Donor Hemovigilance during Preparatory Plasmapheresis

Safety of Plasmapheresis in Donors with Low IgG Levels: Results of a Prospective, Controlled Multicentre Study

Background and Objectives

Although plasmapheresis is generally considered safe, there are still concerns about the long-term effects of plasma donation on immunoglobulin G (IgG) levels. The aim of the present study was to investigate if there is a need to permanently defer donors who donated three times with an IgG level below 6.0 g/L.

Study Design and Methods

From September 2007 to December 2017, adverse events (AEs) including infections were analysed from data of a prospective, controlled multicentre study of healthy volunteer donors, participating in an individualized plasmapheresis programme stratified by initial IgG level and body weight (individualized arm) or in standard plasmapheresis according to national guidelines (control arm). IgG was monitored at every fifth donation, and donors with IgG levels below the threshold were identified and followed up for possible AEs.

Results

In total, 97,540 donations in 1,462 donors in the control arm and 1,491,223 donations in 14,281 donors in the individualized arm were included. Donation-based incidences of at least severe AEs and any infections were 0.019% and 0.192% in the control arm, and 0.014% and 0.153% in the individualized arm. Three or more IgG-measurements below the threshold occurred in 38.2% of control arm donors and 20.9% of individualized arm donors. There were no increased incidence rates of at least severe AEs or any infections in donors with ≥3 IgG-measurements below the threshold in either donor's arm.

Conclusions

Our data show no signs of compromised donor safety in donors with ≥3 IgG-measurements below the threshold, indicating that plasmapheresis is feasible and safe in these donors.

Donor Safety in Haemapheresis: Development of an Internet-Based Registry for Comprehensive Assessment of Adverse Events from Healthy Donors

BACKGROUND

Currently, there is an extensive but highly inconsistent body of literature regarding donor adverse events (AEs) in haemapheresis. As the reports diverge with respect to types and grading of AEs, apheresis procedures and machines, the range of haemapheresis-related AEs varies widely from about 0.03% to 6.6%.

METHODS

The German Society for Transfusion Medicine and Immunohaematology (DGTI) formed a 'Haemapheresis Vigilance Working Party' (Arbeitsgemeinschaft Hämapheresevigilanz; AGHV) to create an on-line registry for comprehensive and comparable AE assessment with all available apheresis devices in all types of preparative haemapheresis: plasmapheresis (PLS), plateletpheresis (PLT), red blood cell apheresis, all kind of leukaphereses (autologous/allogeneic blood stem cell apheresis, granulocyte apheresis, lymphocyte/monocyte apheresis) and all possible types of multi-component apheresis. To ensure the comparability of the data, the AGHV adopted the 'Standard for Surveillance of Complications Related to Blood Donation' from the International Society for Blood Transfusion in cooperation with the International Haemovigilance Network (IHN) and the American Association of Blood Banks for AE acquisition and automated evaluation. The registry is embedded in a prospective observational multi-centre study with a study period of 7 years.

RESULTS

A preliminary evaluation encompassed the time period from January, 2012 to December, 2015. During this time, the system proved to be safe and stable. Out of approximately 345,000 haemaphereses 16,477 AEs were reported (4.9%) from 20 participating centres. The majority of AEs occurred in PLSs (63%), followed by PLT (34.5%) and SC (2.2%). Blood access injuries (BAI) accounted for about 55% of the supplied AEs, whereas citrate toxicity symptoms, vasovagal reactions and technical events (e.g. disposable leakages, software failures) rather equally affected haemaphereses at 8-15%. Out of 12,348 finalized AEs, 8,759 (70.1%) were associated with a procedure-related break-off, with BAI being the prevailing cause (5,463/8,759; 62.4%). An automated centre- and procedure-specific AE evaluation according to the latest IHN standard and AGHV pre-settings is available within a few minutes.

CONCLUSIONS

An on-line electronic platform for comprehensive assessment and centre-specific automated evaluation of AEs in haemaphereses has been developed and proved to be stable and safe over a period of 4 years.

Report on 50 cases of severe acute hypotension at donor plasmaphereses: treatment and course

INTRODUCTION

This paper reports our experience in 50 cases with severe hypotensive reactions at plasma donations (synonymous with donor plasmaphereses).

METHODS

Plasma donors who developed a severe acute hypotensive reaction at donor plasmapheresis, and were treated by placing the donor in the Trendelenburg position and rapid infusion of 1,000 mL saline were investigated. Plasmaphereses were performed with the Haemonetics® plasma collecting system 2 (PCS2). The results were analyzed using Excel.

RESULTS

We observed 50 severe hypotensive reactions in plasma donors. The average systolic and diastolic blood pressures (SBP, DBP) were 128/75 mmHg - and heart rates were 78 beats/min (B/M) before plasmaphereses, 83/56 mmHg - 60 B/M at the event, and after treatment 119/71 mmHg - 69 B/M at the time of discharge. The volume of collected plasma was 602 ± 240 mL including anticoagulant (AC). The time until the event was 45 ± 20 minutes. With treatment 49 ± 18 minutes after the event all plasma donors had normal blood pressures and heart rates and could safely leave the center.

CONCLUSIONS

Treatment by placing the donor in the Trendelenburg position and rapid infusion of 1,000 mL saline appears to be an effective procedure for resolving severe acute hypotension associated with donor plasmaphereses.

Donor Hemovigilance with Blood Donation

BACKGROUND

Reports on unexpected events (UEs) during blood donation (BD) inadequately consider the role of technical UEs.

METHODS

Defined local and systemic UEs were graded by severity; technical UEs were not graded. On January 1, 2008, E.B.P.S.-Logistics (EBPS) installed the UE module for plasma management software (PMS). Donor room physicians entered UEs daily into PMS. Medical directors reviewed entries quarterly. EBPS compiled data on donors, donations, and UEs from January 1, 2008 to June 30, 2011.

RESULTS

6,605 UEs were observed during 166,650 BDs from 57,622 donors for a corrected incidence of 4.30% (0.66% local, 1.59% systemic, 2.04% technical UEs). 2.96% of BDs were accompanied by one UE and 0.45% by >1 UE (2-4). 6.3% of donors donating blood for their first time, 3.5% of those giving blood for their second time, and 1.9% of donors giving their third or more BD experienced UEs. Most common UEs were: discontinued collections due to venous access problems, repeated venipuncture, and small hematomas. Severe circulatory UEs occurred at a rate of 16 per 100,000 BDs.

CONCLUSIONS

Technical UEs were common during BD. UEs accompanied first and second donations significantly more often than subsequent donations.

Distribution of citrate and citrate infusion rate during donor plasmaphereses

BACKGROUND

The purpose of this study was to describe the distribution of trisodium-citrate 4% (TSC) anticoagulant (AC) between the product and the donors undergoing plasma donation.

SUBJECTS AND METHODS

Data of 32 regular donors of plasma initially collected for a study published in 2010 were re-analyzed to determine the amount of citrate received by the donor and the citrate infusion rate (CIR) in mg/kg/min to the donor. Donor plasmaphereses (DP) were performed with the automated Haemonetics plasma collecting system 2 (PCS2). Plasma volume was programmed at 760 ml including AC. CIR was calculated from citrate received by the donors divided by the body weight over time.

RESULTS

130 ± 12 ml TSC was used for 760 ml plasma. An average of 110 ml TSC or 84.6% of citrate load was in collected plasma and not given to the donor. From the difference of 20 ml or 514 mg citrate an average CIR of 0.16 mg/kg/min was calculated.

CONCLUSION

The total amount of citrate received by the donor is minimal and the average CIR is below the critical level of 1 mg/kg/min.

Donor vigilance data of a blood transfusion service: A multicenter analysis

BACKGROUND

Donor vigilance is an important part of the quality management system of blood transfusion services. The evaluation of donor side effects helps to improve the donation process and donor compliance. The aim of the present study was to evaluate donor vigilance data in whole blood and plasmapheresis donors of a blood donor service.

MATERIALS AND METHODS

Donors fulfilling current national and European eligibility criteria underwent whole blood and plasmapheresis donation (PCS and MCS+ (Haemonetics, Braintree, USA), A 200 (Fenwal, Round Lake, USA). Whole blood was collected at fixed and mobile sites while plasmaphereses were performed at 8 plasma centers. From 2011 to 2013 donor information was provided for gender, age, body weight, height, first and repeat donation. Donors were monitored for venipuncture and circulatory associated side effects.

RESULTS

The total incidences of adverse events were 5004 (0.56%) in repeat donors and 2111 (2.78%) in first time donors for whole blood donation and 3323 (1.01%) and 514 (7.96%) for plasmaphereses, respectively. Circulatory associated events were 2679 (0.30%) for whole blood donation and 1624 (0.49%) for plasmaphereses.

CONCLUSION

Our donor vigilance data of a blood transfusion service show that whole blood and plasmapheresis are safe with low incidences of adverse events. Repeat donation and age are predictors for low rates of adverse events. On the other hand, first time donation and female gender were associated with higher incidences of adverse events.