A 3-year analysis of plateletpheresis donor deferral pattern in a tertiary health care institute: assessing the current donor selection criteria in Indian scenario

Plateletpheresis donor deferral patterns at a tertiary care hospital in North India: A need for rethink of haemoglobin cutoff

INTRODUCTION

The donor deferral criteria for blood or apheresis donations are established for two main reasons: (i) to ensure the safety of the blood donor (non-maleficence); (ii) to obtain safe blood of standard quality that has therapeutic benefit for the patient (beneficence). This study was planned to assess the various causes and patterns of plateletpheresis donor deferral in our hospital and to subsequently assess whether any evidence based changes can be done in the current plateletpheresis donor deferral criteria in India to maximize the platelet donor pool without compromising donor safety.

MATERIAL AND METHODS

The present study was conducted from May 2021 till June 2022 in the department of transfusion medicine of a tertiary care hospital in North India. The first part of the study was conducted from May 2021 till March 2022 to assess the various causes of donor deferral by analysing the plateletpheresis donor deferral data during the corresponding period. The second part of the study was conducted from April 2022 till June 2022, to assess: (i) average decrease in haemoglobin after plateletpheresis procedure; (ii) red blood cell loss during plateletpheresis procedure; (iii) to determine whether any correlation exists between donor haemoglobin and platelet yield.

RESULTS

During the study period, a total of 260 donors were screened for plateletpheresis, out of which 221 (85%) donors were accepted and 39 (15%) donors were deferred for various reasons. Out of the 39 deferred donors, 33 (84.6%) were temporary deferrals, while 6 (15.4%) were permanent deferrals. Low haemoglobin (Hb < 12.5 g/dl) was a cause of deferral in 12.8% (n = 5) of the deferred donors. 192 (73.9%) out of the 260 donors were replacement donors. The calculated mean decrease in haemoglobin as a result of plateletpheresis procedure was 0.4 g/dl. No correlation was seen between donor pre-donation haemoglobin and platelet yield (p = 0.86, r = 0.06, R² = 0.003). The calculated mean red cell loss as a result of plateletpheresis procedure was 28 ml.

CONCLUSION

Low haemoglobin (<12.5 g/dl) is a significant cause of temporary plateletpheresis donor deferral in India. In view of the advancement in plateletpheresis technology, which has resulted in minimal red cell loss with the current generation apheresis devices, haemoglobin cutoff of 12.5 g/dl needs to be reconsidered. Perhaps, after performing a multi-centric trial, a consenscus can be reached for revision of haemoglobin cutoff for plateletpheresis donations.

Prevalence and causes of pre-donation deferrals among potential plateletpheresis donors at a blood center in Eastern China

BACKGROUND

In China, the platelet donation interval is 14 days. The eligibility criterion of plateletpheresis donors (PD) is more stringent than that of whole blood donors, so the deferral causes are very complicated. However, the deferral prevalence and causes among PDs are not well known in China.

OBJECTIVE

To analyse the deferral prevalence and influencing factors during pre-donation among PDs in a blood centre in Eastern China.

METHODS

From December 26, 2020 to December 25, 2021, all data of potential PDs during pre-donation were extracted from the register system and collected using Microsoft Excel. The number of deferred visits and the corresponding causes were retrospectively analysed, and the re-donation rate of deferred donors was calculated.

RESULTS

A total of 19,762 visits were included in the study. Of these 17,847 (90.3%) donated platelets successfully and 1915 (9.7%) were deferred. The prevalence of deferrals was high among those less than 35 years old (p < 0.05) and first-time donors (p = 0). The leading cause for deferral was elevated alanine transaminase (51.4%) followed by abnormal haematological parameters (37.15%). High white blood cell count was the first deferral factor (26.9%) in abnormal haematological parameters. In more than 2 ineligible items, low haemoglobin and haematocrit simultaneously were dominant (58.3%). The re-donation rate of repeat donors (65.4%) was higher than that of first-time donors (19.3%) (p = 0).

CONCLUSION

The deferral prevalence in Chinese plateletpheresis donors was not high. First-time and young donors were more frequently deferred. The repeat donors should be of concern, especially with abnormal haematological parameters.

Plateletpheresis donor deferral pattern: A retrospective 4-year data analysis at tertiary care center in India

BACKGROUND

Increasing demand of single donor platelet requires blood banks to expand the donor pool. A reassessment of donor deferral criteria for plateletpheresis is required to ensure that this increasing demand is met without compromising on product quality and donor safety.

AIMS

(1) To list the various causes of SDP donor deferral. (2) To discuss various approaches to minimize it.

MATERIALS AND METHODS

Data of plateletpheresis donor deferral were collected from records retrospectively over a period of 4 years from January 2017 to December 2020.

STATISTICAL ANALYSIS

All statistical tests were performed using IBM SPSS software for Windows version 20. Categorical variables were presented as proportions, while continuous variables were presented as mean with standard deviation, mean calculated P < 0.05 was considered statistically significant.

RESULTS

Out of the 7478 donors screened for plateletpheresis procedure, 3232 (43.2%) were deferred among which 3089 (42.5%) were male and 142 (63.1%) were female donors. Majority (96.5%) of deferral were temporary. These included low platelet count (47.4%) followed by poor venous access (22.4%) and low hemoglobin (Hb) (7.2%). Among the donors deferred for low Hb, 24.7% (58 out of 234) had Hb between 12 and 12.4 g%. Similarly, among donor deferred for low platelet count, 12% (184 out of 1532) had platelet count between 140 and 149 × 103/μl.

CONCLUSION

There is potential for increasing the number of eligible plateletpheresis donors if the present donor selection criteria were relaxed to a minimum Hb of 12 g/dl and minimum platelet count of 140 × 103/μl.

Reference interval of platelet counts and other platelet indices in apparently healthy blood donors in North India according to Clinical and Laboratory Standards Institute guidelines: Need to redefine the platelet count cutoffs for repeat plateletpheresis donation?

BACKGROUND

In clinical practice, laboratory results are of great importance for the diagnosis and treatment. Reference intervals of different parameters aid health-care professionals in the interpretation of results. There are very few studies on reference intervals from India. This prospective study was conducted to determine the reference intervals for platelet count (PLT) and PLT indices; mean PLT volume (MPV), PLT distribution width (PDW), and PLT large cell ratio (P-LCR). These values can be obtained as a part of a routine complete blood count (CBC) and have diagnostic and prognostic significance in certain diseases. PLT count is an important criterion for the selection of donors for repeat plateletpheresis donation.

MATERIALS AND METHODS

Sixteen hundred and thirty-four first-time healthy volunteer plateletpheresis donors were enrolled for the study. CBC was done, values of PLT, MPV, PDW, and P-LCR were noted, and the results were analyzed. The 95% of the reference distribution was estimated using the 2.5th and 97.5th percentiles following Clinical and Laboratory Standards Institute guidelines. Adverse donor reactions, if any and quality parameters of single donor PLTs (SDP) were also studied.

RESULTS

Reference range values of PLT, MPV, PDW, and P-LCR were 137,825-355,175/μl, 8.1-13.9/fl, 9.1-22.5/fl, and 11.7%-52.9%, respectively, and compared well with other published studies from India. It was observed that reference values of PLT count obtained in the study were lower than reference values that are currently used in most laboratories (150,000-450,000/μl) in India.

CONCLUSION

Based on our results, we are of the opinion that the PLT count cutoffs for repeat plateletpheresis donation may need to be revised downwards for our country which would also mitigate the scarcity of apheresis donors.

Assessing the performance of a plateletpheresis unit at a tertiary-care academic medical center in Mexico: A 6-year experience

BACKGROUND

Optimization of platelet (PLT) apheresis collection is a priority to satisfy the increasing demand of hemato-oncology patients. We assessed the performance of a plateletpheresis unit supporting hematology patients.

STUDY DESIGN AND METHODS

This descriptive retrospective study included 561 plateletpheresis collections from 2013 to 2018. For data analysis, descriptive statistics and receiver operating characteristic (ROC) curve were used. A 5-item satisfaction questionnaire was analyzed.

RESULTS

Ninety percent of the donors were males. The median plateletpheresis time was 89 minutes; its success rate was 92.5%; median donor PLT count was 232 × 10⁹ /L, women median PLT count was 247 × 10⁹ /L vs 231x10⁹ /L in men (P = .017). Seventy-seven percent donors were candidates for a double product and 24.5% were processed; 20.8% of these donors had a weight ≤75 and 79.2% >75 kg, P = .003, and 6.6% were women and 93.4% men, P = .161. Thirty-six of donors had ≥250 × 10⁹ /L and 16.8% was processed as a triple product. ROC analysis showed that with donor PLT counts ≥200 × 10⁹ /L the sensitivity for obtaining double products was 0.981 and specificity 0.714, with an area under the curve (AUC) = 0.877. The adverse effect rate was 4.3%. Of the potential donors, 6.3% were rejected. The cost of processing single or double products was 430 USD. Comfort and time spent during plateletpheresis were areas for improvement.

CONCLUSION

Platelet count and donor weight predicted PLT yield and obtaining double products. Women had higher PLT counts, but no significant difference was found between donor gender and processed products. Assessment of the apheresis unit can help to improve its performance.

Plateletpheresis in the Era of Automation: Optimizing Donor Safety and Product Quality Using Modern Apheresis Instruments

The increases in major surgeries, transplantations and speciality clinics have significantly increased the utilization of platelet concentrates including single donor platelets (SDP). The advantages of SDP or apheresis platelet have been discussed elaborately by previous authors as compared to random donor platelets. Here we share our experiences of plateletpheresis procedures using the modern apheresis machines with regards to product quality and donor safety. This study included 3016 procedures of plateletpheresis (1397 on Amicus and 1619 on Trima accel cell separators) on eligible donors using recommended apheresis kits. A target yield of 3 × 1011 was set as the end point of each procedure. Donor details, procedure details and donor adverse reactions if any were documented. Statistical analysis was done using the SPSS statistical package (version 13, USA). Of the total 6276 donors screened 2049 (32.6%) were deferred due to various reasons. Out of remaining 4227 eligible donors; 3016 (71.4%) underwent plateletphereis procedures based on the requirement of SDP by the patients. Mean pre-procedure platelet count and hematocrit in donors were 188.3 × 106/mL and 41.7% respectively. Mean procedure time in Amicus (76.6 min) was significantly more than the Trima accel (64.3 min) (p = 0.02). Platelet yield by Trima accel and Amicus was 2.96 × 1011 and 3.08 × 1011 respectively (p = 0.061). A total of 40 donors (1.33%) suffered adverse effect during or after apheresis procedures. While the modern plateletpheresis devices are both donor and user friendly at the same time they provide quality product consistently in lesser time.

Effect of plateletpheresis on hematocrit, hemoglobin and erythrocyte count: Meta-analysis 1980-2018

The effects of platelet donation by apheresis on different parameters of the erythrogram are still unclear. The objective was to meta-analyze the effect of plateletpheresis on hematocrit, hemoglobin, and erythrocyte count, with a systematic review with random effects meta-analysis of the mean difference. The PRISMA guidelines were considered, as well as 133 search strategies on four different databases. Reproducibility was guaranteed and methodological quality was evaluated. Heterogeneity was evaluated with Galbraith and DerSimonian-Laird’s, publication bias with a funnel plot and a Begg’s test, sensitivity analysis and a cumulative meta-analysis were also conducted. Eighteen (18) articles were included, 17 evaluated the effects on hematocrit in 2,564 donors; 13 on hemoglobin in 1,640 donors; and 4 on red blood cell count in 243 donors. A decrease of 2.26% (CI95% = 2.11–2.41) was observed in hematocrit, of 0.80 g/dL (CI95% = 0.75–0.86) in hemoglobin and −0.21 × 10¹²/L (CI95% = −0.13; −0.29) in red blood cell count. Plateletpheresis has a negative effect on the erythrogram parameters, explained by blood loss in the kits used for the procedure and cell lysis. Such evidence is relevant to secure the efficiency and safety of the procedure, improve selection processes or determine the number of donations that can be performed without affecting donors’ health.

A Retrospective Analysis of Apheresis Donor Deferral and Adverse Reactions at a Tertiary Care Centre in India

INTRODUCTION

With increasing demand of platelet component each day, blood bank plays a pivotal role in ensuring supply of safe blood as and when required. Plateletpheresis procedure is a relatively simple, safe and important adjunct to blood bank inventory. However, recruitment of healthy blood donors is a challenge that the health industry is facing today.

AIM

To determine the reasons and rates of apheresis donor deferral along with investigation of adverse reactions encountered during the procedure.

MATERIALS AND METHODS

Records of single donor apheresis were retrospectively analysed from 1st January 2010 to 31st December 2014. The study was carried out at Blood Bank, Safdarjung Hospital, New Delhi, India. The donor details that were studied included - age, sex, type of donation (voluntary/replacement/ repeat), reason for donor deferral and type of adverse reaction, if encountered during the procedure.

RESULTS

Among the 478 donors screened for plateletpheresis procedure during a study period of 5 years, 134 (28.03%) were deferred. Temporary deferrals accounted for majority (93.28%) of the deferrals. Low platelet count (50.75%) was the main reason of donor deferral followed by low haemoglobin (20.89%). Amongst the 344 selected donors, 15 (4.36%) had some type of adverse reaction associated with the procedure.

CONCLUSION

We suggest that the selection criteria for plateletpheresis donors should be revised to deal with shortage of apheresis donors. The criteria regarding minimum pre-procedure platelet count (above1.5 lac/μl) and haemoglobin (above 12.5 g/dl) need to be lowered so as to suit the Indian scenario. The lower adverse reaction rates, 14/344 (4.06%) associated with this procedure encourages safety of donors and is important in recruitment of new donors.

Donor deferral characteristics for plateletpheresis at a tertiary care center in India- a retrospective analysis

BACKGROUND

The demand for plateletpheresis is increasing day by day due to its many merits over random donor platelets. However, in our country, there is a dearth of apheresis donors due to greater devotion and time required for the procedure and lack of awareness.

AIM

The aim of the present study is to analyse the reasons for deferral of apheresis donors at a tertiary care center.

MATERIALS AND METHODS

This retrospective analysis was conducted to study the causes, frequency and the type of plateletpheresis donor deferral at regional blood transfusion center, Lady Hardinge Medical College and associated Shrimati Sucheta Kriplani Hospital and Kalawati Saran Childrens' Hospital. The study was undertaken over a period of two years (from January 2010 to December 2011.

RESULTS

Out of a total of 343 donors screened, 87 donors were deferred, the overall deferral rate being 25.36%. The most frequent cause of deferral was a low platelet count accounting for 43.5% of all the causes followed by a low hemoglobin level (27.05%). Among the donors deferred for anaemia, 15 out of 23 (65.2%) had hemoglobin in the range of 11.5-12.4gm%, representing 17.2% of all deferrals.

CONCLUSION

Based on these findings and the scarcity of apheresis donors in our country, we are of the opinion that the selection criteria for plateletpheresis donors should be revised to accommodate more donors and reduce deferral rate without compromising on the health of the donors.

A systematic review of factors associated with the deferral of donors failing to meet low haemoglobin thresholds

BACKGROUND/OBJECTIVES

Blood donors attending a donation session may be deemed ineligible to donate blood due to a failure to meet low haemoglobin (Hb) thresholds. Several studies have identified factors associated with a donor falling below these Hb thresholds. A review of these factors will inform future prospective studies and form the basis for predictive models of deferral due to low Hb.

MATERIALS/METHODS

Studies were identified by searching MEDLINE, EMBASE, The Cochrane Library and the WHO International Clinical Trials Registry from 1980 to September 2012. Demographic data, donor history, haematological/biological factors and the primary outcome of deferral due to low Hb were extracted. Analyses were descriptive and quantitative; pooled odds ratios (ORs) were obtained by meta-analysis.

RESULTS

Fifty-five studies met the inclusion criteria. A consistently higher rate of low Hb deferral was reported in females compared with males; meta-analysis showed a significantly greater risk of deferral due to low Hb in females compared with males in studies with universal Hb thresholds for males and females (OR 14.91, 95% confidence interval (CI) 12.82-17.34) and in studies with sex-specific Hb thresholds (OR 8.19, 95% CI 4.88-13.74). Greater rates of deferral due to low Hb were also associated with increasing age, higher ambient temperature, low body weight, shorter inter-donation interval and in donors of Hispanic or African descent.

CONCLUSION

This work will help to define the criteria that should be considered in any large scale study of blood donor deferral, especially those that measure or aim to change failure to meet low Hb thresholds.

Feasibility of applying the 2day deferral for repeat plateletpheresis: Indian perspective

As the use of single donor apheresis platelets and plateletpheresis procedures done steadily increases in India, the plateletpheresis donors are at an increased risk of postpheresis anemia and thrombocytopenia. This study was planned in order to evaluate the effect of plateletpheresis on the hematological parameters in the local donor population and to evaluate the possibility of following the 2day deferral for repeat plateletpheresis. A total of 60 plateletpheresis procedures performed over a period of 1year with CS 3000 Plus Baxter Fenwal were evaluated. All the post-donation hematological parameters showed a significant decrease from the pre-donation values (p<0.001). Post-donation hemoglobin <12g, which is defined by WHO as anemia irrespective of the gender occurred in 25% (n=15) of the donors. The post-donation platelet count was less than 100×10(9)/L in 16.6% (n=10) of the procedure. The ability of these donors to serve as repeat plateletpheresis donor after 2days as recommended by AABB needs to be evaluated by further studies done post donation. Keeping in view the hematological profile of our donor population we recommend that donors who already have a low or borderline pre-donation platelet count and hemoglobin should be assessed and monitored post-donation for decrements in these parameters. While serving as repeat donors, their pre donation hemoglobin and platelet counts should be tested again.

A prospective quality evaluation of single donor platelets (SDP) - an experience of a tertiary healthcare center in India

Quality assurance of single donor platelets (SDP) is incomplete unless clinical response to platelet transfusion is measured. The primary objective of the study was to evaluate the quality of SDP derived from plateletpheresis procedures and to evaluate the response to platelet transfusion. Procedures were performed on 2287 accepted donors while 271 donors were deferred. Platelet count <1.5 lac/μl and hemoglobin <12.5 g/dl were the leading cause of deferral. The median platelet yield in a SDP bag was found to be 3.1×10(11). The median corrected count increment (CCI) and post-transfusion platelet recovery (PPR) were found to be 10110×m(2)/μl and 24.5%, respectively. In India, the criteria for the selection of plateletpheresis donors should be revisited. Based on quality parameters, the Fresenius COM.TEC cell separator is comparable to other cell separators.

Automated platelet collection using the latest apheresis devices in an Indian setting

In a developing nation like India where there is a scarcity of resources and voluntary donors, provision of safe and good quality blood and its components is a huge challenge. The demand for platelets is increasing constantly due to better management of various patient categories, specifically hemato-oncological cases, where there is an increased demand of platelet transfusion. The use of apheresis single donor platelets (SDPs) has been attributed to increased gap between demand and supply of whole blood derived random donor platelets (RDPs). Moreover, the other benefits of SDPs such as decreased donor exposure and simplification of inventory management cannot be overlooked. However, the increased costs and logistic problems, compounded by the lack of awareness, limit the donor recruitment and procedures for SDPs. In Indian scenario, there are no specific guidelines or standards available which can be followed, while simultaneously addressing the associated problems. In this review, we have tried to analyze the various problems of donor selection, donor safety and the quality issues regarding plateletpheresis. Based on this we have tried to give certain recommendations which might help the centers in resolving the problems related to plateletpheresis.