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Kaufman RM. T-cell lymphopenia in frequent volunteer platelet donors. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2023; 2023:305-310. [PMID: 38066852 PMCID: PMC10727108 DOI: 10.1182/hematology.2023000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
In the United States, more than 2 000 000 apheresis platelet units are collected annually from volunteer donors. Platelet donors in the United States and elsewhere are permitted to donate up to 24 times per year. Recently, frequent apheresis platelet donation has been associated with severe T-cell lymphopenia. Several frequent platelet donors have been found to have peripheral blood CD4+ T-cell counts below 200 cells/µL, the threshold for AIDS in HIV-positive individuals. Independent risk factors for plateletpheresis-associated lymphopenia include lifetime donations, age, and donations on the Trima Accel instrument (Terumo BCT), which uses a leukoreduction system (LRS) chamber to trap white blood cells. Less often, severe lymphopenia can occur in donors collected on the Fenwal Amicus instrument (Fresenius Kabi), which has no LRS. For Trima Accel donors, lymphopenia can be partially mitigated by performing a plasma rinseback step at the end of collection. To date, there is no definitive evidence that plateletpheresis-associated lymphopenia is harmful. In a study of frequent platelet donors with lymphopenia who were administered COVID-19 messenger RNA vaccines, immune responses were normal. The homeostatic mechanisms responsible for maintaining a normal peripheral blood T-cell count remain obscure, as do the causal mechanisms underlying plateletpheresis-associated lymphopenia.
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Kaufman RM, Marks DC, Flamand Y, Acker JP, Brown BL, Olafson C, Marschner S, Pandey S, Papari M, Petraszko T, Serrano K, Ward D, Bazin R. Risk factors for T-cell lymphopenia in frequent platelet donors: The BEST collaborative study. Transfusion 2023; 63:2072-2082. [PMID: 37818894 DOI: 10.1111/trf.17567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/28/2023] [Accepted: 08/28/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Severe T-cell lymphopenia of uncertain clinical significance has been observed in frequent apheresis platelet donors. Two commonly used plateletpheresis instruments are the Trima Accel, which uses a leukoreduction system (LRS) chamber to trap leukocytes and the Fenwal Amicus, which does not use an LRS chamber. STUDY DESIGN AND METHODS We performed an international, multicenter, observational study comparing T-cell populations in frequent platelet donors collected exclusively using the Trima instrument (n = 131) or the Amicus instrument (n = 77). Age- and sex-matched whole blood donors (n = 126) served as controls. RESULTS CD4+ T-cell counts <200 cells/μL were found in 9.9% of frequent Trima (LRS+) platelet donors, 4.4% of frequent Amicus (LRS-) platelet donors, and 0 whole blood donors (p < .0001). CD4+ T-cell counts <200 cells/μL were only seen in platelet donors with ≥200 lifetime donations. In multivariable analysis, age, lifetime donations, and instrument (Trima vs. Amicus) were independent risk factors for lymphopenia. In 40 Trima platelet donors, a plasma rinseback procedure was routinely performed following platelet collections. No Trima platelet donors receiving plasma rinseback had a CD4+ T-cell count <200 cells/μL versus 13/91 Trima platelet donors not receiving plasma rinseback (p = .01). DISCUSSION Recurrent bulk lymphocyte removal appears to contribute to the development of T-cell lymphopenia in frequent, long-term platelet donors. Lymphopenia is more common when an LRS chamber is used during platelet collection but can occur without an LRS chamber. Blood centers using LRS chambers can mitigate donor lymphopenia by performing plasma rinseback.
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Affiliation(s)
- Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Denese C Marks
- Research and Development, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
| | - Yael Flamand
- Department of Data Science, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jason P Acker
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Bethany L Brown
- American Red Cross, Biomedical Services, Medical and Scientific Office, Washington, DC, USA
| | - Carly Olafson
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | | | - Suchitra Pandey
- Department of Pathology, Stanford University School of Medicine and Stanford Blood Center, Palo Alto, California, USA
| | | | - Tanya Petraszko
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Katherine Serrano
- Medical Affairs and Innovation, Canadian Blood Services, Ottawa, Ontario, Canada
| | - Dawn Ward
- Wing-Kwai and Alice Lee-Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Renée Bazin
- Héma-Québec, Medical Affairs and Innovation, Quebec City, Quebec, Canada
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Sayers M. Duties to donors. Transfusion 2023; 63:2009-2012. [PMID: 37850936 DOI: 10.1111/trf.17578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/05/2023] [Indexed: 10/19/2023]
Abstract
See article on page 2072–2082, in this issue
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Affiliation(s)
- Merlyn Sayers
- Carter BloodCare, Bedford, Texas, USA
- Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Laumaea AE, Lewin A, Chatterjee D, Marchitto L, Ding S, Gendron‐Lepage G, Goyette G, Allard M, Simard C, Tremblay T, Perreault J, Duerr R, Finzi A, Bazin R. COVID-19 vaccine humoral response in frequent platelet donors with plateletpheresis-associated lymphopenia. Transfusion 2022; 62:1779-1790. [PMID: 35919021 PMCID: PMC9539235 DOI: 10.1111/trf.17037] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Plateletpheresis involves platelet separation and collection from whole blood while other blood cells are returned to the donor. Because platelets are replaced faster than red blood cells, as many as 24 donations can be done annually. However, some frequent apheresis platelet donors (>20 donations annually) display severe plateletpheresis-associated lymphopenia; in particular, CD4+ T but not B cell numbers are decreased. COVID-19 vaccination thereby provides a model to assess whether lymphopenic platelet donors present compromised humoral immune responses. STUDY DESIGN AND METHODS We assessed vaccine responses following 2 doses of COVID-19 vaccination in a cohort of 43 plateletpheresis donors with a range of pre-vaccination CD4+ T cell counts (76-1537 cells/μl). In addition to baseline T cell measurements, antibody binding assays to full-length Spike and the Receptor Binding Domain (RBD) were performed pre- and post-vaccination. Furthermore, pseudo-particle neutralization and antibody-dependent cellular cytotoxicity assays were conducted to measure antibody functionality. RESULTS Participants were stratified into two groups: <400 CD4/μl (n = 27) and ≥ 400 CD4/μl (n = 16). Following the first dose, 79% seroconverted within the <400 CD4/μl group compared to 87% in the ≥400 CD4/μl group; all donors were seropositive post-second dose with significant increases in antibody levels. Importantly differences in CD4+ T cell levels minimally impacted neutralization, Spike recognition, and IgG Fc-mediated effector functions. DISCUSSION Overall, our results indicate that lymphopenic plateletpheresis donors do not exhibit significant immune dysfunction; they have retained the T and B cell functionality necessary for potent antibody responses after vaccination.
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Affiliation(s)
- Annemarie Eare Laumaea
- Centre de Recherche du CHUMMontréalCanada
- Département de Microbiologie, Infectiologie et ImmunologieUniversité de MontréalMontréalQuébecCanada
- Héma‐QuébecAffaires Médicales et InnovationQuébecCanada
| | - Antoine Lewin
- Héma‐QuébecAffaires Médicales et InnovationMontréalQuébecCanada
| | | | - Lorie Marchitto
- Centre de Recherche du CHUMMontréalCanada
- Département de Microbiologie, Infectiologie et ImmunologieUniversité de MontréalMontréalQuébecCanada
| | | | | | | | | | - Carl Simard
- Héma‐QuébecAffaires Médicales et InnovationQuébecCanada
| | - Tony Tremblay
- Héma‐QuébecAffaires Médicales et InnovationQuébecCanada
| | | | - Ralf Duerr
- Department of MicrobiologyNew York University School of MedicineNew York CityNew YorkUSA
| | - Andrés Finzi
- Centre de Recherche du CHUMMontréalCanada
- Département de Microbiologie, Infectiologie et ImmunologieUniversité de MontréalMontréalQuébecCanada
| | - Renée Bazin
- Héma‐QuébecAffaires Médicales et InnovationQuébecCanada
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