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Pérez-Aliaga AI, Ayerra I, Sánchez-Guillén J, López FJ, Puente F, Aranda A, Domingo JM, Garcés C. Routine results of an algorithm for managing the production of blood components. Vox Sang 2024. [PMID: 38410835 DOI: 10.1111/vox.13609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/06/2024] [Accepted: 02/12/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND OBJECTIVES The variability in the number of donations together with a growing demand for platelet concentrates and plasma-derived medicines make us seek solutions aimed at optimizing the processing of blood. Some mathematical models to improve efficiencies in blood banking have been published. The goal of this work is to validate and evaluate an algorithm's impact in the production of blood components in the Blood and Tissues Bank of Aragon (BTBA). MATERIALS AND METHODS A mathematical algorithm was designed, implemented and validated through simulations with real data. It was incorporated into the fractionation area, which uses the Reveos® fractionation system (Terumo BCT) to split blood into its components. After 9 months of daily routine validation, retrospective activity data from the Blood Bank and Transfusion Services before and during the use of the algorithm were compared. RESULTS Using the algorithm, the outdating rate of platelet concentrates (PC) decreased by 87.8% in the blood bank. The average shelf life remaining of PC supplied to Transfusion Services increased by almost 1 day. As a consequence, the outdating rate in the Aragon Transfusion Network decreased by 33%. In addition, extra 100 litres of plasma were obtained in 9 months. CONCLUSIONS The algorithm improves the blood establishment's workflow and facilitates the decision-making process in whole blood processing. It resulted in a decrease in PC outdating rate, increase in PC shelf life and finally an increase in the volume of recovered plasma, leading to significant cost savings.
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Affiliation(s)
| | | | | | - F Javier López
- Department of Statistical Methods and Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, Zaragoza, Aragón, Spain
| | - Fernando Puente
- Blood and Tissues Bank of Aragón (BTBA), Zaragoza, Aragón, Spain
| | - Alfonso Aranda
- Blood and Tissues Bank of Aragón (BTBA), Zaragoza, Aragón, Spain
| | | | - Carmen Garcés
- Blood and Tissues Bank of Aragón (BTBA), Zaragoza, Aragón, Spain
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Malvaux N, Defraigne F, Bartziali S, Bellora C, Mommaerts K, Betsou F, Schuhmacher A. In Vitro Comparative Study of Platelets Treated with Two Pathogen-Inactivation Methods to Extend Shelf Life to 7 Days. Pathogens 2022; 11:pathogens11030343. [PMID: 35335667 PMCID: PMC8949436 DOI: 10.3390/pathogens11030343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives: Since 2015, platelet products have been pathogen-inactivated (PI) at the Luxemburgish Red Cross (LRC) using Riboflavin and UV light (RF-PI). As the LRC should respond to hospital needs at any time, platelet production exceeds the demand, generating a discard rate of 18%. To reduce this, we consider the extension of storage time from 5 to 7 days. This study’s objective was to evaluate the in vitro 7-day platelet-storage quality, comparing two PI technologies, RF-PI and amotosalen/UVA light (AM-PI), for platelet pools from whole-blood donations (PPCs) and apheresis platelets collected from single apheresis donation (APCs). Materials and Methods: For each product type, 6 double-platelet concentrates were prepared and divided into 2 units; one was treated with RF-PI and the other by AM-PI. In vitro platelet-quality parameters were tested pre- and post-PI, at days 5 and 7. Results: Treatment and storage lesions were observed in PPCs and APCs with both PI methods. We found a higher rate of lactate increase and glucose depletion, suggesting a stronger stimulation of the glycolytic pathway, a higher Annexin V binding, and a loss of swirling in the RF-PI-treated units from day 5. The platelet loss was significantly higher in the AM-PI compared with the RF-PI units. Conclusions: Results suggest that RF-PI treatment has a higher deleterious impact on in vitro platelet quality compared to AM-PI, but we observed higher loss of platelets with AM-PI due to the post-illumination amotosalen adsorption step. If 7-day storage is needed, it can only be achieved with AM-PI, based on our quality criteria.
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Affiliation(s)
- Nicolas Malvaux
- Red Cross of Luxemburg, Boulevard Joseph II, 40, L-1840 Luxembourg, Luxembourg; (F.D.); (S.B.); (A.S.)
- Correspondence: ; Tel.: +352-2755-4000
| | - Fanette Defraigne
- Red Cross of Luxemburg, Boulevard Joseph II, 40, L-1840 Luxembourg, Luxembourg; (F.D.); (S.B.); (A.S.)
| | - Styliani Bartziali
- Red Cross of Luxemburg, Boulevard Joseph II, 40, L-1840 Luxembourg, Luxembourg; (F.D.); (S.B.); (A.S.)
| | - Camille Bellora
- Integrated Biobank of Luxembourg, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg; (C.B.); (K.M.); (F.B.)
| | - Kathleen Mommaerts
- Integrated Biobank of Luxembourg, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg; (C.B.); (K.M.); (F.B.)
- Luxembourg Center for Systems Biomedicine, 6 Av. du Swing, L-4367 Esch-sur-Alzette, Luxembourg
| | - Fay Betsou
- Integrated Biobank of Luxembourg, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg; (C.B.); (K.M.); (F.B.)
- Laboratoire National de Sante, 1 rue Louis Rech, L-3555 Dudelange, Luxembourg
| | - Anne Schuhmacher
- Red Cross of Luxemburg, Boulevard Joseph II, 40, L-1840 Luxembourg, Luxembourg; (F.D.); (S.B.); (A.S.)
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Rebulla P, Prati D. Pathogen Reduction for Platelets—A Review of Recent Implementation Strategies. Pathogens 2022; 11:pathogens11020142. [PMID: 35215085 PMCID: PMC8879285 DOI: 10.3390/pathogens11020142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 02/04/2023] Open
Abstract
The development of pathogen reduction technologies (PRT) for labile blood components is a long-pursued goal in transfusion medicine. While PRT for red blood cells and whole blood are still in an early phase of development, different PRT platforms for plasma and platelets are commercially available and routinely used in several countries. This review describes complementary strategies recommended by the US FDA to mitigate the risk of septic reactions in platelet recipients, including PRT and large-volume delayed sampling, and summarizes the main findings of recent reports discussing economical and organizational issues of platelet PRT implementation. Sophisticated mathematical analytical models are available to determine the impact of PRT on platelet costs, shortages and outdates in different settings. PRT implementation requires careful planning to ensure the availability of sufficient economical, technological and human resources. A phased approach was used in most PRT implementation programs, starting with adult and pediatric immunocompromised patients at higher risk of developing septic platelet transfusion reactions. Overall, the reviewed studies show that significant progress has been made in this area, although additional efforts will be necessary to reduce the storage lesion of PRT platelets and to expand the sustainable applicability of PRT to all labile blood components.
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Affiliation(s)
- Paolo Rebulla
- Correspondence: ; Tel.: +39-335-8258625; Fax: +39-(0)2-5458129
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Pérez Aliaga AI, Labata G, Aranda A, Cardoso M, Puente F, Domingo JM, Garcés C. Improvement of Blood Processing and Safety by Automation and Pathogen Reduction Technology. Transfus Med Hemother 2021; 48:290-297. [PMID: 34803572 DOI: 10.1159/000516696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/02/2021] [Indexed: 01/18/2023] Open
Abstract
Introduction The objective of the present study was to describe the experience of the Blood and Tissues Bank of Aragon with the Reveos® Automated Blood Processing System and Mirasol® Pathogen Reduction Technology (PRT) System, comparing retrospectively routine quality data obtained in two different observation periods. Methods Comparing quality data encompassing 6,525 blood components from the period 2007-2012, when the semi-automated buffy coat method was used in routine, with 6,553 quality data from the period 2014-2019, when the Reveos system and subsequently the Mirasol system were implemented in routine. Results Moving from buffy coat to Reveos led to decreased discard rates of whole blood units (1.2 to 0.1%), increased hemoglobin content (48.1 ± 7.6 to 55.4 ± 6.6 g/unit), and hematocrit (58.9 ± 6.5% to 60.0 ± 4.9%) in red blood cell concentrates. Platelet concentrates (PCs) in both periods had similar yields (3.5 ×1011). Whereas in the earlier period, PCs resulted from pooling 5 buffy coats, in the second period 25% of PCs were prepared from 4 interim platelet units. The mean level of factor VIII in plasma was significantly higher with Reveos (92.8 vs. 97.3 IU). Mirasol PRT treatment of PCs reduced expiry rates to 1.2% in 2019. One septic transmission was reported with a non-PRT treated PCs, but none with PRT-treated PCs. Conclusion Automation contributed to standardization, efficiency, and improvement of blood processing. Released resources enabled the effortless implementation of PRT. The combination of both technologies guaranteed the self-sufficiency and improvement of blood safety.
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Affiliation(s)
| | - Gorka Labata
- Technological Institute of Aragón, Zaragoza, Spain
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Blake JT, McTaggart K, Couture C. Estimating the impact on the inventory of implementing pathogen-reduced platelets in Canada. Transfusion 2021; 61:3150-3160. [PMID: 34612539 DOI: 10.1111/trf.16691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/14/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pathogen reduction (PR) technology will be implemented in pooled platelets in Canada. It is anticipated that PR platelets will be licensed in Canada for a maximum shelf life of 5 days, while non-treated apheresis platelet products will continue to be licensed for 7 days. STUDY DESIGN AND METHODS This study evaluates the impact on inventory, wastage, and shortages of implementing PR platelets. A custom-built simulation model was used to represent a regional distribution network. Experiments with the model were used to estimate product wastage and shortages when a 5-day PR pooled platelet product is introduced alongside a 7-day apheresis platelet product. RESULTS Pooled platelet waste and shortages both increase as pooled shelf life decreases. Apheresis platelets, however, show a different response: While shortages of apheresis platelets increase as the shelf life of pooled units decreases, apheresis waste declines as pooled shelf life decreases. CONCLUSION Additional platelet collections will be necessary to accommodate the shorter PR platelet shelf life and to cover increased patient transfusion needs due to a lower platelet yield in PR units. Increases of 9% for pooled units and 6% for apheresis units beyond expected demand, were found to be sufficient to ensure a non-inferior level of customer service while minimizing waste.
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Affiliation(s)
- John T Blake
- Department of Industrial Engineering, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Blood Service, Centre for Innovation, Ottawa, Ontario, Canada
| | - Ken McTaggart
- Canadian Blood Service, Centre for Innovation, Ottawa, Ontario, Canada
| | - Chantal Couture
- Canadian Blood Service, Centre for Innovation, Ottawa, Ontario, Canada
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Fenwick AJ, Gehrie EA, Marshall CE, Tobian AAR, Shrestha R, Kacker S, Brunker PAR, Shifflett L, Carroll KC, Gozelanczyk D, Goel R, Ness PM, Bloch EM. Secondary bacterial culture of platelets to mitigate transfusion-associated sepsis: A 3-year analysis at a large academic institution. Transfusion 2020; 60:2021-2028. [PMID: 32750171 PMCID: PMC10007897 DOI: 10.1111/trf.15978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/16/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND In 2019, the United States Food and Drug Administration published its final recommendations to mitigate bacterial contamination of platelets. We sought to evaluate our secondary bacterial culture (SBC) strategy in light of those recommendations. STUDY DESIGN AND METHODS A retrospective analysis was conducted of SBC data (October 2016-2019) at our institution. SBC was performed upon receipt (Day 3 after collection); 5 mL of platelet product was inoculated aseptically into an aerobic bottle and incubated at 35°C for 3 days. For 8 months, a 10-mL inoculum was trialed. No quarantine was applied. All positive cultures underwent Gram staining and repeat culture of the platelet product (if available). A probable true positive was defined as concordant positive culture between the initial and repeat culture. The incidence of probable true- and false-positive cultures were reported descriptively and differences evaluated by sampling volume. RESULTS Over 3 years, 55 896 platelet products underwent SBC, yielding 30 initial positive results (approx. 1/1863 platelets); 25 (83.3%) signaled within 24 hours of SBC. The rates of probable true positive, false positive, and indeterminate for 5 mL were 0.027% (1/3771), 0.002% (1/45 251) and 0.018% (1/5656), respectively. The respective rates for 10 mL were 0.018% (1/5323), 0.07% (1/1521), and 0%. Seven of eight (87.5%) false-positive SBCs occurred with a 10-mL inoculum. No septic transfusion reactions were reported. CONCLUSION SBC continues to interdict bacterially contaminated units of platelets. Our findings suggest higher rates of false positivity using large-volume inocula.
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Affiliation(s)
- Alexander J Fenwick
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eric A Gehrie
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Christi E Marshall
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Ruchee Shrestha
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Seema Kacker
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Patricia A R Brunker
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,American Red Cross Biomedical Services, Greater Chesapeake & Potomac Region, Baltimore, Maryland, USA
| | - Lisa Shifflett
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen C Carroll
- Division of Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Donna Gozelanczyk
- American Red Cross Biomedical Services, Greater Chesapeake & Potomac Region, Baltimore, Maryland, USA
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Mississippi Valley Regional Blood Center, Springfield, IL, USA
| | - Paul M Ness
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Evan M Bloch
- Division of Transfusion Medicine, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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