Preparation of blood products for transfusion: Is there a best method?

Blood Donors with Thalassemic Trait, Glucose-6-Phosphate Dehydrogenase Deficiency Trait, and Sickle Cell Trait and Their Blood Products: Current Status and Future Perspective

The use of blood products for different medical purposes has increased in recent years. To meet increasing demand, some blood centers allow volunteer donors with thalassemic trait, glucose-6-phosphate dehydrogenase deficiency (G6PD) trait, and sickle cell trait (SCT) to donate blood if their hemoglobin values fall within acceptable ranges and show no signs of hemolysis. Currently, there are no standard guidelines or policies regarding the use or management of blood products obtained from these donors. However, in recent years, there has been advanced research on eligible donors who have these underlying conditions. In this review, we summarize the current knowledge from in vitro and in vivo studies regarding donor characteristics, changes in physical and biochemical parameters in blood products during processing and storage, and posttransfusion efficacy of blood products. In addition, we discuss some unresolved issues concerning blood products from thalassemic trait, G6PD-deficiency trait, and SCT donors.

Buffy coat platelets coming to America: Are we ready?

BACKGROUND

Buffy coat (BC) platelets (PLTs) have been used globally for many years. In 2004 Canadian Blood Services (CBS) made the decision to transition from PLT-rich plasma (PRP) to BC PLTs. We reviewed the benefits and manufacture process of BC and the implementation challenges involved.

STUDY DESIGN AND METHODS

A literature review was performed in the following areas: BC efficacy, donor population shifts, production and good stewardship of PLTs, logistic considerations with overnight holds, advantages of the overnight hold, the CBS experience, licensure and standards, and changes needed to produce BC PLTs in the United States. The aim was to analyze current practice and identify possible actions for blood centers and hospitals.

RESULTS

Implementation of BC would offer an additional source of PLTs to address the growing elderly population and the declining apheresis donor base. Substantial logistic, operational, and financial benefits were seen when CBS transitioned to BC with overnight hold.

CONCLUSIONS

Buffy coat blood products are widely used throughout the world. Recent conversion from PRP to BC by CBS showed that conversion can be accomplished with planning, communication, and partnership from all stakeholders. In conclusion, BC PLTs are worth serious consideration in the United States, but regulatory barriers in the United States will need to be addressed.

Exploring donor and product factors and their impact on red cell post-transfusion outcomes

The impact of donor characteristics, red cell age, and red cell processing methods on recipient outcomes is an emerging area of research. Knowledge generated from exploring this transfusion continuum has the potential to change the way donors are selected and how donations are processed and stored with important clinical and operational impact. Recently, donor characteristics including age, gender, donation frequency, genetics, and ethnicity have been shown to affect product quality and possibly recipient outcomes. The structural, biochemical and immunological changes that occur with red cell storage appear to not cause harm to blood recipients after 14 randomized clinical trials. However, both in vitro and clinical data are now beginning to question the safety of blood stored for a shorter duration. Whole blood filtration, a method of blood processing, has been linked to inferior recipient outcomes when compared to red cell filtration. Collectively, this emerging body of literature suggests that pre-transfusion parameters impact product quality and recipient outcomes and that no 2 units of red cells are quite the same. This review will summarize both the pre-clinical and clinical studies evaluating these associations.

Cost of Purchased Versus Produced Plasma from Donor Recruitment Through Transfusion

BACKGROUND

Plasma is used to treat acquired coagulopathy or thrombotic thrombocytopenic purpura, or to reverse warfarin effect. Scant data are available, however, about its costs.

OBJECTIVE

To estimate total costs of plasma from production through administration, from the perspective of a US hospital blood donor center (BDC).

STUDY DESIGN AND METHODS

Six sequential decision analytic models were constructed and informed by primary and secondary data on time, tasks, personnel, and supplies for donation, processing, and administration. Expected values of the models were summed to yield the BDC's total cost of producing, preparing, and transfusing plasma. Costs ($US 2015) are reported for a typical patient using three units of plasma. Models assume plasma was obtained from whole blood donation and transfused in an inpatient setting. Univariate sensitivity analyses were performed to test the impact of changing inputs for personnel costs and adverse event (AE) rates and costs.

RESULTS

BDC production cost of plasma was $91.24/patient ($30.41/unit), a $30.16/patient savings versus purchased plasma. Administration and monitoring costs totaled $194.64/patient. Sensitivity analyses indicated that modifying BDC personnel costs during donation and processing has little impact on total plasma costs. However, the probability and cost of transfusion-associated circulatory overload (TACO) have a significant impact on costs.

CONCLUSION

Plasma produced by our BDC may be less costly than purchased plasma. Though plasma processes have multiple tasks involving staff time, these are not the largest cost driver. Major plasma-related AEs are uncommon, but are the biggest driver of total plasma costs.

Comparative studies on drug binding to the purified and pharmaceutical-grade human serum albumins: Bridging between basic research and clinical applications of albumin

Human serum albumin (HSA), the most abundant protein in blood plasma, is a monomeric multidomain protein that possesses an extraordinary capacity for binding, so that serves as a circulating depot for endogenous and exogenous compounds. During the heat sterilization process, the structure of pharmaceutical-grade HSA may change and some of its activities may be lost. In this study, to provide deeper insight on this issue, we investigated drug-binding and some physicochemical properties of purified albumin (PA) and pharmaceutical-grade albumin (PGA) using two known drugs (indomethacin and ibuprofen). PGA displayed significantly lower drug binding capacity compared to PA. Analysis of the quenching and thermodynamic parameters indicated that intermolecular interactions between the drugs and the proteins are different from each other. Surface hydrophobicity as well as the stability of PGA decreased compared to PA, also surface hydrophobicity of PA and PGA increased upon drugs binding. Also, kinetic analysis of pseudo-esterase activities indicated that Km and Vmax parameters for PGA enzymatic activity are more and less than those of PA, respectively. This in vitro study demonstrates that the specific drug binding of PGA is significantly reduced. Such studies can act as connecting bridge between basic research discoveries and clinical applications.

Use of a cytokine-release assay to demonstrate loss of platelet secretory capacity during blood bank processing and storage

CONTEXT

The extent to which changes in secretory function contribute to the storage lesion of platelets (PLTs) prepared for transfusion is not well described.

OBJECTIVE

To develop a cytokine-release assay for the assessment of PLT secretory capacity during the preparation and storage of PLTs.

DESIGN

Small volumes of PLT-rich plasma and PLT concentrate (PC) were prepared from whole blood (WB; N = 4 donors). Aliquots of WB, PLT-rich plasma, and PC were treated with 20 μM adenosine diphosphate or saline (control). Samples of WB-derived PCs obtained from a regional blood center were similarly stimulated at various storage times (N = 10 units). Plasma levels of RANTES (chemokine ligand 5; regulated on activation, normal T cell expressed and secreted) and PLT aggregation were measured following agonist addition.

RESULTS

Adenosine diphosphate stimulated RANTES release from PLTs in fresh WB on average by 4.1-fold (P < .001), in PLT-rich plasma by 4.7-fold (P = .002), and in PC by 1.3-fold (P < .001). For blood center PCs, adenosine diphosphate failed to stimulate RANTES release at day 2 of storage or later (P ≥ .31). Baseline RANTES levels in the plasma/supernatant increased 660% during PC preparation (P = .02) and an additional 30% during subsequent storage (P < .001). Mean PLT aggregation decreased during processing from WB (95.6%) to PC (60.5%; P = .04). For blood center PCs, mean PLT aggregation decreased substantially from days 2 (41.0%) to 7 (2.3%; P < .001).

CONCLUSIONS

A cytokine-release assay revealed a diminution in PLT secretory capacity during PC processing and storage, with complete elimination by day 2 of storage. Loss of PLT aggregability occurred more slowly. The cytokine-release assay may be a useful endpoint for optimizing PLT preparation and storage.

Transfusion reactions: a comparative observational study of blood components produced before and after implementation of semiautomated production from whole blood

BACKGROUND

A semiautomated method of component production from whole blood was implemented at Canadian Blood Services. To assess safety of the new components, the frequency of adverse transfusion events (ATEs) to platelet components (PCs) and red blood cell (RBCs) produced before and after implementation of the new method was surveyed and compared.

STUDY DESIGN AND METHODS

This retrospective, observational, noninferiority study was conducted in 12 sentinel hospitals across Canada. The control group received RBCs in additive solution-3 (AS-3) and platelet-rich plasma (PRP)-produced platelets (PLTs) for 3 to 11 months before implementation of semiautomated production, and the study group received RBCs in saline-adenine-glucose-mannitol (SAGM) and buffy coat (BC)-produced PLTs for 3 to 11 months after implementation. ATE definitions at each hospital and standard practice for reporting did not change between control and study periods. Data for analysis were obtained from databases and original report forms.

RESULTS

The pooled risk ratio of a reaction to SAGM versus AS-3 RBCs was 0.77 (95% confidence interval [CI], 0.66-0.90), suggesting that SAGM products had significantly lower reaction rates than AS-3 products (p < 0.01). Reported allergic reactions to RBCs decreased from 0.07% (AS-3) to 0.04% (SAGM). For PLTs, the difference in reaction rates between BC and PRP was not significant (p = 0.37), and the pooled risk ratio of BC versus PRP was 1.14 (95% CI, 0.86-1.50).

CONCLUSION

The change in manufacturing method was associated with lower reaction rates to SAGM RBCs than to AS-3 RBCs. Pooled BC PLTs were noninferior to random-donor PRP PLTs with respect to ATEs.