Effects of plateletpheresis on blood coagulation parameters in healthy donors at National Blood Centre, Kuala Lumpur, Malaysia

The effect of thrombocytapheresis on hemogram and biochemistry parameters in patients with essential thrombocytemia

BACKGROUND

Essential thrombocythemia is one of the chronic myeloproliferative neoplasms characterized by clonal proliferation of myeloid cells with variable morphological maturation and hematopoietic activity.It is characterized by excessive clonal platelet production with a tendency to thrombosis and bleeding. Thrombocytapheresıs is the removal of platelets by apheresis techniques. Thrombocytapheresıs is generally recommended in patients with essential thrombocythemia with acute, severe thrombotic or hemorrhagic events.

METHODS

The study included 39 patients who were diagnosed with essential thrombocythemia, started cytoreductive and aspirin therapy, and underwent thrombocytapheresıs due to the development of acute severe thrombotic or hemorrhagic events, diagnosed in the adult hematology clinic of İnönü University Turgut Ozal Medical Center. Hemogram and biochemistry values of the patients were scanned retrospectively.

RESULTS

After thrombocytapheresıs, a statistically significant difference was found between the first and last measurements of hemoglobin, mean platelet volume, White blood cell, neutrophil, platelet, platelet distribution width, creatine, lactate dehydrogenase, fibronogen and calcium levels of the patients.

CONCLUSION

The use of thrombocytapheresıs in patients with essential thrombocytosis causes a rapid decrease in platelet values as well as an effect on hemogram and biochemistry parameters. Other hemogram and biochemistry parameters such as platelet value should be monitored in patients.

Therapeutic Plateletpheresis in Patients With Thrombocytosis: Gender, Hemoglobin Before Apheresis Significantly Affect Collection Efficiency

Background: Thrombocytosis is a common symptom in myeloproliferative neoplasms (MPN), and excessive proliferation may deteriorate into thrombosis, bleeding, myelofibrosis, and may ultimately convert to acute leukemia. This study aimed to investigate the collection efficiency of plateletpheresis (CEPP) and factors influencing its efficacy in patients with thrombocytosis.

Materials and Methods: From September 2010 to December 2016, 81 patients from two institutions in China with myeloproliferative neoplasms and thrombocytosis accompanied by severe symptoms were treated with plateletpheresis by Fresenius COM. TEC machine.

Results: After apheresis, the median CEPP was 20.71% (IQR: 9.99–36.69%) and median PLT reduction rate was 25.87% (IQR: 21.78–36.23%). Further analysis showed that no significant difference was observed between PLT count with 800–1,000 × 10⁹/L and > 1,000 × 10⁹/L. The PLT counts significantly decreased (P < 0.001) after plateletpheresis, the red blood cell (RBC), white blood cell (WBC), hemoglobin (HGB), and hematocrit (HCT) levels showed no significant differences before- or after- plateletpheresis. Multivariate analysis showed that female sex (P = 0.009) and HGB (P = 0.010) before apheresis were associated with CEPP. Female (P = 0.022), HCT (P = 0.001) and blood volume (P = 0.015) were associated with the PLT reduction rate. Furthermore, symptoms were relieved after apheresis in patients whose PLT count was 800–1,000 × 10⁹/L accompanied with symptoms.

Conclusions: It is reasonable to perform plateletpheresis when the PLT count is over 800 × 10⁹/L and patients are complicated by clinical symptoms such as dizziness, headache, somnolence, and stupor. Plateletpheresis is effective in removing PLTs especially in females with high HGB.

Therapeutic thrombocytapheresis in myeloproliferative neoplasms: A single-institution experience

Thrombocytosis is usually seen in myeloproliferative neoplasms (MPNs) and associated with thrombohemorrhagic complications. Therapeutic thrombocytapheresis using an automatic cell separator can help to achieve prompt platelet count reduction to decrease the rate of thrombotic events. In this study, we report a single center's experience in managing MPN patients with thrombocytapheresis prior to chemotherapy. Thrombocytapheresis procedures were performed in 185 MPN patients with thrombocytosis between January 2016 and June 2017. The median percentage reduction of platelets was 44.5% and the median percentage removal efficiency was 65.2% for 83 procedures where the waste bag was sampled. Procedures were generally well tolerated with few patients having mild adverse events (13 out of 185 patients).

Effect of plateletpheresis on total platelet count and mean platelet volume: A meta-analysis

OBJECTIVE

Currently, there are discrepancies in the reports on the extent of the reduction in platelet count after platelet donation by apheresis, and its impact on mean platelet volume (MPV). This study was conducted to meta-analyze the effect of plateletpheresis on platelet count and on mean platelet volume, based on studies published between 1980 and 2018.

METHODS

Medline-Pubmed, Scielo, ScienceDirect, and Scopus databases were searched from inception to December 31 2019. The PRISMA guidelines, reproducibility, and evaluation of the methodological quality were guaranteed. Heterogeneity was evaluated with DerSimonian-Laird's, publication bias with a Begg's test. Sensitivity analysis and cumulative meta-analysis were also conducted, as well as a forest plot.

RESULTS

Twenty-five studies with 3769 donors were systematized to analyze platelet count, and seven studies with 1176 donors to observe MPV. Most studies were published in India and the United States. There was a postprocedure reduction in both variables. The reduction in platelet count was 14.3 × 10³ /μL (95% CI 11.4 to 17.1 × 10³ ⁄μL). The reduction in MPV was 1.43 fL (95% CI 0.3 to 2.5 fL). The analysis of subgroups showed that, in the case of platelet count, the reduction is not statistically significant two weeks after donation.

CONCLUSION

Platelet donation by apheresis reduces platelet count and MPV in donors, which is detrimental to the purposes of the procedure; although the decrease is not clinically significant for the donor or the recipient. This demonstrates the need for subsequent studies to evaluate variables, such as donation frequency and donation intervals, should be considered to evaluate if the reported decrease is easily compensated, without adverse consequences for donors, or if modifications in donor selection criteria are required.

Comparative assessment of single-donor plateletpheresis by Haemonetics® MCS® plus and Trima Accel®

BACKGROUND

Single-donor platelets (SDPs) prepared by sophisticated automated equipment offer several advantages over random-donor platelets and are being increasingly used to support thrombocytopenic patients. Different apheresis machines working on the principle of centrifugation are being used worldwide to collect platelets. This retrospective study was done to compare plateletpheresis on two automated cell seperators - Haemonetics^® MCS^® Plus and Trima Accel^®.

MATERIALS AND METHODS

Data for 100 single-donor plateletpheresis procedures, fifty on each machine, were retrospectively collected and analyzed. Donor characteristics were analyzed by Student's t-test and no significant difference was found between the two groups. The parameters compared between the two machines were yield, collection efficiency, blood volume processed, procedure time, acid-citrate-dextrose (ACD) used, leukodepletion achieved, quality control of the products, and adverse donor reactions.

RESULTS

Platelet yield (3.054 ± 0.14 vs. 3.120 ± 0.25), quality control of the platelets, leukodepletion achieved, and donor safety were comparable in both the machines. The blood volume processed (2230.74 ± 227.01 vs. 2452.90 ± 318.61), ACD used during procedure (265.48 ± 43.21 vs. 298.10 ± 53.32), procedural time (55.92 ± 13.00 vs. 68.86 ± 12.64), and the postprocedural decrease in donor count in Trima Accel^® (183.10 ± 23.99 vs. 161.44 ± 63.47) were significantly less than those in Haemonetics^® MCS^® Plus. The median collection efficiency of Trima Accel^® was found to be greater than Haemonetics^® MCS^® Plus (0.000649 vs. 0.000608, P = 0.020).

CONCLUSION

Both Trima Accel^® and Haemonetics^® MCS^® Plus can collect SDPs safely and efficiently. Trima Accel^® has higher collection efficiency and reduced incidence of citrate-related adverse effects. It also has better potential to optimize productivity due to decreased procedural time.

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.

Haemostatic parameters, platelet activation markers, and platelet indices among regular plateletpheresis donors

OBJECTIVE

Plateletpheresis is generally a safe procedure for platelet donation. Studies on the effects of haemostatic parameters and possible association between automated plateletpheresis and hypercoagulable state are limited. Hence, this study aimed to investigate the effects of plateletpheresis on regular donors using haemostatic parameters, i.e. natural anticoagulant proteins, platelet indices, and platelet activation markers.

METHODS

A total of 139 participants (plateletpheresis donors and normal controls) were recruited and divided into two groups: Group 1 participants who underwent tests for haemostatic and platelet indices and Group 2 participants who underwent tests for platelet activation markers using CD62P and PAC-1 monoclonal antibodies.

RESULTS

A significant mild shortening of prothrombin time and platelet activation were demonstrated (by increased CD62P and PAC-1 markers) among regular plateletpheresis donors as compared to healthy controls. The current pre-donation platelet count of plateletpheresis donors was significantly lower than their mean baseline platelet count obtained before their first plateletpheresis procedure. However, no significant differences were observed for the other platelet parameters (platelet count, mean platelet volume, platelet distribution width, activated partial thromboplastin time, protein C, protein S, antithrombin, and von Willebrand Factor antigen) between plateletpheresis donors and healthy controls.

CONCLUSION

This study concludes that regular plateletpheresis is a safe procedure. A possibility of mild platelet activation among regular donors requires further confirmation. However, pre-analytical platelet and FVII activations could occur in vitro contributing to these findings.

Changes in pre- and post-donation platelet function in plateletpheresis donors

OBJECTIVES

This study aimed to investigate the changes of platelet (PLT) function and coagulation time before and after plateletpheresis donation.

MATERIAL AND METHODS

The healthy donors were divided into four groups according to the annual number of plateletpheresis donation: 20 times group, 15 times group, 10 times group and 5 times group. The healthy non-blood donors were selected as controls. The donation interval was 14 days. The blood samples were collected before plateletpheresis donation and after 30min, 7 d, and 14 d of donation for determination of coagulation time, PLT function, plasma protein, serum iron and blood routine change.

RESULTS

After 30min of plateletpheresis donation, the PLT function decreased and the coagulation time was prolonged. However, PLT function recovered to the pre-collection after 7 d of plateletpheresis donation and coagulation time recovered to the pre-collection after 14 d of plateletpheresis donation. Additionally, there was no difference regarding blood coagulation time and PLT function among blood donors and controls. The plasma protein and serum iron levels in 20 times and 15 times groups were within the normal reference range.

CONCLUSION

The frequency of plateletpheresis donation will not affect PLT function, coagulation time, plasma protein and serum iron in donors.

The role of thrombocytapheresis in the contemporary management of hyperthrombocytosis in myeloproliferative neoplasms: A case-based review

Extreme thrombocytosis induces an acquired thrombotic-hemorrhagic diathesis, and left uncontrolled is a harbinger of potentially fatal vascular complications. Currently, cytoreduction with medical therapy remains the mainstay of hyperthrombocytosis management. However, it offers a less-than-ideal option in situations where a rapid reduction in platelets is urgently needed, as in the presence of vital end-organ ischemia or to ameliorate of life-threatening hemorrhage. The role of thrombocytapheresis, or plateletpheresis, in hyperthrombocytosis has become increasingly obsolete given the proactive titration of cytoreductive therapies and early identification and correction of reversible causes of reactive thrombocytosis. Despite its narrowed indications, plateletpheresis continues to offer a valuable temporizing measure in platelet count reduction before cytoreductive agents exert their maximal effect. In this context, it is important for the treating physician to be aware of the symptoms and risks associated with hyperthrombocytosis to inform best clinical practices. In this review, we discuss the role of plateletpheresis in the modern-day management of hyperthrombocytosis in patients with myeloproliferative neoplasms through a case based review of the literature. It becomes apparent throughout the discussion that the decision to perform plateletpheresis should be individualized based upon the clinical scenario, degree of thrombocytosis, available infrastructure and every patient's risk profile.

Upper-extremity Deep Vein Thrombosis Complicating Apheresis in a Healthy Donor

Venous thrombus was recognized in the upper extremity of a 53-year-old man after blood donation. The patient presented with a 15-day history of swelling in the left upper-extremity that started 6 hours after apheresis. Contrast-enhanced computed tomography revealed clots in the deep veins of the left arm and the peripheral pulmonary artery. Blood donation had proceeded smoothly, and the patient had no thrombotic predisposition, except for a smoking habit. The thrombus resolved following anticoagulant therapy, and the patient' s clinical course was uncomplicated. Despite a thorough investigation, the cause of this thrombus remains unknown.