Quality monitoring of platelet concentrates: the need for standardization/harmonization of cellular content and assessment of platelet functional reserve

A new platelet storage lesion index based on paired samples, without and with EDTA and cell counting: Comparison of three types of leukoreduced preparations

Platelets derived from whole blood and diverse apheresis procedures come in contact with various artificial surfaces and undergo contact activation, sheer stress-induced shape changes, aggregation and microvesiculation during collection, processing and storage. These dynamic changes are qualitatively reflected in the log-normal platelet size distribution patterns seen, when using modern automated cell counters and can be measured quantitatively by counting the paired samples, without and with added EDTA, and calculating the differences (d) in platelet cellular indices (dPLT/dMPV/dPDW). Reporting the differences instead of the absolute values of cellular indices makes the measurements independent of basic principles used for cell counting (i.e. aperture-impedance or flow-optic). The measurements can be performed either in blood centres, hospital blood banks or nearby patient clinics equipped with a validated cell counter. At least three useful quality indices could be derived simultaneously from this procedure (accurate estimation of platelet yields using the value of the EDTA-containing sample); quantitative assessment of the % of reversible platelet aggregates, an age/pH/temperature-dependent degree of microvesiculation/apoptosis/PS exposure, based on the response to EDTA. This new set of indices correlate significantly with other conventional tests for platelet quality; hence, provide additional supportive evidence for confirming the low pH values and the subjective poor swirling data occasionally seen with stored PC. In the following study, the Sysmex SE 9000 was successfully employed for estimation of platelet cellular indices comparing the platelet storage lesion index of three types of leukoreduced platelet concentrates in current practice. The relationship between this in vitro response to clinical outcome remains to be established.

Universal leucodepletion: an overview of some unresolved issues and the highlights of lessons learned

Universal leucodepletion (ULD) has been introduced in several countries based on the evidence that selective leucodepletion improves the clinical safety of blood components and based on animal studies that TSE infectivity is 5-7 times higher in the buffy coat than in plasma. Therefore it is perceivable that the removal of the buffy coat, by filtration, removing both leucocytes and platelets, may prove beneficial in reducing the potential risk of transmission of variant CJD by blood components. The implementation of a ULD policy has created some new requirements: Validation/standardisation of various leucodepletion processes to ensure compliance with set specifications. Standardisation/harmonisation of sampling and low leucocyte counting technologies to ensure the interchangeability of results nationally. The establishment of external quality assessment schemes on 'real' leucodepleted products where the cells come in contact with the filter matrix, to monitor the low leucocyte counting performance, nationally. Assessment of filtration-induced generation/retention of major biological response modifiers (BRM), having potential for the development of transfusion reactions. Using these approaches we have identified that, while the overall leucodepletion performance has improved following harmonisation/standardisation of the operational and counting technologies, there are still some unresolved problems and ULD alone may not provide complete protection from some viral transmission such as HTLV and CMV infections or reduction of bacterial sepsis and generation of some BRM. Moreover, ULD has not fully abrogated febrile non-haemolytic transfusion reactions (FNHTR). Therefore the key issue is not the 3-4 log(10) reduction of residual leucocytes but the design of new generation filters or leucodepletion processes with better performance characteristics, to further reduce some specific leucocyte subsets and their fragments as well as reduce the activation of coagulation/complement/kinin and inflammatory systems. Efforts should also be made to reduce the rapid development of apoptotic/necrotic cells and the residual risk associated with plasma, which often contains a vast array of BRM, responsible for residual transfusion reactions. These could only be effectively achieved by working in cooperation with the suppliers of blood component technologies. This overview briefly highlights some of the unresolved issues related to ULD, based on the experience in the UK. Technical details can be found in the reading list provided at the end.

The role of in process qualification in quality improvement of the haemonetics MCS plus leucodepleted platelet concentrate

With the implementation of universal leucodepletion in UK all leucodepletion processes have gone through a standard process qualification and quality improvement. The Haemonetics MCS system is a well established automated platelet collection system for the production of double dose leucoreduced platelet concentrate (WBC approximately 70x10(6)/dose). Recently an automated post collection filtration harness system has been introduced (MCS plus LDP) in which platelets are filtered, using an in-line PALL polyester filter (LRFH6 PALL) to reduce the WBC level to below 5x10(6) WBC/dose. This system passed our Phase I evaluation process based on 20-40 runs. However, some changes in the final volume of the products were needed to conform to national guidelines. Large scale trials using the new volume adjusted protocol revealed occasional failure in the leucocyte content. Therefore, 100% testing had to be implemented on all products. A national evaluation was carried out to determine whether changing the filter to a more efficacious one, the LRFXL (PALL) or slowing the filtration flow rate can influence the overall outcome. To reduce donor variability, known donor population were used with identical apheresis conditions. A more consistent and systematic drop in leucocyte content was observed by reducing the flow rate whereas a similar failure (i.e. 1-3%) rate was found both in controls and LRFXL when using the standard head pressure, which is recommended by the manufacturer. A similar failure rate was found using three different low leucocyte counting technologies (Nageotte, flow cytometry and Imagn 2000). It is recommended that a process qualification/validation program should be implemented when even a small modification in the collection system is introduced.