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Thompson TZ, Krull AA, Strasburg DJ, Adamski J, Jacob EK, DiGuardo MA. Collection and processing of hematopoietic progenitor cell products at risk of presenting with cold agglutination. Cytotherapy 2023:S1465-3249(23)00065-8. [PMID: 37045729 DOI: 10.1016/j.jcyt.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/16/2023] [Accepted: 03/07/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND AIMS Cold agglutinins are commonly identified in transfusion laboratories and are defined by their ability to agglutinate erythrocytes at 3-4°C, with most demonstrating a titer >64. Similarly, cryoglobulins can precipitate from plasma when temperatures drop below central body temperature, resulting in erythrocyte agglutination. Thankfully, disease associated from these autoantibodies is rare, but unfortunately, such temperature ranges are routinely encountered outside of the body's circulation, as in an extracorporeal circuit during hematopoietic progenitor cell (HPC) collection or human cell therapy laboratory processing. When agglutination occurs ex vivo, complications with the collection and product may be encountered, resulting in adverse events or product loss. Here, we endeavor to share our experience in preventing and responding to known cases at risk of or spontaneous HPC agglutination in our human cell therapy laboratory. CASE REPORTS Four cases of HPC products at risk for, or spontaneously, agglutinating were seen at our institution from 2018 to 2020. Planned modifications occurred, including ambient room temperature increases, tandem draw and return blood warmers, warm product transport and extended post-thaw warming occurred. In addition, unplanned modifications were undertaken, including warm HPC product processing and plasma replacement of the product when spontaneous agglutination of the product was identified. All recipients successfully engrafted after infusion. CONCLUSIONS While uncommon, cold agglutination of HPC products can disrupt standard processes of collection and processing. Protocol modifications can circumvent adverse events for the donor and minimize product loss. Such process modifications should be considered in individuals with known risks for agglutination going to HPC donation/collection.
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Affiliation(s)
- Thomas Z Thompson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Ashley A Krull
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Dustin J Strasburg
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Jill Adamski
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Eapen K Jacob
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA
| | - Margaret A DiGuardo
- Department of Laboratory Medicine and Pathology, Mayo Clinic Minnesota, Rochester, Minnesota, USA.
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2
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Alston E, Xu X, Nikiforow S, Stowell S, Lu W. Unusual non-platelet predominant clumping in a hematopoietic progenitor cell apheresis collection bag. Transfusion 2022; 62:931-932. [PMID: 35297058 DOI: 10.1111/trf.16853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/31/2022] [Accepted: 02/06/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Erin Alston
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Xiang Xu
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Sarah Nikiforow
- Department of Medical Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Sean Stowell
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Wen Lu
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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3
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Nelson R, Mathews R, Palesi C, Carter J, Szymanski J, Uehlinger J, Weinberg R, Paroder M. Mysterious clumping in a cell therapy product. Transfusion 2021; 61:2232-2233. [PMID: 34273121 DOI: 10.1111/trf.16569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/27/2021] [Accepted: 05/21/2021] [Indexed: 12/26/2022]
Affiliation(s)
- Randin Nelson
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Carlo Palesi
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jamal Carter
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - James Szymanski
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | - Joan Uehlinger
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Monika Paroder
- Department of Pathology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA
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Gokhale A, Quraishy N, Veemara V, Howdyshell H, Murray L, Royer J, Salmi L, Ricci K, Liu H. Clotting during autologous hematopoietic progenitor cells collection. J Clin Apher 2017; 32:560-561. [PMID: 28485035 DOI: 10.1002/jca.21539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/28/2017] [Accepted: 03/15/2017] [Indexed: 11/07/2022]
Abstract
Autologous hematopoietic progenitor cell (HPC) transplant through peripheral blood mobilization and leukapheresis is a standard treatment for many patients with hematopoietic malignancies. Although leukapheresis is usually completed with no complications, we present a case in which the hematopoietic progenitor cells clotted during collection. The patient had no history of hypercoagulopathy. It was identified that the anticoagulant infusion line was partially constricted by a blood warmer clamp. The machine did not alarm. Most of the multiple Food and Drug Administration reports of clotting occurring during apheresis procedures were due to the patients' preexisting hypercoagulopathy or insufficient anticoagulant solution being used. The machine alarmed in most of these cases. Our case demonstrates that inadequate anticoagulation can occur during an HPC collection procedure without activation of an alarm.
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Affiliation(s)
- Amit Gokhale
- Section of Transfusion Medicine, Cleveland Clinic, Cleveland, Ohio.,Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut
| | | | - Viva Veemara
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Heather Howdyshell
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Lynn Murray
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Jennifer Royer
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Linda Salmi
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Kristin Ricci
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
| | - Hien Liu
- Department of Hematology and Oncology, Cleveland Clinic, Cleveland, Ohio
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Reich-Slotky R, Patel N, Dael S, Semidei-Pomales M, Stephens H, Reich M, Schwartz J. Postthaw clotting of peripheral blood stem cell products due to insufficient anticoagulant. J Clin Apher 2009; 24:265-8. [PMID: 19908303 DOI: 10.1002/jca.20220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The amount of acid citrate dextrose formula A (ACD-A), which is a commonly used anticoagulant in leukopheresis, has to ensure both the safety of the donor and guarantee the integrity of the peripheral blood stem cell (PBSC) product until its transplant. Two recent consecutive cases of postthaw PBSC product clotting initiated a look-back investigation of the ACD-A percentage in leukopheresis products collected in our facility. The data indicated a significant difference between the average amount of ACD-A in prefreezing products collected during 2006 (11.4%) and in products collected during 2007 and 2008 (8.8% and 8.7%, respectively). These findings and the fact that the two clotted products had less than 7% ACD-A indicated that insufficient amount of anticoagulant might contribute to their clotting. This investigation prompted us to modify our collection and thawing procedures to prevent similar events in the future.
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Affiliation(s)
- Ronit Reich-Slotky
- Division of Transfusion Medicine, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York, USA.
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Reich-Slotky R, Patel N, Schwartz J. Transfusion medicine illustrated. Solving an unusual clotting event during thawing of peripheral blood hematopoietic progenitor cell product. Transfusion 2009; 49:622-3. [PMID: 19335377 DOI: 10.1111/j.1537-2995.2008.02094.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Ronit Reich-Slotky
- Pathology, Transfusion Medicine, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY 10032, USA.
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Park YA, Tuttle R, Kammler E, Kurtz S, Brecher ME. Transfusion medicine illustrated. Clumping in an apheresis-collected peripheral blood progenitor cell product. Transfusion 2008; 48:1777. [PMID: 18811897 DOI: 10.1111/j.1537-2995.2008.01808.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yara A Park
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
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Urosević I, Balint B, Popović S. Peripheral blood hematopoietic stem cells: Biology, apheresis collection and cryopreservation. ACTA ACUST UNITED AC 2007; 60:42-7. [PMID: 17853710 DOI: 10.2298/mpns0702042u] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Introduction Hematopoiesis is a continuous, dynamic and highly complex process resulting in production of various mature blood cells from a small population of pluripotent stem and progenitor cells through diverse proliferative and differentiative events. Numerous studies have demonstrated that a complex network of interactive cytokines regulates the survival, maturation, and proliferation of hematopoietic stem and progenitor cells (HSPCs). Application of cell-mediated therapy Massive application of different cell-mediated therapeutic methods has resulted in an increased need for both specific HSPCs and operating procedures providing minimal cell damage during collection, processing and storage in a liquid or frozen state. Therefore, the basic aim of cell harvesting, selection, as well as cryopreservation is to minimize cell damage during these procedures. HSPCs are cells which exhibit extensive self-renewal and proliferative capacity, associated with the capacity to differentiate into all blood cells and other cell lineages (plasticity of HSPC). Thanks to these properties, stem cells can provide complete and permanent restoration of hematopoiesis, which is the basis for clinical employment of HSPC transplantation. In addition, totipotent stem cells can be used for the so called "cell-therapy" in different clinical settings (e.g. myocardial regeneration after acute infarction). Conclusion Despite the fact that HSPC transplantation is already in routine use, some questions related to the optimal blood progenitor/cell collection, selection, storage and clinical use are still unresolved. Therefore, this review only briefly discusses the therapeutic use of HSPCs in different clinical areas and focuses on the recommendations, as well as the specific transfusion policies related to HSPC collection, processing, and cryopreservation with an emphasis on quality control.
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Affiliation(s)
- Ivana Urosević
- Klinicki centar Novi Sad, Novi Sad, Institut za interne bolesti
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Robert D, Barelli S, Crettaz D, Bart PA, Schifferli JA, Betticher D, Tissot JD. Clinical proteomics: study of a cryogel. Proteomics 2006; 6:3958-60. [PMID: 16718732 DOI: 10.1002/pmic.200600228] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cryoproteins are proteins precipitating at low temperature. Usually, the precipitate contains immunoglobulins (Igs), and are therefore called cryoglobulins. Very rarely, Igs do not precipitate, but, upon cooling, form a gel. Here, we report a case of cryogel observed in a patient presenting with Waldenström's disease. Using proteomic tools, a monoclonal IgM was identified as being the cause of the gel formation. Furthermore, addition of H(2)O before incubation at 4 degrees C demonstrated that the monoclonal IgM was precipitable as a type I cryoglobulin (hypocryoglobulin).
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Affiliation(s)
- Daniel Robert
- Service Régional Vaudois de Transfusion Sanguine, rue du Bugnon 27, 1005 Lausanne, Switzerland
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Thadikkaran L, Siegenthaler MA, Crettaz D, Queloz PA, Schneider P, Tissot JD. Recent advances in blood-related proteomics. Proteomics 2005; 5:3019-34. [PMID: 16041673 DOI: 10.1002/pmic.200402053] [Citation(s) in RCA: 142] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Blood is divided in two compartments, namely, plasma and cells. The latter contain red blood cells, leukocytes, and platelets. From a descriptive medical discipline, hematology has evolved towards a pioneering discipline where molecular biology has permitted the development of prognostic and diagnostic indicators for disease. The recent advance in MS and protein separation now allows similar progress in the analysis of proteins. Proteomics offers great promise for the study of proteins in plasma/serum, indeed a number of proteomics databases for plasma/serum have been established. This is a very complex body fluid containing lipids, carbohydrates, amino acids, vitamins, nucleic acids, hormones, and proteins. About 1500 different proteins have recently been identified, and a number of potential new markers of diseases have been characterized. Here, examples of the enormous promise of plasma/serum proteomic analysis for diagnostic/prognostic markers and information on disease mechanism are given. Within the blood are also a large number of different blood cell types that potentially hold similar information. Proteomics of red blood cells, until now, has not improved our knowledge of these cells, in contrast to the major progresses achieved while studying platelets and leukocytes. In the future, proteomics will change several aspects of hematology.
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Affiliation(s)
- Lynne Thadikkaran
- Service régional vaudois de transfusion sanguine, Rue du Bugnon 27, CH-1005 Lausanne, Switzerland
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Siegenthaler MA, Schneider P, Vu DH, Tissot JD. Haemovigilance in a general university hospital: need for a more comprehensive classification and a codification of transfusion-related events. Vox Sang 2005; 88:22-30. [PMID: 15663719 DOI: 10.1111/j.1423-0410.2005.00559.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND OBJECTIVES The purpose of this study was to analyse the transfusion-related events recorded in a general university hospital. MATERIALS AND METHODS The method we used was retrospective analysis of the data collected between 1999 and 2003. RESULTS The incidence of transfusion reactions (n = 394) was 4.19 per 1000 blood products distributed: 59% (n = 231) were febrile non-haemolytic transfusion reactions; 22% (n = 88) were caused by allergy; 5% (n = 21) were caused by bacterial infection; and 14% (n = 54) were classified as other reactions. Platelet concentrates gave rise to a significantly greater number of reactions than erythrocyte concentrates and fresh-frozen plasma. Transfusion errors and near-miss events were also observed and were analysed separately. A series of transfusion-related events, such as haemosiderosis, metabolic disturbances or volume overload, were not reported. CONCLUSIONS Our experience prompts us to propose a more comprehensive classification and codification of transfusion-related events.
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Affiliation(s)
- M A Siegenthaler
- Service Régional Vaudois de Transfusion Sanguine, Lausanne, Switzerland.
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