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Hoad VC, Castrén J, Norda R, Pink J. A donor safety evidence literature review of the short- and long-term effects of plasmapheresis. Vox Sang 2024; 119:94-101. [PMID: 37641582 DOI: 10.1111/vox.13512] [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: 05/04/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
Many blood establishments are expanding plasmapheresis collection capacity to achieve increasing plasma for fractionation volume targets, driven by immunoglobulin product demand. Some adverse events occur in both apheresis and whole blood collection, such as venepuncture-related trauma and vasovagal reactions. Others are specifically related to the apheresis procedure, such as citrate reactions, haemolysis, infiltration and air embolism. Whilst plasmapheresis procedures are generally well tolerated, theoretical longer term donor health considerations, such as the effects on donor plasma protein levels, bone mineral density, iron deficiency and malignancy also require consideration. An evidence-based framework that supports a safe and sustainable increase in the collection of plasma is essential. Our review demonstrates a lack of high-quality evidence on risks and outcomes specifically in plasmapheresis. Whilst conservative procedural controls and donor harm minimization policies will mitigate risk, high-quality evidence is needed to facilitate practice change that is safe and sustainable and maximizes the potential of individual donor differences.
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Affiliation(s)
- Veronica C Hoad
- Donor and Product Safety (DAPS) Policy Unit, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | | | - Rut Norda
- Clinical Immunology and Transfusion Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Joanne Pink
- Donor and Product Safety (DAPS) Policy Unit, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
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He R, Lin H, Xie S, Lv Q, Kong Y, Li L, Xu H, Wang J, Li W, Fang P, Wu Y, Liu Z. Donor tolerability of convalescent plasma donation. J Clin Apher 2021; 36:429-436. [PMID: 33587767 PMCID: PMC8013347 DOI: 10.1002/jca.21882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/18/2021] [Accepted: 01/22/2021] [Indexed: 11/06/2022]
Abstract
Background Since early 2020, convalescent plasma has been widely used for treating coronavirus disease 2019 (COVID‐19). There is limited information regarding donor tolerability of convalescent plasma donation. In this study, we evaluated the short‐term donor tolerability of convalescent plasma donation. Methods A prospective study of 309 convalescent plasma donation related adverse events were conducted at Wuhan Blood Center of China, from February 12 to April 1, 2020. Additionally, up to 28‐day post‐donation follow‐ups were performed on the donors. Results Sixteen (5.2%) adverse events were reported in 309 donations. All of these were mild vasovagal without loss of consciousness. The frequency of adverse reactions was higher in donors with a per donation volume of >8 mL/kg body weight or ≥ 600 mL, <100 mm Hg in pre‐donation systolic blood pressure, or less than 28 days from the onset of COVID‐19 symptoms. There was no correlation to donation history, weight, sex, ABO blood type, pre‐donation diastolic blood pressure, pulse, or hemoglobin. Conclusion The donation of convalescent plasma is generally safe. Mitigation of risk factors associated with adverse events can further enhance donor tolerability of convalescent plasma donation.
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Affiliation(s)
- Rui He
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan Province, P.R. China.,Key laboratory of transfusion adverse reactions, CAMS, Chengdu, Sichuan Province, P.R. China
| | - Hui Lin
- Blood Collection Center, Wuhan Blood Center, Wuhan, Hubei Province, P.R. China
| | - Songli Xie
- Blood Collection Center, Wuhan Blood Center, Wuhan, Hubei Province, P.R. China
| | - Qilu Lv
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan Province, P.R. China.,Key laboratory of transfusion adverse reactions, CAMS, Chengdu, Sichuan Province, P.R. China
| | - Yujie Kong
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan Province, P.R. China.,Key laboratory of transfusion adverse reactions, CAMS, Chengdu, Sichuan Province, P.R. China
| | - Ling Li
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan Province, P.R. China.,Key laboratory of transfusion adverse reactions, CAMS, Chengdu, Sichuan Province, P.R. China
| | - Haixia Xu
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan Province, P.R. China.,Key laboratory of transfusion adverse reactions, CAMS, Chengdu, Sichuan Province, P.R. China
| | - Jue Wang
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan Province, P.R. China.,Key laboratory of transfusion adverse reactions, CAMS, Chengdu, Sichuan Province, P.R. China
| | - Wenjuan Li
- School of Public Health, Anhui Medical University, Hefei, China
| | - Peng Fang
- School of Public Health, Anhui Medical University, Hefei, China
| | - Yanyun Wu
- Clinical Transfusion Center, University of Miami, Miami, Florida, USA
| | - Zhong Liu
- Clinical Transfusion Research Center, Institute of Blood Transfusion, Chinese Academy of Medical Sciences and Peking Union Medical College, Chengdu, Sichuan Province, P.R. China.,Key laboratory of transfusion adverse reactions, CAMS, Chengdu, Sichuan Province, P.R. China
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Abstract
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.
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Masser B, Smith G, Williams LA. Donor research in australia: challenges and promise. ACTA ACUST UNITED AC 2014; 41:296-301. [PMID: 25254025 DOI: 10.1159/000365016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2013] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Abstract
Donors are the key to the core business of Blood Collection Agencies (BCAs). However, historically, they have not been a focus of research undertaken by these organizations. This model is now changing, with significant donor research groups established in a number of countries, including Australia. Donor research in the Australian Red Cross Blood Service (Blood Service) is concentrated in the Donor and Community Research (DCR) team. Cognizant of the complex and ever-changing landscape with regard to optimal donor management, the DCR team collaborates with academics located at universities around Australia to coordinate a broad program of research that addresses both short- and-long term challenges to the blood supply. This type of collaboration is not, however, without challenges. Two major collaborative programs of the Blood Service's research, focusing on i) the recruitment and retention of plasmapheresis donors and ii) the role of the emotion pride in donor motivation and return, are showcased to elucidate how the challenges of conducting collaborative BCA research can be met. In so doing, these and the other research programs described herein demonstrate how the Blood Service supports and contributes to research that not only revises operational procedures but also contributes to advances in basic science.
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Affiliation(s)
- Barbara Masser
- School of Psychology, University of Queensland, St Lucia, QLD, Australia
| | - Geoff Smith
- The School of Advertising, Marketing and Public Relations, Queensland University of Technology, Brisbane, QLD (paper completed while affiliated with Australian Red Cross Blood Service, Melbourne, VIC), Australia
| | - Lisa A Williams
- School of Psychology, The University of New South Wales, Sydney, NSW, Australia
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Diekamp U, Gneißl J, Rabe A, Kießig ST. Donor Hemovigilance during Preparatory Plasmapheresis. Transfus Med Hemother 2014; 41:123-33. [PMID: 24847188 PMCID: PMC4025159 DOI: 10.1159/000357991] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/08/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Reports on unexpected donor events (UEs) during preparatory plasmapheresis (PPP) are scarce, and rarely consider 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 the PMS. Medical directors reviewed entries quarterly. EBPS compiled data on donors, donations and UEs from January 1, 2008 to June 30, 2011. RESULTS 66,822 UEs were observed during 1,107,846 PPPs for a corrected incidence of 6.55% (1.4% local, 0.55% systemic, 4.6% technical UEs). 3.36% of PPPs were accompanied by 1 UE and 1.18% by >1 UE (2-5). 13.7% of donors undergoing PPP for the first time, 9.7% of those having a second PPP and 4.0% of those having a third or more PPPs were associated with UEs. Most common UEs were repeated venipuncture, and broken-off collection due to venous access problems and small hematomas. Severe systemic UEs occurred at a rate of 36 per 100,000 PPPs. CONCLUSIONS Technical UEs were common with PPP. UEs accompanied first and second donations significantly more frequently than for subsequent donations.
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Bueno JL, Castro E, García F, Barea L, González R. Hematomas in multicomponent apheresis: searching for related factors. Transfusion 2006; 46:2184-91. [PMID: 17176333 DOI: 10.1111/j.1537-2995.2006.01050.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The objective of this study was to identify donation variables that could be related to the development of hematoma during multicomponent apheresis collections (MACs). STUDY DESIGN AND METHODS This is an observational retrospective study where 1375 donors donated 5177 MACs during a 2-year period with two different machines (Amicus Crescendo [AC], Baxter Healthcare Corp.; and Trima Accel [TA], Gambro BCT). Variable data were recorded prospectively. In the multiple logistic regression analysis, generalized estimating equations were used with an exchangeable correlation matrix to take into account the nonindependence of several measurements from the same donor. RESULTS During the study period, 170 procedures failed due to hematoma (3.3%). Several variables were related to hematoma development in the adjusted model: operator experience (less than 500 procedures supervised vs. more; odds ratio [OR], 1.66; 95% confidence interval [CI], 1.19-2.31), previous apheresis donations (first time vs. more than 16 donations; OR, 2.87; 95% CI, 1.52-5.45), vein canalized (basilic vs. intermediate antebrachial or cephalic; OR, 1.42; 95% CI, 1.04-1.94), diastolic blood pressure (units divided by 10 mmHg; OR, 0.79; 95% CI, 0.66-0.94), and type of machine used (TA high return limit configuration [RLC] setting configuration vs. AC; OR, 1.94; 95% CI, 1.27-2.96; TA low RLC setting configuration vs. AC; OR, 1.24; 95% CI, 0.83-1.84). CONCLUSIONS Our study suggests that hematoma in MAC is not a random event. Appropriate machine configuration in the TA could reduce the hematoma rate to a level comparable with that of the AC. Operator training and donor blood pressure are also interesting variables for study because these could be modified to reduce the hematoma rate.
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Affiliation(s)
- José Luis Bueno
- The Spanish Red Cross Blood Transfusion Center and the Unit of Clinical Epidemiology, Hospital Puerta de Hierro, Madrid, Spain.
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Klein HG, McCurdy PR, Braine HG, MacPherson JL, Dowling RN. Panel IX: Complications related to equipment and technique. J Clin Apher 1983; 1:190-5. [PMID: 6546057 DOI: 10.1002/jca.2920010311] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Automated cytapheresis, when performed by experienced operators using modern equipment, is remarkably free of adverse effects. A declining pattern of equipment failure and related problems has been recorded in the 220,000 procedures performed by the American Red Cross in the past 5 years. Other cytapheresis centers report similar findings. Current CBCS are safe and reliable, and defects in plastic disposables, while irritating, result in little danger to the donor. Operator vigilance and careful attention to the details of the procedure can eliminate the majority of serious potential complications that have been encountered to date.
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