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Rahmani M, Fortin BM, Berliner N, Issa N, Neuberg D, Kaufman RM, Gansner JM. CD4+ T-cell lymphopenia in frequent platelet donors who have ceased platelet donation for at least 1 year. Transfusion 2019; 59:1644-1647. [PMID: 30747442 DOI: 10.1111/trf.15192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 01/02/2019] [Accepted: 01/02/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND We recently discovered that 30% of current frequent apheresis platelet donors in a study at our donor center had CD4+ counts below 200 cells/μL. How long CD4+ lymphopenia persists after ceasing plateletpheresis is unknown. Whether there are infectious or other complications in former frequent donors that could relate to CD4+ lymphopenia is also unknown. STUDY DESIGN AND METHODS We mailed a letter to former frequent apheresis platelet donors who had not donated platelets for at least 12 months. Frequent donation was defined as 20 to 24 plateletpheresis sessions in at least one 365-day period starting in 2011. Donors who expressed interest in the study were contacted to schedule a study visit. Participants in the study provided a blood sample and completed a health questionnaire that included questions about opportunistic infections and malignancies. RESULTS Of 50 potential study candidates who were mailed a letter, 15 participated in the study. There were 2 participants with CD4+ counts below 200 cells/μL, one of whom had prior counts that documented a small improvement with cessation of plateletpheresis. Three participants had counts between 200 and 300 cells/μL. No study participant had a history of an opportunistic infection or a malignancy associated with immune dysregulation. CONCLUSION We detected CD4+ lymphopenia in former frequent apheresis platelet donors who had ceased platelet donation for more than 1 year. There was no evidence that the CD4+ lymphopenia predisposes to opportunistic infections or to malignancies associated with immune dysregulation.
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Affiliation(s)
- Mahboubeh Rahmani
- Division of Hematopathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Brooke M Fortin
- Hematology Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nancy Berliner
- Hematology Division, Brigham and Women's Hospital, Boston, Massachusetts
| | - Nicolas Issa
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
| | - Donna Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| | - John M Gansner
- Hematology Division, Brigham and Women's Hospital, Boston, Massachusetts
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Gansner JM, Rahmani M, Jonsson AH, Fortin BM, Brimah I, Ellis M, Smeland-Wagman R, Li ZJ, Schenkel JM, Brenner MB, Yefidoff-Freedman R, Sloan SR, Berliner N, Issa NC, Baden LR, Longo DL, Wesemann DR, Neuberg D, Rao DA, Kaufman RM. Plateletpheresis-associated lymphopenia in frequent platelet donors. Blood 2019; 133:605-614. [PMID: 30429159 PMCID: PMC6367645 DOI: 10.1182/blood-2018-09-873125] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/08/2018] [Indexed: 01/22/2023] Open
Abstract
More than 1 million apheresis platelet collections are performed annually in the United States. After 2 healthy plateletpheresis donors were incidentally found to have low CD4+ T-lymphocyte counts, we investigated whether plateletpheresis causes lymphopenia. We conducted a cross-sectional single-center study of platelet donors undergoing plateletpheresis with the Trima Accel, which removes leukocytes continuously with its leukoreduction system chamber. We recruited 3 groups of platelet donors based on the total number of plateletpheresis sessions in the prior 365 days: 1 or 2, 3 to 19, or 20 to 24. CD4+ T-lymphocyte counts were <200 cells per microliter in 0/20, 2/20, and 6/20 donors, respectively (P = .019), and CD8+ T-lymphocyte counts were low in 0/20, 4/20, and 11/20 donors, respectively (P < .001). The leukoreduction system chamber's lymphocyte-extraction efficiency was ∼15% to 20% for all groups. Immunophenotyping showed decreases in naive CD4+ T-lymphocyte and T helper 17 (Th17) cell percentages, increases in CD4+ and CD8+ effector memory, Th1, and regulatory T cell percentages, and stable naive CD8+ and Th2 percentages across groups. T-cell receptor repertoire analyses showed similar clonal diversity in all groups. Donor screening questionnaires supported the good health of the donors, who tested negative at each donation for multiple pathogens, including HIV. Frequent plateletpheresis utilizing a leukoreduction system chamber is associated with CD4+ and CD8+ T-cell lymphopenia in healthy platelet donors. The mechanism may be repeated extraction of these cells during plateletpheresis. The cytopenias do not appear to be harmful.
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Affiliation(s)
- John M Gansner
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Mahboubeh Rahmani
- Division of Hematopathology, Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - A Helena Jonsson
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | | | | | | | | | - Zhihan J Li
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Jason M Schenkel
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Michael B Brenner
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Revital Yefidoff-Freedman
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Steven R Sloan
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, MA
| | - Nancy Berliner
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Nicolas C Issa
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and
| | - Lindsey R Baden
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA; and
| | - Dan L Longo
- Division of Hematology, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Duane R Wesemann
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Donna Neuberg
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Deepak A Rao
- Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Richard M Kaufman
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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