemic period to 72.2% in 2020 and 77.7% in 2021. Replacement donors increased by 60.81% and 72.89% in 2020 and 2021 respectively. There was a decline of 48.4% in the number of plateletpheresis procedures in 2020 which increased in 2021 during the dengue outbreak. The decline in total blood donations and issue of packed red blood cells was statistically significant but supply and demand were balanced with no deficit. TTI seroprevalence increased from 1.01% to 1.49%(p<0.001) and 1.51%(p<0.001) in 2020 and 2021 respectively. Replacement donors showed a significantly higher TTI prevalence as compared to voluntary donors(p<0.001). A significant increase in prevalence was observed for Syphilis (0.4%) in 2020 and HBsAg (0.54%), HCV(0.63%) and syphilis (0.25%) in 2021. CONCLUSION: The potential consequences of the COVID-19 pandemic on blood safety cannot be undermined. Developing a strong database of regular voluntary donors can be instrumental in dealing with future waves and surges in infections.

Comparison of Hematocrit Change in Preterm Neonates with Birth Weight Based Versus Formula Based Packed Red Blood Cell Transfusion: A Randomized Control Trial.

Conventionally the packed red blood cell (PRBC) transfusion volume given to neonates is 10 ml/kg to 20 ml/kg. The weight-based formulae underestimate the volume of PRBC required to achieve a target hematocrit (Hct) in preterm neonates. The study was done to compare the rise in Hct after transfusing PRBC volume calculated either based on body weight or using formula considering Hct of blood bag and Hct of preterm neonates. This prospective study included a total of 68 preterm neonates requiring transfusion for the first time having ≤ 34 weeks of gestational age. Neonates were randomized using block randomization, to receive 15 ml/kg of PRBC transfusion (group A) or transfusion based on the formula (group B). The primary outcome of interest was post-transfusion rise in hematocrit. The secondary outcome was the effect of transfusion on neonatal morbidities in terms of retinopathy of prematurity, bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and death. Baseline variables (birth weight, gestation age, APGAR score and score of neonatal acute physiology) pre-transfusion hemodynamics and hematocrit of the bag were comparable in both groups. The mean volume of PRBC in group A was 18.8 ± 4.9 ml, whereas in group B it was 29.6 ± 7.3 ml, p = 0.0001. Group B transfusions had a statistically significant change in 24 h post-transfusion hematocrit. Secondary outcomes were comparable in two groups. Post transfusion rise in Hct of the patient in group B was significant as compared to group A. The study needed huge sample size to establish a difference in the number of re-transfusions required across two groups. The trial was registered under the clinical trial registry of India (CTRI/2018/01/011,063). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12288-021-01420-1.

Assessment of serum iron stores in regular plateletpheresis donors.

BACKGROUND: Iron deficiency anaemia is the most common nutritional deficiency disorder in the world. Iron deficiency is a potential complication in repeated apheresis donation. The present study was aimed to evaluate serum iron stores in regular plateletpheresis donors. MATERIALS AND METHODS: A total of 60 donors were included in this study, which included 30 regular plateletpheresis donors as cases and controls were 30 first time donors. The donor samples were collected before donation for complete hemogram, transfusion transmissible infections screening and serum iron, total iron binding capacity, percentage saturation of transferrin and serum ferritin. RESULTS: Out of 60 donors, more than half of the donors (56.6 %) had serum ferritin less than 30 ng/mL. Out of these 34 donors, 25 were from the case group and 9 donors in the control group. The median serum ferritin level in cases and controls was 11.86 ng/mL (Interquartile range 4.18-17.34 ng/mL) and 37.92 ng/mL (Interquartile range 27.87-86.20 ng/mL) respectively (p < 0.001). The mean serum iron in cases and controls was 71.23 ± 31.32 µg/dL and 93.53 ± 33.53 µg/dL respectively (p = 0.016). The mean percentage saturation in cases and controls was 20.09 ± 9.31 % and 26.26 ± 9.03 % respectively (p = 0.012). A significant decline in mean serum ferritin with increase in number of annual donations and decrease in donation interval was observed. DISCUSSION: Regular plateletpheresis donation may lead to depletion of iron stores and subclinical iron deficiency. Donors with high platelet count are more likely to exhibit iron deficiency. Periodic serum ferritin estimation in donors participating in regular plateletpheresis donation is warranted.

Alteration in biochemical parameters during plateletpheresis in healthy donors: A compendious analysis.

OBJECTIVES: During plateletpheresis, citrate induces hypocalcemia and hypomagnesemia, which are usually transient and self-limiting, but they can lead to significant donor discomfort. The aim of study was to determine the effect of citrate infusion on a multitude of biochemical parameters during plateletpheresis in healthy donors and to correlate changes with adverse donor reactions. METHODS: The study was conducted on 60 healthy plateletpheresis donors. Blood samples were drawn on three occasions, a baseline pre-donation sample, 30min at start of procedure and 30min post procedure. Heparinized samples were taken to measure ionized calcium and plain samples to measure serum calcium, serum magnesium, parathyroid hormone, total protein and serum albumin. RESULTS: There was statistically significant decline in mean total calcium (9.27±0.66mg/dl to 8.72±0.87mg/dl) and ionized calcium (3.8±0.51mg/dl to 2.9±0.67mg/dl) from baseline until 30min after the start of procedure respectively. A significant fall in serum magnesium, total protein and serum albumin was observed. The mean parathyroid hormone showed significant increase from baseline levels till at the completion of procedure (19.94±12.1pg/ml to 92.08±36.78pg/ml). If the yield was set constant, there was negative correlation between ACD used and pre-donation platelet count. Majority of adverse donor reactions were hypocalcemic reactions, which were more with Amicus double yield plateletpheresis and were managed with calcium supplementation. CONCLUSION: Plateletpheresis induces marked reduction in serum calcium and magnesium levels. Moreover, increase in parathyroid hormone levels was significant. In addition, decline in total protein and serum albumin may be a concern in donors also participating in plasmapheresis.

Comparison of micro column technology with conventional tube methods for antibody detection.

BACKGROUND AND OBJECTIVES: Conventional tube technique (CTT) has been the mainstay for antibody detection in pretransfusion testing. There have been rapid technological advances in blood banking and methodology of crossmatch has been modified to improve the sensitivity of these tests and to enable automation. This study was done to compare the efficacy of three crossmatch techniques: CTT, tube low-ionic-strength-saline indirect antiglobulin test (tube LISS-IAT), and micro column technology (MCT) used in the blood bank serology laboratory. MATERIALS AND METHODS: In this prospective study, 150 samples from patients who had received two or more transfusions on two different occasions (with at least 72 h between two transfusions) were subjected to cross match by three different techniques - CTT, LISS-IAT, and MCT. RESULTS: A total of 16 cases with antibodies were identified in 150 patients. Out of 16 cases, 14 were clinically significant (anti-c = 5, anti-K = 4, anti-E = 2, anti-S = 2, anti-Jka = 1) and 2 nonclinically significant antibody cases (anti-Lea). MCT detected all the 14 clinically significant antibody cases and no case of nonclinically significant antibody. Tube LISS-IAT detected 14 antibody cases including 2 cases of non-clinically significant antibody but failed to detect 1 case of anti-c and the only case of anti-Jka. CTT detected only 10 antibody cases including 2 cases of non-clinically significant antibody and but failed to detect 3 cases of anti-c, 1 case of anti-K, 1 case of anti-E, and the only case of anti-Jka. CONCLUSION: MCT was found to be most efficacious when compared to CTT and tube LISS-IAT in detecting clinically significant red cell antibodies; although MCT missed 2 cases of Lea antibody which were detected by CTT and LISS-IAT.

Clinical Significance of Rare Maternal Anti Jka Antibody.

We hereby report a rare case of HDFN because of antibody to Kidd (Jk) blood group system-anti Jka. An EDTA sample of a baby along with mother's sample was received in the Department for Direct Antiglobulin Test (DAT) alongwith blood requisition for double volume exchange transfusion. On blood grouping, baby's and mother's blood group was found to be B Rh D positive. DAT with polyspecific anti human globulin (AHG) was positive. Screening of mother's serum for irregular antibodies showed anti-Jka antibody. AHG phase titers using tube technique were 1:64. Mother was found to be Jka antigen negative; father and neonate were found to be Jka antigenpositive. Antibody was observed to be of IgG type on Dithiothreitol treatment. Baby had total serum bilirubin of 20.5 mg/dl on day 3 of life and phototherapy was started. Exchange transfusion was not required in the baby. The present case emphasises the significance of minor blood group antigens other than Rh blood group system as a cause of HDFN. Although HDFN due to Jk antibodies is rare, however, the clinician must be aware of the occurrence of these antibodies as they can lead to severe HDFN and persistent anemia in the infant.

Segregation of blood inventory: A key driver for optimum blood stock management in a resource-poor setting.

BACKGROUND: Blood inventory management entails maintaining a delicate balance between guaranteeing blood availability and minimizing wastage. The study was conducted to identify and analyze various factors of wastage which can provide insight to ideal inventory management, thus help in formulating policies and improve efficiency of blood transfusion services. MATERIALS AND METHODS: The study was conducted in a tertiary care hospital. To determine various causes of wastage, a retrospective analysis was done over 6 months and preventive strategies adopted. Issuable stock index (ISI) and wastage as percentage of issue (WAPI) were used to compare the effect on blood inventory before and after adoption of strategies. The average number of times each ABO group and Rh type was crossmatched before final transfusion was calculated and compared for randomly selected units over the first 6 months of 2012 and 2013. RESULTS: Outdating was found to be the largest cause, and decrease in discarding rate was observed after adoption of strategies. Mean ISI for different study periods was comparable. However, significant decrease (P = 0.015) was observed for WAPI and WAPI with respect to outdating. Significant decrease in average number of times a unit was crossmatched before final transfusion for all positive blood groups and O-negative blood group was observed over corresponding first 6 months of 2012 and 2013. CONCLUSION: Division of inventory into two parts, enlistment of soon to outdate blood components, and reduction of holding of blood units to minimum period for elective surgery patients are simple measures which can minimize wastage.

Antibody screening in multitransfused patients: a prerequisite before each transfusion.

Life-long red blood cell (RBC) transfusions remain the main treatment for severe thalassemia. We hereby report a case of anti S and anti Lu(a) in a ß-thalassemia major patient detected incidentally on antibody screening. The patient was a known case of ß-thalassemia major and was on regular blood transfusion every 3 weeks from the institute from the age of 6 months. Subsequently, on one occasion, patient's crossmatch was compatible despite positive antibody screen using microcolumn gel technique. Autocontrol and direct antiglobulin test were negative on microcolumn gel. Anti S and anti Lu(a) antibodies were identified. Blood unit found compatible was negative for S and Lu(a) antigens. Antibody titers were 1:1 for both anti S and anti Lu(a) in AHG phase using tube technique and antibodies were of IgG type. Blood unit was transfused uneventfully to the patient. Donors were traced back (last three donations) and called for repeat blood sample testing for S and Lu(a) antigen. Two out of three donors were found to be S antigen positive and one out of these two was Lu(a) antigen positive. Anti S and anti Lu(a) antibodies were again identified on patient's subsequent visit for transfusion. The present case re-emphasize the importance of antibody screening at each visit in earlier detection of antibodies in multi transfused patients. Encouraging patients to receive transfusion from one center and dedicating donors could reduce alloimmunization rate but larger studies are required.

DAT positivity in blood donors: a perplexing scenario.

A blood request was received for 70 year male patient suffering from Chronic Obstructive Pulmonary Disease with anemia. One unit was found incompatible in AHG phase. Patient's antibody screen, indirect antiglobulin test (IAT), direct antiglobulin test (DAT) and auto control was negative. DAT of donor unit was positive with anti IgG gel card and negative with C3d reagent along with positive auto control. Donor was 30 year male with no history of blood transfusion and medication and had no evidence of hemolysis. Donors with positive DAT should be deferred, notified and referred to physician but further studies are required.

Discolored blood and blood components: a dilemma for transfusion specialists.

BACKGROUND AND OBJECTIVES: It is not uncommon in transfusion practice to see blood/components with abnormal colored plasma. The present study was conducted to identify and determine the etiology of blood and/or blood components showing altered color. MATERIAL AND METHODS: The present study was conducted in the Department of Transfusion Medicine, Government Medical College and Hospital, Chandigarh over a period of seven months. All the blood units/components having an abnormal appearance were segregated as: 1. Green discoloration. 2. Yellow discoloration. 3. Bright cherry red color. 4. Lipemic plasma. The donor's history was carefully evaluated and relevant investigations were done depending on discoloration. RESULTS: Seventeen units out of 7370 (0.23%) donations showed discoloration. In 3 units the plasma was green, 5 units were yellow, in 3 units PRBC/WB unit was bright cherry red and in the remaining 6 units the plasma was lipemic. Total bilirubin of all the 5 donors with yellowish plasma ranged from 1.6 to 2.3mg/dl. The hemoglobin and hematocrit of two out of three donors with cherry red discoloration of PRBC/WB was low. All the donors with lipemic plasma gave history of intake of fatty meal prior to donating blood. CONCLUSION: The existing rules prohibit issue of blood and blood components if the plasma is abnormal in color. Our study showed that many of the discolored units could have been safely transfused but further larger studies are required to confirm the safety of recipients receiving such units.

Tetany by transfusion of small volume of blood: a rare case report.

A requisition for two units of packed red blood cells was received for a 54 year female, known case of genitourinary carcinoma. After transfusion of approximately 15-20 ml of blood, a call was received from resident in charge of radiotherapy ward stating that patient had clenching of hands along with circumoral tingling and paresthesias in her limbs. Her investigations showed decreased serum potassium and calcium levels but serum magnesium levels were not available. Multiple electrolyte disturbances probably precipitated tetany even by small volume of blood transfusion. We therefore recommend careful monitoring of electrolytes, including magnesium, before starting blood transfusion.

Bombay phenotype in two North Indian brothers: a case report.

Bombay phenotype is unique in the aspect that the red cells are not agglutinated by antisera A, B and H. However the serum of such individuals contains anti A, B and strongly reactive anti H which agglutinates red cells of 'O' group individuals through a wide thermal range. The blood specimen of a 35 year old male donor who donated blood for the first time was subjected to detailed cell and serum grouping. There was a discrepancy between the results. The possibility of Bombay phenotype was considered and the sample was tested with anti H lectin. Further confirmation of blood group and secretor status was done from a reference laboratory. Family studies showed the same blood group in the elder sibling of the propositus. The present case highlights the significance of correlating cell and serum grouping results. Moreover, this blood group is very rare in North India. Family studies revealed the propositus to possess the B gene which was suppressed in the donor but expressed in the offsprings. The use of anti H in discrepant blood grouping results is recommended.