[Adaptation of platelet concentrates delivery to HAS/ANSM requirements evolution in EFS Grand-Est]. / Adaptation de la délivrance des concentrés plaquettaires aux recommandations HAS/ANSM 2015 à l'EFS Grand-Est.

Evolution of French HAS/ANSM guidelines in 2015 about optimal platelet transfusion dose for patients brought us to review about our practices for platelet concentrates delivery in EFS Grand-Est region. In addition, pathogen inactivation in platelet concentrates has been implemented all over the country and transfusion centers have merged. All these changes required harmonization. In this context, our major issue was to answer patient's requirements, according to the new guidelines keeping in mind the cost effectiveness on public finances. We report here on the changes in our practices and their impacts.

Platelet transfusion: Current challenges.

Since the late sixties, platelet concentrates are transfused to patients presenting with severe thrombocytopenia, platelet function defects, injuries, or undergoing surgery, to prevent the risk of bleeding or to treat actual hemorrhage. Current practices differ according to the country or even in different hospitals and teams. Although crucial advances have been made during the last decades, questions and debates still arise about the right doses to transfuse, the use of prophylactic or therapeutic strategies, the nature and quality of PC, the storage conditions, the monitoring of transfusion efficacy and the microbiological and immunological safety of platelet transfusion. Finally, new challenges are emerging with potential new platelet products, including cold stored or in vitro produced platelets. The most debated of these points are reviewed.

Characterization of efficacy and safety of pathogen inactivated and quarantine plasma in routine use for treatment of acquired immune thrombotic thrombocytopenic purpura.

BACKGROUND: Auto-immune thrombotic thrombocytopenic purpura (TTP) is a morbid multi-organ disorder. Cardiac involvement not recognized in initial disease descriptions is a major cause of morbidity. Therapeutic plasma exchange (TPE) requires exposure to multiple plasma donors with risk of transfusion-transmitted infection (TTI). Pathogen inactivation (PI) with amotosalen-UVA, the INTERCEPT Blood System for Plasma (IBSP) is licensed to reduce TTI risk. METHODS: An open-label, retrospective study evaluated the efficacy of quarantine plasma (QP) and IBSP in TTP and defined treatment emergent cardiac abnormalities. Medical record review of sequential patient cohorts treated with QP and IBSP characterized efficacy by remission at 30 and 60 days (d) of treatment, time to remission, and volume (L/kg) of plasma required. Safety outcomes focused on cardiac adverse events (AE), relapse rates, and mortality. RESULTS: Thirty-one patients (18 IBSP and 13 QP) met study criteria for auto-immune TTP. The proportions (%) of patients in remission at 30 d (IBSP = 61·1, QP = 46·2, P = 0·570) and 60 d (IBSP = 77·8, QP = 76·9, P = 1·00) were not different. Median days to remission were less for IBSP (15·0 vs. 24·0, P = 0·003). Relapse rates (%) 60 d after remission were not different between cohorts (IBSP = 7·1, QP = 40·0, P = 0·150). ECG abnormalities before and during TPE were frequent; however, cardiac AE and mortality were not different between treatment cohorts. CONCLUSIONS: Cardiac and a spectrum of ECG findings are common in TTP. In this study, IBSP and QP had similar therapeutic profiles for TPE.

Inventory management.

A critical aspect of blood transfusion is the timely provision of high quality blood products. This task remains a significant challenge for many blood services and blood systems reflecting the difficulty of balancing the recruitment of sufficient donors, the optimal utilization of the donor's gift, the increasing safety related restrictions on blood donation, a growing menu of specialized blood products and an ever-growing imperative to increase the efficiency of blood product provision from a cost perspective. As our industry now faces questions about our standard practices including whether or not the age of blood has a negative impact on recipients, it is timely to take a look at our collective inventory management practices. This International Forum represents an effort to get a snap shot of inventory management practices around the world, and to understand the range of different products provided for patients. In addition to sharing current inventory management practices, this Forum is intended to foster an exchange of ideas around where we see our field moving with respect to various issues including specialty products, new technologies, and reducing recipient risk from blood transfusion products.

In vitro evaluation of Haemonetics MCS+ apheresis platelet concentrates treated with photochemical pathogen inactivation following plasma volume reduction using the INTERCEPT Preparation Set.

Pathogen inactivation using the INTERCEPT Blood System requires platelet resuspension in InterSol and reduced plasma. Platelets in plasma collected on the Haemonetics MCS+ were processed on the INTERCEPT Preparation Set for plasma volume reduction and addition of InterSol. The use of the Preparation Set resulted in a mean platelet loss of 5.6 +/- 3.4%. Subsequent photochemical treatment (PCT) with amotosalen and ultraviolet A light, and 7 days of storage, resulted in acceptable changes for platelet swirling, lactate, lactate dehydrogenase (LDH), platelet factor-4 (PF4), p-selectin, glycoprotein V (GpV), pO2, pCO2, tumour necrosis factor-alpha (TNF-alpha) and interleukin-8 (IL-8). All platelet units processed with the Preparation Set and PCT met European requirements for leucoreduction and pH values.

Leukodepletion of platelet concentrates and plasma collected with haemonetics MCS+ apheresis system. Experience of EFS-Alsace.

The prevention of transfusion reactions and transmission of infectious diseases partly relies on the systematic removal of leukocytes from blood products. Apheresis platelets and plasma collected on the Haemonetics MCS+ collection system require filtration to obtain low levels of residual leukocytes. This filtration step is automated for platelet concentrates, whereas plasma filtration requires sterile docking of a leukoreduction filter. Our experience shows residual leukocyte levels of approximately 10(5) for platelets (the French requirements are 10(6) per unit) and 10(2) for apheresis plasma (no existing standard in France). Leukocyte residuals in platelets are highly dependent on the filtration rate, which should be as slow as possible. Whereas the current method of filtration is convenient for platelets, the connection of an in-line filter for plasma causes some organizational problems and is also associated with a loss of plasma. Haemonetics' latest development, the use of a filtering core bowl, should avoid the requirement for the connection of an additional filter for plasma filtration and will ensure continuous filtration of platelets, reducing, even further, the residual leukocyte count in platelet concentrates.

[Quality control of homologous blood collection activities: 5 years' experience]. / Contrôle de qualité des activités de prélévements homologues: 5 ans d'expérience.

Quality control (QC) of blood collection activities for transfusion is a regulatory requirement. The authors report on their experience in this field over the past 5 years. In their institution, this QC is based on both the recording and analyzing of predefined data, as well as the search for an active collaboration from each person involved in these activities. QC of medical selection relies on the assessment of several associated criteria: effectiveness of the information given to blood donors for recruitment, preparation of the medical interview and encouragement to perform regular donations; frequency of donors deferred after the medical interview; frequency of biological abnormalities detected at donation; results of the inquiries into the corresponding medical interviews following adverse transfusion reactions. The quantitative and qualitative evaluation of blood collection permits assessment of the quality of the blood collection program, collection procedures and directly derived blood products. Quality assessment of facilities and equipment is also included in this QC. Results have been improving in recent years, especially regarding medical selection. In particular, an increase in the mean donation rate of donors, a decrease in biological abnormalities detected at donation and an absence of adverse transfusion reactions attributed after inquiry to an inadequate medical interview have been noticed. A decrease in both shortage and outdating of labile blood products likewise indicates an improvement of blood collection planning. However, this QC reveals deficiencies in the information given to donors and a lack of analysis of the data specific to first time donors. In order to further improve the efficiency of QC, these results now require comparison with similar data collected on a nation-wide scale.