Impact of saline infusion and citrate infusion rate during donor plasmapheresis.

The purpose of our research was to evaluate the effects of saline infusion to counteract incidents of severe hypotension during donor plasmapheresis (DP; synonym with plasma donation), and on immunoglobulin G (IgG) content in collected plasma, and on donor hematological values. It examines the clearance (Cl) of IgG during DP without saline to calculate the distribution of citrate and citrate infusion rate (CIR) during DP. It is based on three studies: an observation of saline infusion in donors with severe drops in blood pressure at DP, and two crossover trials of 32 repeat plasma donors each on saline infusion during DP. We observed 50 cases with a significant drop of mean systolic blood pressure ≤90 mm Hg in 1 year, predominantly in young, female first-time donors. In trial 1, there was a reduction of IgG concentration in collected plasma related to the average IgG serum concentration without saline to 85.5% vs to 80.5% with saline (P < .001). In trial 2, there was an important 11%-12% increase of the donor hematological values without saline during DP. An average of 84.6% of citrate was removed in retained plasma; our calculated minimal CIR of 0.16 ± 0.17 mg/kg/min was confirmed by other empirical studies. Our research has led to significant improvements in the practice of DP: (a) Saline should be infused at DP as clinically indicated in agreement with the donor. (b) Young, female first-time donors require special care. (c) The long-time effects of minimal amounts of citrate on bone metabolism are improbable.

Anticoagulation, bleeding, and clotting at donor plasmapheresis.

This article is based on a question of a colleague from North America how coagulation could be triggered between a donor's arm and a fistula needle during plasma donation (synonymous with donor plasmapheresis). The technique of venipuncture and citrate anticoagulation are described. Uncommon and rare problems such as prolonged bleeding, scarring, and thrombosis in plasma donors are discussed. If venous puncture and citrate: blood flow ratio at 1:16 are correctly performed, however, there will be no anticoagulation abnormalities due to plasma donation.

Report on 50 cases of severe acute hypotension at donor plasmaphereses: treatment and course.

INTRODUCTION: This paper reports our experience in 50 cases with severe hypotensive reactions at plasma donations (synonymous with donor plasmaphereses). METHODS: Plasma donors who developed a severe acute hypotensive reaction at donor plasmapheresis, and were treated by placing the donor in the Trendelenburg position and rapid infusion of 1,000 mL saline were investigated. Plasmaphereses were performed with the Haemonetics® plasma collecting system 2 (PCS2). The results were analyzed using Excel. RESULTS: We observed 50 severe hypotensive reactions in plasma donors. The average systolic and diastolic blood pressures (SBP, DBP) were 128/75 mmHg - and heart rates were 78 beats/min (B/M) before plasmaphereses, 83/56 mmHg - 60 B/M at the event, and after treatment 119/71 mmHg - 69 B/M at the time of discharge. The volume of collected plasma was 602 ± 240 mL including anticoagulant (AC). The time until the event was 45 ± 20 minutes. With treatment 49 ± 18 minutes after the event all plasma donors had normal blood pressures and heart rates and could safely leave the center. CONCLUSIONS: Treatment by placing the donor in the Trendelenburg position and rapid infusion of 1,000 mL saline appears to be an effective procedure for resolving severe acute hypotension associated with donor plasmaphereses.

[Lifespan of Doctorate and Non-doctorate Physicians in Northrine]. / Lebensdauer promovierter und nicht promovierter Ärzte in Nordrhein.

AIM: The purpose of this study was to evaluate the lifespan of physicians in North Rhine depending on the criterion if they had graduated with a Dr. med. thesis under German law or not. North Rhine is part of the German federal state North Rhine-Westphalia. METHODS: The date of birth and date of death of 1133 deceased physicians from the journal of the medical association of North Rhine were recorded according to their doctoral degree from January 2013 until June 2016 inclusive. For the calculation of their length of life, the descriptive statistics and for further statistical analysis, the R program 1 was applied. RESULTS: Physicians with a doctoral degree under German law (Dr. med.) reached an average age of 80.9 ± 12.1 years whereas physicians without a dissertation reached an age of 67.6 ± 13.8 years, on average. After correction for year of birth no significant difference between the average lifespan of the two groups could be found. CONCLUSION: The analysis of the survival data of deceased physicians showed a much longer length of life if they had graduated with a doctoral thesis under German law, which was not significant after a year of birth correction. For every statistical analysis possible confounders need to be considered.

Distribution of citrate and citrate infusion rate during donor plasmaphereses.

BACKGROUND: The purpose of this study was to describe the distribution of trisodium-citrate 4% (TSC) anticoagulant (AC) between the product and the donors undergoing plasma donation. SUBJECTS AND METHODS: Data of 32 regular donors of plasma initially collected for a study published in 2010 were re-analyzed to determine the amount of citrate received by the donor and the citrate infusion rate (CIR) in mg/kg/min to the donor. Donor plasmaphereses (DP) were performed with the automated Haemonetics plasma collecting system 2 (PCS2). Plasma volume was programmed at 760 ml including AC. CIR was calculated from citrate received by the donors divided by the body weight over time. RESULTS: 130 ± 12 ml TSC was used for 760 ml plasma. An average of 110 ml TSC or 84.6% of citrate load was in collected plasma and not given to the donor. From the difference of 20 ml or 514 mg citrate an average CIR of 0.16 mg/kg/min was calculated. CONCLUSION: The total amount of citrate received by the donor is minimal and the average CIR is below the critical level of 1 mg/kg/min.

Course of Hemoglobin and Hematocrit during and after Preparatory Plasmaphereses without and with Infusion of NaCl 0.9% 500 ml.

BACKGROUND: The aim of this study was to evaluate the course of hemoglobin (HGB) concentration and hematocrit (HCT) in donor blood during and after preparatory plasmaphereses (PP) without NaCl and with an infusion of 500 ml 0.9% NaCl during PP. METHODS: After informed consent 32 plasma donors were studied in a crossover design. They underwent PP once without NaCl infusion and once, on a different day, with infusion of 500 ml 0.9% NaCl. HGB concentration and HCT values in donor blood were analyzed using a Sysmex KX-21N analyzer. The values of HGB concentration and HCT before PP were set to 100%. Changes in HGB concentration and HCT were calculated in percent directly after PP, and after 24 and 72 h. RESULTS: During PP, there was a notable change in HGB concentration (11.2 ± 4.0%) and HCT (11.6 ± 3.9%) in donor blood. The difference between the 2 samples without and with NaCl was highly significant (p < 0.001). After 24 and 72 h, all differences were reduced. CONCLUSION: We observed significant changes in HGB concentration and HCT in donor blood during PP. We recommend a concomitant infusion of 500 ml 0.9% NaCl during PP to all donors.

Influence of NaCl 0.9% Infusion during Plasmapheresis on IgG Content in Plasma.

BACKGROUND: The aim of this study was to evaluate the influence of an infusion of NaCl 0.9% 500 ml during preparatory plasmapheresis or apheresis on the immunoglobulin G (IgG) content in separated plasma. METHODS: 32 donors of plasma were studied in a crossover design after informed consent on one day without NaCl 0.9% 500 ml during apheresis and on another day with infusion of NaCl 0.9% 500 ml during apheresis. Infusion of NaCl 0.9% 500 ml was given step by step in divided doses after each cycle through the harness set of the Haemonetics® plasma collecting system 2 (PCS2). Concentrations of IgG in serum and in plasma were measured by an immunoturbidimetric assay. Percentages of IgG concentrations in plasma were calculated by dividing the IgG concentration in plasma by the mean serum IgG concentrations (x 100). RESULTS: Without infusion of NaCl 0.9% 500 ml, the mean percentage of IgG in separated plasma was 85.5 ± 2.3% while it was 80.5 ± 3.4% when NaCl 0.9% 500 ml was given. The difference between the two samples was statistically highly significant (p < 0.001). CONCLUSIONS: We conclude that the gradual infusion of NaCl 0.9% 500 ml during apheresis causes a statistically highly significant difference of IgG content in separated plasma.