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Thuer L, Brosig A, Hutchinson JA, Hähnel V, Offner R, Burkhardt R, Ahrens N. Total platelet donation count and donation frequency are determinants of plateletpheresis-associated lymphopenia. Transfusion 2021; 61:3161-3173. [PMID: 34545947 DOI: 10.1111/trf.16666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Plateletpheresis using a leukocyte reduction system (LRS) traps donor WBCs in the LRS chamber, which may lead to lymphopenia, especially in frequent plateletpheresis donors. It seems plausible that this might cause adverse effects. However, current knowledge about potential confounders and donor health impacts is incomplete. DONORS AND METHODS Recent platelet donors and donations collected at University Hospital Regensburg from 2016 to 2019 using the Terumo BCT Trima Accel LRS system were retrospectively analyzed and compared with historical platelet donors and donations collected mainly with Fresenius Kabi Amicus non-LRS system from 2010 to 2013. Additionally, recent donors were prospectively surveyed using a health-related topics questionnaire. RESULTS Analysis of 819 recent donors with 11,254 blood counts and 1464 questionnaires and 1011 historical donors with 12,848 blood counts revealed that increased annual platelet donation frequencies were associated with decreased lymphocyte counts in both groups. Median lymphocyte counts in recent donors with no versus ≥24 previous annual donations declined from 2.0 to 1.2 × 103 /μL (p < 2.2 × 10-16 ), and those in historical donors with no versus ≥24 previous annual donations decreased from 2.0 to 1.5 × 103 /μL (p = 6 × 10-4 ), respectively. The questionnaire results showed that donation frequency and lymphopenia were not associated with upper respiratory tract infection (URTI) incidence or duration, but platelet donors who concomitantly donated granulocytes had significantly shorter URTI durations than those who did not (p = .008). CONCLUSION This study confirmed that plateletpheresis-associated lymphopenia occurs in LRS and to a lesser degree in non-LRS platelet donors, but revealed no evidence of a negative impact on donor health.
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Affiliation(s)
- Linda Thuer
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Andreas Brosig
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - James A Hutchinson
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Viola Hähnel
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Robert Offner
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Ralph Burkhardt
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Norbert Ahrens
- Institute for Clinical Chemistry and Laboratory Medicine, University Hospital Regensburg, Regensburg, Germany.,MVZ for Laboratory Diagnostics Raubling, Amedes, Raubling, Germany
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2
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Bachowski G. Blood Donor Medical Assessment, Collection, and Complications. Transfus Med 2021. [DOI: 10.1002/9781119599586.ch4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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3
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Gansner JM, Rahmani M, Jonsson AH, Fortin BM, Brimah I, Ellis M, Smeland-Wagman R, Li ZJ, Schenkel JM, Brenner MB, Yefidoff-Freedman R, Sloan SR, Berliner N, Issa NC, Baden LR, Longo DL, Wesemann DR, Neuberg D, Rao DA, Kaufman RM. Plateletpheresis-associated lymphopenia in frequent platelet donors. Blood 2019; 133:605-614. [PMID: 30429159 PMCID: PMC6367645 DOI: 10.1182/blood-2018-09-873125] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/08/2018] [Indexed: 01/22/2023] Open
Abstract
More than 1 million apheresis platelet collections are performed annually in the United States. After 2 healthy plateletpheresis donors were incidentally found to have low CD4+ T-lymphocyte counts, we investigated whether plateletpheresis causes lymphopenia. We conducted a cross-sectional single-center study of platelet donors undergoing plateletpheresis with the Trima Accel, which removes leukocytes continuously with its leukoreduction system chamber. We recruited 3 groups of platelet donors based on the total number of plateletpheresis sessions in the prior 365 days: 1 or 2, 3 to 19, or 20 to 24. CD4+ T-lymphocyte counts were <200 cells per microliter in 0/20, 2/20, and 6/20 donors, respectively (P = .019), and CD8+ T-lymphocyte counts were low in 0/20, 4/20, and 11/20 donors, respectively (P < .001). The leukoreduction system chamber's lymphocyte-extraction efficiency was ∼15% to 20% for all groups. Immunophenotyping showed decreases in naive CD4+ T-lymphocyte and T helper 17 (Th17) cell percentages, increases in CD4+ and CD8+ effector memory, Th1, and regulatory T cell percentages, and stable naive CD8+ and Th2 percentages across groups. T-cell receptor repertoire analyses showed similar clonal diversity in all groups. Donor screening questionnaires supported the good health of the donors, who tested negative at each donation for multiple pathogens, including HIV. Frequent plateletpheresis utilizing a leukoreduction system chamber is associated with CD4+ and CD8+ T-cell lymphopenia in healthy platelet donors. The mechanism may be repeated extraction of these cells during plateletpheresis. The cytopenias do not appear to be harmful.
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Affiliation(s)
- John M Gansner
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Mahboubeh Rahmani
- Division of Hematopathology, Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - A Helena Jonsson
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | | | - Zhihan J Li
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jason M Schenkel
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michael B Brenner
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Revital Yefidoff-Freedman
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Steven R Sloan
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA
| | - Nancy Berliner
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nicolas C Issa
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and
| | - Lindsey R Baden
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and
| | - Dan L Longo
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Duane R Wesemann
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Donna Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Deepak A Rao
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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4
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Blood Donor Medical Assessment and Blood Collection. Transfus Med 2016. [DOI: 10.1002/9781119236504.ch4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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5
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Gulley JL, Mulders P, Albers P, Banchereau J, Bolla M, Pantel K, Powles T. Perspectives on sipuleucel-T: Its role in the prostate cancer treatment paradigm. Oncoimmunology 2015; 5:e1107698. [PMID: 27141392 PMCID: PMC4839373 DOI: 10.1080/2162402x.2015.1107698] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/06/2015] [Accepted: 10/08/2015] [Indexed: 02/04/2023] Open
Abstract
Sipuleucel-T is an autologous cellular immunotherapy approved in the US for patients with asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancer (mCRPC). This significant advance for mCRPC treatment provides healthcare professionals with another effective therapy to extend survival. As an immunotherapy, sipuleucel-T possesses specific characteristics differentiating it from traditional therapies. At a roundtable meeting of experts, sipuleucel-T data were discussed, focusing on interpretation and clinical implications. Important differences between immunotherapies and traditional therapies were explored, e.g., mode of action, outcomes, data consistency and robustness, timing of sipuleucel-T treatment, and future perspectives in areas such as short-term markers of long-term benefit.
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Affiliation(s)
- James L Gulley
- Genitourinary Malignancies Branch and Laboratory of Tumor Immunology and Biology, National Cancer Institute, National Institutes of Health , Bethesda, MD, USA
| | - Peter Mulders
- Radboud University Nijmegen Medical Center , Nijmegen, The Netherlands
| | - Peter Albers
- Düsseldorf University, Medical Faculty , Düsseldorf, Germany
| | | | - Michel Bolla
- Department of Radiation Therapy, C.H.U. Grenoble , Grenoble, France
| | - Klaus Pantel
- Department of Tumor Biology, University Medical Center Hamburg Eppendorf , Hamburg, Germany
| | - Thomas Powles
- Barts Cancer Institute, Queen Mary University of London , London, UK
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Gulley JL, Marté J, Heery CR, Madan RA, Steinberg SM, Leitman SF, Tsang KY, Schlom J. The impact of leukapheresis on immune-cell number and function in patients with advanced cancer. Cancer Immunol Immunother 2015; 64:1429-35. [PMID: 26243387 DOI: 10.1007/s00262-015-1738-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 06/16/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Leukapheresis is often performed in cancer patients to harvest stem cells, manufacture therapeutic vaccines, or follow immunologic response to therapy. We have recently described the minimal impact of leukapheresis on normal donors. Here we provide additional immunologic data from patients with advanced cancer who underwent leukapheresis. METHODS Using data from cancer patients on clinical trials who had leukapheresis (n = 64) or peripheral blood draws only (n = 90) as controls for immune analysis, we evaluated the impact of leukapheresis on number and function of lymphocytes. RESULTS In the leukapheresis group, median age was 63.5 (range 38-82); 87.5 % were male. Comparing pre- and post-leukapheresis values within the groups, with each patient as its own control, there was no significant difference in enzyme-linked immunosorbent spot (ELISPOT), antivector humoral response, absolute lymphocyte count (ALC), or T cell number. Twelve patients completed three leukaphereses with subsequent ELISPOT analysis; seven had increased responses to flu (1.1- to 2.3-fold) with an even distribution around no change. Nineteen patients had matched ALC values after completing three leukaphereses with no significant change from baseline. CONCLUSIONS These data provide evidence that leukapheresis has no detectable effects on a cancer patient's immune system in terms of number or function. These results contribute to a growing body of evidence refuting the hypothesis that a patient's immune competence is meaningfully affected by the procedure. Limitations include a restriction to 2-L leukapheresis procedure and small sample size.
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Affiliation(s)
- James L Gulley
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA. .,Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
| | - Jennifer Marté
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Christopher R Heery
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ravi A Madan
- Genitourinary Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Susan F Leitman
- Department of Transfusion Medicine, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Kwong Y Tsang
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jeffrey Schlom
- Laboratory of Tumor Immunology and Biology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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McNeel DG, Gardner TA, Higano CS, Kantoff PW, Small EJ, Wener MH, Sims RB, DeVries T, Sheikh NA, Dreicer R. A transient increase in eosinophils is associated with prolonged survival in men with metastatic castration-resistant prostate cancer who receive sipuleucel-T. Cancer Immunol Res 2014; 2:988-99. [PMID: 25189164 DOI: 10.1158/2326-6066.cir-14-0073] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sipuleucel-T is an autologous cellular immunotherapy used to treat asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancer (mCRPC). Traditional short-term indicators of clinical response commonly used with chemotherapy have not correlated with survival in patients treated with sipuleucel-T. This retrospective study aimed to evaluate laboratory parameters as possible early biomarkers associated with clinical benefit following sipuleucel-T treatment. Patients treated with sipuleucel-T from three randomized, controlled, phase III clinical trials in mCRPC were considered: IMPACT (NCT00065442; n = 512), D9901 (NCT00005947; n = 127), and D9902A (NCT01133704; n = 98). Patients from these trials were included in this study if their samples were analyzed by the central laboratory and if data were available from baseline and ≥ 1 posttreatment time point (n = 377). We found that sipuleucel-T treatment was associated with a transient increase in serum eosinophil count at week 6 that resolved by week 14 in 28% of patients (105 of 377). This eosinophil increase correlated with induced immune response, longer prostate cancer-specific survival [HR, 0.713; 95% confidence interval (CI), 0.525-0.970; P = 0.031], and a trend in overall survival (HR, 0.753; 95% CI, 0.563-1.008; P = 0.057). Median serum globulin protein levels also increased transiently, which was associated with antigen-specific antibody responses; however, this finding did not correlate with longer survival. We conclude that transient increases in eosinophils at week 6 may be a useful, objective, short-term indicator of global immune activation and survival benefit with sipuleucel-T in patients with mCRPC. This observation warrants prospective evaluation in future clinical trials.
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Affiliation(s)
- Douglas G McNeel
- Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.
| | - Thomas A Gardner
- Department of Urology, Indiana University Simon Cancer Center, Indianapolis, Indiana
| | - Celestia S Higano
- Department of Medicine, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Philip W Kantoff
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Eric J Small
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco Comprehensive Cancer Center, San Francisco, California
| | - Mark H Wener
- Department of Laboratory Medicine, University of Washington, Seattle, Washington
| | | | | | | | - Robert Dreicer
- Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio
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8
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Hematopoietic stem cell donation. Int J Hematol 2013; 97:446-55. [DOI: 10.1007/s12185-013-1298-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Revised: 02/07/2013] [Accepted: 02/08/2013] [Indexed: 10/27/2022]
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9
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Flanigan RC, Polcari AJ, Shore ND, Price TH, Sims RB, Maher JC, Whitmore JB, Corman JM. An analysis of leukapheresis and central venous catheter use in the randomized, placebo controlled, phase 3 IMPACT trial of Sipuleucel-T for metastatic castrate resistant prostate cancer. J Urol 2012; 189:521-6. [PMID: 23253957 DOI: 10.1016/j.juro.2012.09.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/15/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Sipuleucel-T is an autologous cellular immunotherapy. We review the safety of the leukapheresis procedure required for sipuleucel-T preparation and complications related to venous catheter use in the randomized, placebo controlled phase 3 IMPACT (IMmunotherapy for ProstAte Cancer Trial) study (NCT 00065442). MATERIALS AND METHODS A total of 512 patients with asymptomatic or minimally symptomatic metastatic castrate resistant prostate cancer were enrolled in the study. All patients were scheduled to undergo 3 standard 1.5 to 2.0 blood volume leukapheresis procedures at 2-week intervals. Leukapheresis related adverse events and those related to venous catheter use were reviewed. Immune cell counts were examined throughout the treatment course. RESULTS Of 512 enrolled patients 506 underwent 1 or more leukapheresis procedures and were included in this analysis. Adverse events were comparable between the sipuleucel-T and control arms. Leukapheresis related adverse events were primarily associated with transient hypocalcemia (39.3%). Most leukapheresis related adverse events (97%) were of mild/moderate intensity. Median white blood cell count and absolute monocyte and lymphocyte counts were stable and within normal ranges throughout the treatment course. Of all patients 23.3% had a central venous catheter placed primarily for leukapheresis. Patients with vs without a central venous catheter had a higher risk of infection potentially related to catheter use (11.9% vs 1.3%, p <0.0001) and a trend toward a higher incidence of venous vascular events potentially related to catheter use, excluding the central nervous system (5.9% vs 2.1%, p = 0.06). CONCLUSIONS Adverse events related to leukapheresis are manageable and quickly reversible. The majority of patients can undergo leukapheresis without a central venous catheter. Central venous catheters are associated with an increased risk of infections and venous vascular events. Peripheral intravenous access should be used when feasible.
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Affiliation(s)
- Robert C Flanigan
- Loyola University Stritch School of Medicine, Maywood, Illinois, USA.
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Kantoff PW, Higano CS, Small EJ, Whitmore JB, Frohlich MW, Schellhammer PF. Re: interdisciplinary critique of sipuleucel-T as immunotherapy in castration-resistant prostate cancer. J Natl Cancer Inst 2012; 104:1107-9; author reply 1109-12. [PMID: 22825556 DOI: 10.1093/jnci/djs279] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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11
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Daskalakis M, Schulz-Huotari C, Burger M, Klink I, Umhau M. Evaluation of the performance of Trima Accel® v5.2 for the collection of concentrated high-dose platelet products and concurrent plasma from high platelet count donors, in Germany. J Clin Apher 2012; 27:75-80. [PMID: 22362609 DOI: 10.1002/jca.21205] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 12/20/2011] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES This study was undertaken to test the ability of Trima Accel® version 5.2 to simultaneously collect concentrated high-dose leukoreduced platelet products and double doses of plasma. MATERIALS AND METHODS Random volunteers (18-65 years of age) with preprocedure platelet counts above 270 × 10(3) /μl were recruited among the blood center's apheresis donors. All complied with the center's donor selection criteria. RESULTS One hundred fourteen (114) collections were performed. Depending on which definition of single platelet dose is used (2.0 × 10(11) as prevalent standard in most European countries, and 3.0 × 10(11) as prevalent standard in the United States and Canada) in 107/114 (single dose = 2.0 × 10(11) ) and 39/114 (single dose = 3.0 × 10(11) ) instances, a triple platelet product was obtained. In 87 cases (76%), a double plasmaproduct (>430 ml) was collected, and in seven cases (6%), a single plasma product (>220 ml) was collected. In 20 procedures, only platelets without concurrent plasma were collected (18%). Overall procedure time was 87 ± 13 min and average platelet yield per procedure was 8.5 ± 1.4 × 10(11) (final storage concentration, 1,279 ± 153 × 10(3) /μl). The median residual leukocyte content per transfusion dose was 0.13 × 10(6) (0.02-0.98 × 10(6) ) for a single dose of 2.0 × 10(11) and 0.14 × 10(6) (0.02-0.98 × 10(6) ) for a single dose of 3.0 × 10(11) . CONCLUSIONS Trima Accel® version 5.2 allows for collection of concentrated high yield platelet products. It offers high productivity and reliably achieves the configured yield targets. Leukoreduction performance complied with both US and EU legal requirements. Collection as hyperconcentrates furthermore allowed for concurrent collection of double dose plasma in the majority of the procedures.
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Affiliation(s)
- M Daskalakis
- Department of Transfusion Medicine, University Hospital of Freiburg, Freiburg, Germany
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12
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Blood Donor Medical Assessment and Blood Collection. Transfus Med 2011. [DOI: 10.1002/9781444398748.ch4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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13
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Confer DL, Shaw BE, Pamphilon DH. WMDA guidelines for subsequent donations following initial BM or PBSCs. Bone Marrow Transplant 2011; 46:1409-12. [DOI: 10.1038/bmt.2010.323] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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14
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Amrein K, Katschnig C, Sipurzynski S, Stojakovic T, Lanzer G, Stach E, Pieber TR, Dobnig H. Apheresis affects bone and mineral metabolism. Bone 2010; 46:789-95. [PMID: 19922822 DOI: 10.1016/j.bone.2009.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 10/09/2009] [Accepted: 11/10/2009] [Indexed: 11/26/2022]
Abstract
BACKGROUND Apheresis is a procedure to selectively obtain blood components. For the collection process citrate is routinely used. It inhibits coagulation by binding to ionized calcium and leads to metabolic alkalosis. OBJECTIVE Whether regular apheresis affects bone and mineral metabolism is unknown. The intention of this study was to investigate 1) the acute effects of apheresis on acid-base balance, bone and mineral metabolism and 2) to compare bone mineral density (BMD) at the lumbar spine and hip of donors to matched control subjects. DESIGN In this open, observational, single-center, cross-sectional study we enrolled 102 regular plasma and thrombocyte donors to pursue objective 1) and compared those to 102 matched controls (CTR) for objective 2). RESULTS Platelet donation led to significant decreases in serum ionized calcium (-17%) and phosphate (-18%), to marked increases in base excess (57%) and PTH levels (192%) during apheresis. Baseline biochemical comparisons between donors and CTR revealed significantly lower values for donors for serum calcium, albumin, and 25-hydroxyvitamin D levels. Mean Z-score at the lumbar spine adjusted for BMI, average physical activity and daily calcium intake was lower for donors (-0.28+/-0.11) when compared to CTR subjects (0.06+/-0.11, P<0.05). Total and neck femoral BMD was also lower in the donor group, however, this difference was not significant. CONCLUSIONS Exposure to citrate during the apheresis procedure acutely affects mineral and bone metabolism. Regular donations of blood components compromised BMD at the lumbar spine. If confirmed, strategies to prevent long-term effects on bone need to be formulated.
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Affiliation(s)
- Karin Amrein
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Austria.
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McCullough J, Kahn J, Adamson J, Anderlini P, Benjamin R, Confer D, Eapen M, Hirsch B, Kuter D, Lazarus E, Pamphilon D, Stroncek D, Sugarman J, Wilson R. Hematopoietic growth factors-use in normal blood and stem cell donors: clinical and ethical issues. Transfusion 2008; 48:2008-25. [DOI: 10.1111/j.1537-2995.2008.01788.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Richa E, Krueger P, Burgstaler EA, Bryant SC, Winters JL. The effect of double- and triple-apheresis platelet product donation on apheresis donor platelet and white blood cell counts. Transfusion 2008; 48:1325-32. [DOI: 10.1111/j.1537-2995.2008.01669.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
A decreasing blood donor pool in the presence of increasing blood transfusion demands has resulted in the need to maximally utilize each blood donor. This has led to a trend in the increasing use of automated blood collections. While apheresis donation shares many reactions and injuries with whole blood donation, because of the differences, unique complications also exist. Overall, evidence in the literature suggests that the frequency of reactions to apheresis donation is less than that seen in whole blood donation, though the risk of reactions requiring hospitalization is substantially greater. The most common apheresis-specific reaction is hypocalcemia due to citrate anticoagulation, which, while usually mild, has the potential for severely injuring the donor. Other reactions to apheresis donation are uncommon (e.g., hypotension) or rare (e.g., air embolism). More worrisome, and in need of additional study, are the long-term effects of apheresis donation. Recent evidence suggests that repeated apheresis platelet donations may adversely effect thrombopoiesis as well as bone mineralization. Granulocyte donation has also been implicated in unexpected long-term consequences.
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Affiliation(s)
- Jeffrey L Winters
- Department of Laboratory Medicine and Pathology and Division of Transfusion Medicine, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Wolf CE, Meyer M, Riggert J. Leukapheresis for the extraction of monocytes and various lymphocyte subpopulations from peripheral blood: product quality and prediction of the yield using different harvest procedures. Vox Sang 2005; 88:249-55. [PMID: 15877646 DOI: 10.1111/j.1423-0410.2005.00562.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Leukapheresis of non-mobilized healthy donors is performed to harvest monocytes and lymphocyte subpopulations for use in various therapeutic regimens. In this methodological study, we compared two different leukapheresis programs, using equivalent volumes of processed blood over similar processing periods, to determine the influence of the procedures on the donor peripheral blood count and to establish the procedure that yields the highest quality product. MATERIALS AND METHODS The target variables obtained in 41 healthy blood donors who underwent short-term leukapheresis (80-105 min) were retrospectively compared. Twenty-one volunteers were processed on a COBE Spectra machine at the MNC setting and 20 volunteers were processed at the AutoPBSC setting. Data were collected on pre- and postleukapheresis samples and on the product. RESULTS AutoPBSC and MNC procedures resulted in a decrease of haemoglobin (5-7%), platelets (17-20%), monocytes (22%) and lymphocytes (23-27%), but not of granulocytes in peripheral blood. Both procedures produced nearly identical leucocyte and lymphocyte yields. AutoPBSC products contained a greater number of granulocytes, monocytes and red cells, but fewer platelets. The preleukapheresis values correlated with the yields for monocytes, T-helper and T-suppressor cells, B-lymphocytes and natural killer cells, but not for granulocytes or platelets. CONCLUSIONS Leukapheresis is a safe and efficient procedure for collecting large numbers of peripheral blood monocytes and different lymphocyte populations from non-mobilized donors. The two programs yield comparable leucocyte harvests. Based on our results, yields can be predicted from the peripheral cell counts.
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Affiliation(s)
- C E Wolf
- Department of Transfusion Medicine, University of Goettingen, 37075 Goettingen, Germany.
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20
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De Gruttola S, Boomsma K, Poulikakos D, Ventikos Y. Computational Simulation of the Blood Separation Process. Artif Organs 2005; 29:665-74. [PMID: 16048484 DOI: 10.1111/j.1525-1594.2005.29105.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of this work is to construct a computational fluid dynamics model capable of simulating the quasitransient process of apheresis. To this end a Lagrangian-Eulerian model has been developed which tracks the blood particles within a delineated two-dimensional flow domain. Within the Eulerian method, the fluid flow conservation equations within the separator are solved. Taking the calculated values of the flow field and using a Lagrangian method, the displacement of the blood particles is calculated. Thus, the local blood density within the separator at a given time step is known. Subsequently, the flow field in the separator is recalculated. This process continues until a quasisteady behavior is reached. The simulations show good agreement with experimental results. They shows a complete separation of plasma and red blood cells, as well as nearly complete separation of red blood cells and platelets. The white blood cells build clusters in the low concentrate cell bed.
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Affiliation(s)
- Sandro De Gruttola
- Laboratory of Thermodynamics in Emerging Technologies, Department of Mechanical and Process Engineering, Swiss Federal Institute of Technology, Zurich, Switzerland
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21
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Strasser EF, Zimmermann R, Weisbach V, Ringwald J, Zingsem J, Eckstein R. Mononuclear cell variability and recruitment in non-cytokine-stimulated donors after serial 10-liter leukapheresis procedures. Transfusion 2005; 45:445-52. [PMID: 15752165 DOI: 10.1111/j.1537-2995.2005.04202.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND We introduced monitoring of mononuclear cell (MNC) counts to obtain enhanced donor control and a stable quality of MNC products, because there are limited data available about blood donors after serial leukapheresis (LP) procedures. STUDY DESIGN AND METHODS In a prospective paired study, 13 male healthy blood donors underwent 10-L LP procedures performed on two apheresis devices by use of two MNC program settings (COBE Spectra, Gambro BCT, SF 250 vs. SF 500; and AS.TEC 204, Fresenius Hemocare, CP 129 vs. CP 194). Donors' pre- and postdonation MNC counts were analyzed by fluorescence-activated cell sorting. RESULTS After each 10-L LP procedure, a transient decline (p < 0.05) of CD14+ monocyte and platelet counts appeared in donors. Loss of donors' CD3+ T cells, CD19+ B cells, and CD16+56+ natural killer (NK) cells during MNC collection was partly compensated by cell recruitment. The MNC recruitment factor (RF) seems to be higher with high-yield MNC program settings. Negative correlations (p < 0.01) were noticed between predonation counts and RFs of CD3+ T cells and CD16+56+ NK cells. Four serial 10-L LP procedures did not result in long lasting MNC depletion for donors. CONCLUSION MNC recruitment seems to depend on MNC program settings and collected cell yields. Low MNC counts could result in high cell recruitment that may contribute to stable collection results to some degree. Nevertheless, there seems to be a considerable individual variation of MNC recruitment in donors that should be investigated in more detail.
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Affiliation(s)
- Erwin F Strasser
- Department of Transfusion Medicine and Haemostaseology, University Hospital Erlangen, Erlangen, Germany.
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22
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Beyan C, Cetin T, Kaptan K, Nevruz O. Effect of plateletpheresis on complete blood count values using three different cell separator systems in healthy donors. Transfus Apher Sci 2003; 29:45-7. [PMID: 12877892 DOI: 10.1016/s1473-0502(03)00098-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The aim of this study is to investigate changes of CBC values after plateletpheresis in healthy and volunteer donors by using three different cell separator systems. The platelets were collected from 95 donors using the COBE Spectra, from 87 donors using the Fenwal CS-3000 Plus, and from 83 donors using the Fresenius AS-204. After plateletpheresis, white blood cells (WBC), hemoglobin (HGB), hematocrit (HCT), and platelets (PLT) were decreased significantly. When we used the COBE Spectra, the drop in the values of HGB and HCT was significantly less than for the other devices. It is recommended that hematological parameters should be monitored carefully in donors who are supposed to undergo long-term regular apheresis, and to prevent the occurrence of an artificial anemia, which is likely to happen. Selection of cell separator systems should be based on this possibility.
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Affiliation(s)
- Cengiz Beyan
- Department of Hematology, Gulhane Military Medical Academy, Etlik, 06018 Ankara, Turkey.
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23
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Waxman DA. Volunteer donor apheresis. THERAPEUTIC APHERESIS : OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR APHERESIS AND THE JAPANESE SOCIETY FOR APHERESIS 2002; 6:77-81. [PMID: 11886580 DOI: 10.1046/j.1526-0968.2002.00395.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Volunteer donor apheresis has evolved from early plasmapheresis procedures that collected single components into technically advanced multicomponent procedures that can produce combinations of red blood cells, platelets, and plasma units. Blood collection and utilization is increasing annually in the United States. The number of apheresis procedures is also increasing such that single donor platelet transfusions now exceed platelet concentrates from random donors. Donor qualifications for apheresis vary from those of whole blood. Depending on the procedure, the donor weight, donation interval, and platelet count must be taken into consideration. Adverse effects of apheresis are well known and fortunately occur in only a very small percentage of donors. The recruitment of volunteer donors is one of the most challenging aspects of a successful apheresis program. As multicomponent apheresis becomes more commonplace, it is important for collection centers to analyze the best methods to recruit and collect donors.
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Affiliation(s)
- Dan A Waxman
- Indiana Blood Center, Indianapolis, Indiana 46208, USA
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24
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Abstract
It is possible to reliably obtain sufficient PBSC from most normal donors to perform allogeneic transplantation. The mobilization regimen, usually administration of a single daily dose of G-CSF at 7.5 to 10 micrograms/kg subcutaneously for 4 to 6 days, is tolerable with acceptable side effects. However, there is wide variability among individuals with respect to the extent of mobilization achieved by the regimen and the optimal timing of apheresis. Studies suggest that the likelihood of obtaining an adequate harvest of CD34+ cells, as defined locally may be enhanced by employing higher doses or different schedules of G-CSF, monitoring the mobilization and/or collection of PBPC, and using apheresis procedures processing 2 or more times blood volume. However, an optimal regimen for mobilization and harvesting for all donors has not yet been identified and a small percentage of donors may not mobilize adequately with G-CSF. Alternative regimens employing combinations of G-CSF and GM-CSF are available that may prove useful in such cases and novel cytokines that are even more effective than G-CSF in mobilizing stem cells are eagerly awaited. Based on currently available experience with normal donors, the short-term safety of G-CSF appears to be acceptable, however there exist several scenarios in which marrow harvesting may be preferable to G-CSF mobilization and apheresis collection of PBPC.
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Affiliation(s)
- Ping Law
- Dendreon Corporation, 3005 First Avenue, Seattle, WA 98121, USA
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26
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Furuta M, Shimizu T, Mizuno S, Kamiya T, Ozawa K, Nakase T, Tadokoro K, Takenaka M, Ohkawa T, Yokoyama S, Ogawa Y, Kiyokawa H, Shimizu M, Sekine N, Yoshimura I. Clinical Evaluation of Repeat Apheresis Donors in Japan. Vox Sang 1999. [DOI: 10.1046/j.1423-0410.1999.7710017.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Riggert J, Humpe A, Simson G, Kohler M. Quality and Safety of Platelet Apheresis Concentrates Produced with a New Leukocyte Reduction System. Vox Sang 1998. [DOI: 10.1046/j.1423-0410.1998.7430182.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gutensohn K, Kuehnl P. The role of flow cytometry in improving biocompatibility in transfusion medicine. TRANSFUSION SCIENCE 1998; 19:17-25. [PMID: 10182178 DOI: 10.1016/s0955-3886(98)00005-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In transfusion medicine, blood and blood components, donors and patients are increasingly confronted with biomaterials. The need to understand the response of human blood to contact with these artificial surfaces has led to multiple studies on the biocompatibility of biomaterials. Up to this time, these investigations have predominantly been performed using physical, immunological and biochemical methods. Many of these approaches are useful in investigating the multiple factors involved in blood-biomaterial interactions. However, they always reflect the overall behaviour of whole cellular populations in local or systemic reactions. The application of multiparameter flow cytometry, on the other hand, provides insight into antigenic expression and changes at the single-cell level. Therefore, the technique of flow cytometry represents a new and powerful way of analysing and improving the biocompatibility of these materials in blood-contacting applications in this field.
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Affiliation(s)
- K Gutensohn
- Department of Transfusion Medicine/Transplantation Immunology, University Hospital Eppendorf, University of Hamburg, Germany.
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29
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Novotny J, Kadar J, Hertenstein B, Schröder D, Petersen D, Arseniev L, Stangel W, Ganser A. Sustained decrease of peripheral lymphocytes after allogeneic blood stem cell aphereses. Br J Haematol 1998; 100:695-7. [PMID: 9531336 DOI: 10.1046/j.1365-2141.1998.00629.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
48 healthy donors underwent peripheral blood stem cell (PBSC) apheresis for allogeneic transplantation beginning on day 4 of G-CSF (2 x 5 microg/kg) mobilization. In one to four (median two) large-volume mononuclear cell aphereses, a median of 55.9 x 10(9) of lymphocytes (range 21.0-109.2 x 10[9]) were collected, an amount comparable to lymphocyte numbers removed by therapeutic lymphaphereses in autoimmune diseases. Mean peripheral lymphocyte counts decreased from premobilization values of 2.31 x 10(9)/l to 1.31 x 10(9)/l at a median of 34 d (1 month) and 1.53 x 10(9)/l at a median of 327 d (11 months). The decrease in peripheral lymphocyte counts was significantly correlated with the number of lymphocytes removed and the number of aphereses. Neutrophil and platelet counts returned to normal values after 1 month whereas monocyte counts and haemoglobin concentrations were significantly decreased at 1 month but not at 11 months.
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Affiliation(s)
- J Novotny
- Department of Haematology and Oncology, Hannover Medical School, Germany
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30
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Malacrida A, Perseghin P. Indications for a cost-saving policy in routine flow cytometry. TRANSFUSION SCIENCE 1998; 19:45-51. [PMID: 10182183 DOI: 10.1016/s0955-3886(98)00009-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Flow cytometry has known a growing popularity in last decade as an intriguing research and diagnostic tool, favoured by the availability of newly developed monoclonal antibodies directed against cell surface antigens. Unfortunately, equipment and reagents costs are still prohibitive, and it does not allow a more widespread use of this technology. We realised that most producers suggest to add the same amount of reagents irrespective of the real number of target cells, and this is particularly true if the lysed whole blood technique is used. We investigated if an "individualized" concentration of reagents, based on the real number of MNC to be stained, could have allowed us to achieve qualitative satisfactory results with a concomitant reduction in costs. We studied four groups of individuals: 259 healthy subjects (239 blood donors and 20 volunteers) and 10 HIV+ patients. Our results suggest that lower amounts of reagents could be used, at least in some routinary cytometric analysis, simply following providers instructions (i.e. 1 microL of monoclonal antibody/1 x 10(5) MNC).
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Affiliation(s)
- A Malacrida
- Laboratorio analisi, Azienda Ospedaliera E. Morelli, Sondalo, SO, Italy
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31
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Lewis SL, Kutvirt SG, Bonner PN, Simon TL. Effect of long-term platelet donation on lymphocyte subsets and plasma protein concentrations. TRANSFUSION SCIENCE 1997; 18:205-13. [PMID: 10174686 DOI: 10.1016/s0955-3886(97)00011-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Previous studies of changes in immune function in platelet donors have investigated subjects who were undergoing plateletpheresis using older equipment that is no longer in general use. Therefore, the purpose of this study was to determine the effect of long-term platelet donation on lymphocyte numbers and subsets and plasma protein concentrations in platelet donors using newer cell separators. Three groups included in the study were nondonor controls (n = 27), long-term whole blood donors (n = 29), and long-term platelet donors (n = 20). Using a cross-sectional analysis, lymphocyte numbers and subsets were determined and compared among the three groups. Plasma concentrations of total protein, globulin, albumin, and IgG were also compared. Among the three groups there were no significant differences in total white blood cell counts, percentage or absolute number of lymphocytes, or percentage or absolute number of lymphocyte subsets. Serum total protein, globulin, albumin, and IgG concentrations of platelet donors were within normal ranges. These data support the current Food and Drug Administration (FDA) and American Association of Blood Banks' standards for the frequency of platelet donation allowed and monitoring required for plateletpheresis donors. Furthermore, these data indicate that the FDA could eliminate the requirement for the warning in informed consents about lymphocyte depletion in platelet donors.
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Affiliation(s)
- S L Lewis
- Department of Pathology, School of Medicine, University Of New Mexico, Albuquerque, NM 87131 USA.
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32
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Wright JF, Lazarus AH, Freedman J. Applications of flow cytometry in the analysis of blood leukocytes. TRANSFUSION SCIENCE 1995; 16:333-41. [PMID: 10159504 DOI: 10.1016/0955-3886(95)00044-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Flow cytometric analysis of blood leukocytes is currently used for both routine clinical measurements as well as for cutting edge research applications. This technology has enabled rapid and accurate determination of leukocyte antigens and quantitative analysis of leukocyte subsets, tests of leukocyte function, determination of the presence of antineutrophil and antilymphocyte antibodies in plasma and on cells, measurement of CD34+ hematpoietic stem cells in peripheral blood and bone marrow samples, measurement of apoptosis, and detection of virus-infected leukocytes. This review will focus on the use of the flow cytometer for investigations of blood leukocytes in transfusion medicine.
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Affiliation(s)
- J F Wright
- Department of Immunohematology, University of Toronto, Canada
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33
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Affiliation(s)
- J Freedman
- Department of Immunohaematology, St Michael's Hospital, University of Toronto, Ontario, Canada
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34
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Rogers RL, Johnson H, Ludwig G, Winegarden D, Randels MJ, Strauss RG. Efficacy and safety of plateletpheresis by donors with low-normal platelet counts. J Clin Apher 1995; 10:194-7. [PMID: 8770712 DOI: 10.1002/jca.2920100407] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Our practice is to defer donors with blood platelet (PLT) counts of < 180 x 10(9)/L because PLT yields are low, when compared to PLT units collected from donors with higher counts. In an attempt to minimize deferral, we determined whether 33 donors, who repeatedly demonstrated low-normal PLT counts (150-180 x 10(9)/L) on multiple occasions during the prestudy period. might safely donate satisfactory apheresis PLT units simply by extending the apheresis collection time by 20 min (men) and 40 min (women). Repeat plateletpheresis procedures were scheduled at > or = 28-day intervals. The mean PLT yield (N = 92) was 5.8 x 10(11) with 97% of units containing > or = 4.0 x 10(11) PLTs. Although donors entered the study only after they had repeatedly exhibited predonation PLT counts of < 180 x 10(9)/L, PLT counts were not always below this level at the time of study collections. However, analyzing only donations with true predonation PLT counts of < 180 x 10(9)/L (N = 35), the mean PLT yield was excellent-5.4 x 10(11) with 97% of units containing > or = 4.0 x 10(11) PLTs. The average fall in donor blood PLT counts (pre-vs. postdonation) was 36%, with only ten of 99 postdonation counts being < 100 x 10(9)/L; the lowest was 69 x 10(9)/L. Thus, extending the apheresis collection time permitted donors who in the past were routinely deferred because of low PLT counts to safely donate satisfactory PLT units.
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Affiliation(s)
- R L Rogers
- DeGowin Blood Center, University of Iowa Hospitals and Clinics, Iowa City, USA
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