Acute myocardial infarction secondary to platelet apheresis in a 57-year healthy donor

Lateral ST-elevation myocardial infarction after donation of COVID-19 convalescent plasma in a naïve donor

A 34-year-old man presented with central chest pain heralded by bilateral arm numbness, tingling and pain soon after donation of 1000 mL of COVID-19 convalescent plasma (CP). ECG showed ST-elevation in lateral leads and coronary angiogram showed large thrombus in diagonal branch of the left anterior descending artery. The patient underwent successful thrombus aspiration and percutaneous coronary intervention of diagonal branch. In this report, we describe a case of coronary thrombosis leading to ST-elevation myocardial infarction in a naïve plasma donor after donation of COVID-19 CP.

Does plateletpheresis induce a hypercoagulable state? A global assessment of donor's hemostatic system by ROTEM

Since there is still debate on the effects of plateletpheresis on coagulation system, we aimed to perform a global assessment of donor's hemostatic function undergoing plateletpheresis by rotation thromboelastometry (ROTEM) analysis and to clarify if plateletpheresis procedure induces a hypercoagulable state. Thirty male plateletpheresis donors were included in the study. Four blood samples were drawn at different time intervals: before the beginning of the apheresis procedure; immediately after the completion of the apheresis procedure; 24 h and 7 days after the apheresis procedure. "Hypercoagulability" was diagnosed readily by having an accelerated clot formation, as evidenced by shortening of CFT and an increase of the clot strength, as evidenced by increasing of MCF. In INTEM assay, CFT value after apheresis was significantly prolonged compared with baseline value while CFT value 7 days after apheresis was significantly shortened compared with values immediately and 24 h after apheresis (p < 0.001). However, CFT-INTEM still did not show any shortening in any of the measurements when compared to pre-apheresis value. MCF value after apheresis was significantly shortened compared with baseline value while MCF value 7 days after apheresis was significantly prolonged compared with values immediately and 24 h after apheresis (p < 0.001). However, MCF-INTEM still did not show any increase in any of the measurements when compared to pre-apheresis value. There was no significant difference in CT value between four measurements (p = 0.064). In EXTEM assay, CFT value after apheresis was significantly prolonged compared with baseline value while CFT value 7 days after apheresis was significantly shortened compared with values immediately and 24 h after apheresis (p < 0.001). However, CFT-EXTEM still did not show any shortening in any of the measurements when compared to pre-apheresis value. MCF values immediately and 24 h after apheresis were significantly shortened compared with baseline value while MCF value 7 days after apheresis was significantly prolonged compared with values immediately and 24 h after apheresis (p < 0.001). However, MCF-EXTEM still did not show any increase in any of the measurements when compared to pre-apheresis value. We found no differences in CT value between four measurements (p = 0.208). Since ROTEM tracings on both INTEM and EXTEM assays did not reveal any significant shortening of CFT and increasing of MCF in any of the measurements after apheresis procedure, we concluded that plateletpheresis does not induce a hypercoagulable state in healthy 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.

Regular plateletpheresis increased basal concentrations of soluble P-selectin in healthy donors: Possible involvement of endothelial cell activation?

BACKGROUND

We explored the effects of repeated plateletpheresis on the platelet P-selectin expression and soluble P-selectin (sP-selectin) concentrations in platelet donors.

METHODS

Totally 289 platelet donors and 97 first-time whole blood (WB) donors were enrolled from the blood donor registry at the Fujian provincial blood center, China. The accumulative numbers of plateletpheresis in the last 2 y for participants were recorded, and the basal concentrations of platelet count, sP-selectin and total platelet P-selectin (pP-selectin) were determined.

RESULTS

Platelet donors had significantly higher basal concentrations of sP-selectin compared to WB donors (24.12±7.33ng/mL vs. 20.74±5.44ng/mL, P<0.0001), with no difference in platelet count and pP-selectin concentrations. Increased numbers of platelet donation were correlated with a steady increase of sP-selectin (r=0.18, P=0.002). Multivariate regression analysis identified that the frequency of plateletpheresis is an independent factor for the rise of the sP-selectin concentration (t=2.64, P=0.009) while no association was found for pP-selectin and platelet count.

CONCLUSIONS

Repeated plateletpheresis could result in an increased basal concentration of sP-selectin in blood donors whereas not an alteration in the concentrations of total platelet P-selectin. It remains to be determined whether this might be a consequence of endothelial activation or platelet activation or some other phenomenon.

[Serious adverse effects of blood collection]

The notification of serious adverse events occurring resulting from the collection of blood or blood components is a statutory requirement. The value of this set of surveillance procedures is the use of data collected. This article focuses on the organization of the French notification system, and the management of the main side effects known and reported.