Collection of two units of leukoreduced RBCs from a single donation with a portable multiple-component collection system

Double Dose Plateletpheresis: A Savior to Shrinking Donor Pool and Platelet Inventory Management

The double dose plateletpheresis (DDP) is considered to be a cost effective way of preparing platelets, owing to the low incidence of infectious complications and by also minimizing allogeneic donor exposure to the patients. We aimed at collecting DDP at our center and study its effect on donor hematological parameters, evaluate the product quality and the adverse donor reactions thereafter. Double Dose Platelet was collected from 160 eligible apheresis donors on Amicus cell separator (Fenwal, Inc. Three Corporate Drive Lake Zurich, IL, USA). The donor hematological parameters, product yield, adverse effects on the donors, collection efficiency (CE) and collection rate of the machine were noted. A total of 160 DDPs were collected. The total blood volume processed to achieve the yield of 6.0 × 1011 was 3673.5 ± 276.56 mL. The average yield achieved was 6.14 ± 0.26 × 1011. The average run time was 68.05 ± 6.25 min. Total ACD used was 408.33 ± 33.81 mL. We observed significant relation of pre-donation donor platelet count and platelet yield (p < 0.001). The CE was 78.09 ± 5.15%. There was a significant drop in the post DDP platelet count (p < 0.01) causing no adverse effect. Fourteen donors (8.75%) experienced mild citrate related adverse events. DDP does not lead to major adverse effects and post DDP hematological parameters are also within the acceptable range. It also helps to maintain apheresis platelet inventory, reduce donor exposure, reduce donor requirement and reduce the cost of the product.

Comparison of two double red cell collection settings on Fenwal Alyx apheresis instrument

The Fenwal Alyx for collecting double red cell products has two red cell volume collection settings: fixed collection target of 360 ml (180 ml/unit) and a variable target of collecting either 400 or 360 ml (200 or 180 ml/unit), where the machine aims for the higher possible collection target. We retrospectively compared the two collection targets for the RBC content, donor time, technician time, and collection efficiency. We compared 18 fixed (F) target collections to 40 variable (V) target collections. All collections were performed as per the manufacturer's recommendations on Alyx and donors met the manufacturer's eligibility criteria. There was no significant difference in average whole blood processed (F: 963 ml, V: 1,000 ml); donor time (F: 43 min, V: 45 min) or technician time (F: 64 min, V: 64 min). There was a significant difference in unit volume (F: 283 ml, V: 300 ml); grams Hb/unit (F: 53 g, V: 57 g); ml RBC/unit (F: 157 ml, V: 167 ml); and RBC recovery (F: 87.8%, V: 88.9%). The fixed target had a significantly lower frequency of products with ≥51 g Hb (80.6%) than variable target (96.3%) and ≥153 ml RBC/unit (F: 55.6%, V: 96.3%). In conclusion, the variable target efficiently allows collections of products with higher red cell volume and hemoglobin without a significant increase in collection and processing time.

Double red blood cell collection: comparison of three apheresis systems

BACKGROUND

We compared three instruments for double red blood cell (DRBC) collection to efficiently optimize our RBC inventory.

STUDY DESIGN AND METHODS

Instruments compared were the TerumoBCT Trima Accel (Trima), the Fenwal Alyx (Alyx), and the Haemonetics MCS+ 8150 (MCS+). Forty consecutive collections (80 products) per instrument were evaluated for hemoglobin (Hb) content, leukoreduction, collection time, instrument efficiency, donor acceptance, and reactions. The total number of whole blood donors who could be eligible for DRBC collection was analyzed. All collections were as per the manufacturer recommendations with target volume of 360 or 400mL. Leukoreduction was integral to the collection procedure for the Alyx and Trima, while it was a separate process for the MCS+.

RESULTS

The total numbers of whole blood donors who could be eligible for DRBC collection were 10,116 for the MCS+, 9378 for the Alyx, and 8573 for the Trima. All units collected had more than 42.5 g of Hb. Mean Hb levels were as follows: Trima, 59.2 g; Alyx, 56.8 g; and MCS+, 51.5 g. Donor times for the Trima, Alyx, and MCS+ were 52, 45, and 52 minutes, respectively. Technician times for the Trima, Alyx, and MCS+ (without filtration) were 87, 73, and 64 minutes. All collected products had fewer than 5 × 10(6) white blood cells.

CONCLUSIONS

All three instruments would be capable of collecting an acceptable leukoreduced DRBC product. The Alyx was most portable, with the shortest donor time and total technician time (considering filtration time) and highest collection efficiency and would collect from more donors than the Trima. We thus chose the Alyx as it best fits the specific needs of our center.

Erythrocyte concentrates recovered from under-collected whole blood: experimental and clinical results

Background

Although periodic blood shortages are widespread in major Chinese cities, approximately 1x10⁵ U of whole blood are discarded yearly because of under-collection. To reduce the wastage of acid citrate dextrose solution B (ACD-B) anticoagulated under-collected whole blood (UC-WB), this study was performed to elucidate the effect of extracellular pH and holding time on erythrocyte quality. Mannitol-adenine-phosphate (MAP) erythrocyte concentrates (UC-RBCs) were prepared with UC-WB to assess the safety and efficacy of this component.

Methods

The effect of the different extracellular pH levels and storage times on erythrocytes was assessed by fluorescent probes, SDS-PAGE electrophoresis, electron microscopy and spectroscopy. In vitro properties of 34 UC-RBCs that were prepared with UC-WB at different times after collection were analyzed and compared to normal RBCs during 35 days of storage. The results of transfusion with UC-RBCs and the incidence of adverse reactions in 49 patients were determined.

Results

1) Low extracellular pH levels and long storage time induced increases in RBC fluorescence polarization and mean microviscosity, changes in membrane fluidity, band 1, 2 and 3 protein expression, and erythrocyte morphology. 2) During storage for 35 days, difference in between-subjects effects of K⁺, hemolysis and supernatant erythrocyte membrane protein (EMP) were statistically significant (P = 0.041, 0.007 and 0.002, respectively), while the differences between these parameters in the 4 h group and comparable controls were less significant. 3) Clinical data from 49 patients confirmed that transfusions with UC-RBCs were satisfactory with no adverse reactions.

Conclusion

These results suggest that it is feasible to prepare RBCs with ACD-B anticoagulated UC-WB at a minimum of 66% volume of the labeled collection. It was effective and safe to transfuse the UC-RBCs prepared within 4 h after collection and stored within 7 days. The use of UC-WB would be a welcome addition to limited blood resources in China.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-TRC-13003967

Study of serum ferritin in donors of two red blood cells units collected by apheresis

OBJECTIVE

To analyze the recovery of iron stores without supplementation, when keeping an interval of six months between donations.

MATERIAL AND METHODS

From April 2007 to May 2011, 308 regular and voluntary donors were selected. The apheresis collections were performed using ALYX® Component Collection System-Fenwal™. The hematological parameters were analyzed using the Cell DIN Sapphire - Abbot Diagnostics, and the serum ferritin by sandwich immunoassay method with fluorescence detection in final phase (ELFA) - Vidas® Ferritin-Biomérieux SA. A descriptive statistical analysis was performed for each hematological parameters and serum ferritin.

RESULTS

The median hemoglobin concentration was 15.6g/dL (14, 18.4) in the first procedure and remains constant at subsequent donations. The ferritin median concentration was 64.6 μg/L (7.2, 886). A decrease of 15.6% was observed when compared the first to the second procedure with a median 54.6 μg/L (8.3, 213.7). Paradoxically, this decrease is not evident in the subsequent procedures, where an increase of 14.6% and 3.4% for the third and fourth procedure respectively was observed. Changes in ferritin values show statistically significant differences between the first and second collection, but this difference disappeared in subsequent donations. The analysis of MCH in each collection indicates that the significant difference between first and second donation (p1-2<0.05) and between first and third (p1-3=0.015), agree with the greatest decline of the ferritin found between procedures and the beginning of the stabilization of ferritin levels.

COMMENTARY

The determination of ferritin appears not to be the most important parameter to consider at the time of donor selection and suggests that other factors unrelated to the donation may play a significant role. A decrease in serum ferritin was observed at the beginning, but it seems to attend a recovery and stabilization in the successive procedures.

Automated collection of double red blood cell units with a variable-volume separation chamber

BACKGROUND

Automated collection of blood components offers multiple advantages and has prompted development of portable devices. This study sought to document the biochemical and hematologic properties and in vivo recovery of red cells (RBCs) collected via a new device that employed a variable-volume centrifugal separation chamber.

STUDY DESIGN AND METHODS

Normal subjects (n = 153) donated 2 units of RBCs via an automated blood collection system (Cymbal, Haemonetics). Procedures were conducted with wall outlet power (n = 49) or the device's battery source (n = 104). Units were collected with or without leukoreduction filtration and were stored in AS-3 for 42 days. The units were assessed via standard biochemical and hematologic tests before and after storage, and 24 leukoreduced (LR) and 24 non-LR RBCs were radiolabeled on Day 42 with Na(2)(51)CrO(4) for autologous return to determine recovery at 24 hours with concomitant determination of RBC volume via infusion of (99m)Tc-labeled fresh RBCs.

RESULTS

Two standard RBC units (targeted to contain 180 mL of RBCs plus 100 mL of AS-3) could be collected in 35.7 +/- 2.0 minutes (n = 30) or 40.3 +/- 2.7 minutes for LR RBCs (n = 92). An additional 31 collections were conducted successfully with intentional filter bypassing. RBC units contained 104 +/- 4.1 percent of their targeted volumes (170-204 mL of RBCs), and LR RBCs contained 92 percent of non-LR RBCs' hemoglobin. All LR RBCs contained less than 1 x 10(6) white blood cells. Mean hemolysis was below 0.8 percent (Day 42) for all configurations. Adenosine triphosphate was well preserved. Mean recovery was 82 +/- 4.9 percent for RBCs and 84 +/- 7.0 percent for LR RBCs.

CONCLUSIONS

The Cymbal device provided quick and efficient collection of 2 RBC units with properties meeting regulatory requirements and consistent with good clinical utility.

In vitro quality of red blood cells (RBCs) collected by multicomponent apheresis compared to manually collected RBCs during 49 days of storage

BACKGROUND

New technologic developments enable automated collection and preparation of red blood cells (RBCs). This study's aim was to evaluate quality of apheresis-derived RBCs (ARBCs) collected as single units along with platelets (RBC-Ps) or double units (2-RBCs) with four different apheresis systems.

STUDY DESIGN AND METHODS

Sixty-six donors with similar baseline variables underwent RBC apheresis collection with various machines (Amicus [15 RBC-Ps] and Alyx [15 2-RBCs], Baxter; the Trima Accel [9 RBC-Ps, 8 2-RBCs], Gambro, and the MCS+[9 RBC-Ps, 10 2-RBCs], Haemonetics Corp.). In vitro properties were analyzed during 49 days of storage and compared to manual RBCs (MRBCs, n = 14).

RESULTS

All units but one, Alyx, demonstrated white blood cell counts of less than 1 x 10(6). ARBCs showed lower variability in volume compared to MRBCs. All units met international requirements (European, AABB) for hematocrit (50%-70%), hemoglobin (>40 g/unit), and RBC mass (>or=153 mL). pH values remained similar between study groups without reaching critical limits in any unit. MRBCs had slight advantages for hemolysis at the end of storage and were significantly superior in energy maintenance as indicated by less ATP degradation and potassium leak most likely due to more pronounced anoxidative glycolysis particularly during the first half of storage. Owing to more declining oxidative glucose metabolism, ARBCs demonstrated higher methemoglobin formation and subsequent oxygen release until the end of storage.

CONCLUSION

ARBCs exhibited better predictability in volume and absolute RBC mass than MRBCs and demonstrated sufficient in vitro quality throughout storage, even though lower ATP preservation and higher methemoglobin formation were observed compared to MRBCs probably due to differences in glucose metabolism.

Prospective evaluation of double RBC collection using three different apheresis systems

BACKGROUND

Automated component collection systems offer the possibility of increasing blood supply and improving transfusion safety.

DESIGN

30 blood donors were randomly assigned to double RBC collection with either the Baxter Alyx (AX), the Haemonetics MCS Plus (MCS+), or the Gambro Trima Accel (TA). Procedures were prospectively evaluated focussing on yield, time, efficiency, citrate donor load, and in vitro quality.

RESULTS

All units showed sufficient in vitro quality throughout 42 days of storage and complied with international requirements. Donor reactions were limited to mild citrate reactions. AX was the fastest and most efficient system* * (* *p approximately 0.001) attaining the highest yield* * from similar amounts of whole blood. The drawbacks were a higher RBC loss* (*p < 0.05) and accelerated citrate infusion* *. Due to lower collection rates* * * (* * *p < 0.001), MCS+ was slower than TA* * * but compensated with lower citrate load * * *.

CONCLUSION

Double RBC apheresis was performed safely and efficiently with all three instruments. AX had advantages for most parameters evaluated.

Prospective comparison of high-dose plateletpheresis with the latest apheresis systems on the same donors

BACKGROUND

To improve productivity of automated platelet (PLT) collection, the industry has introduced new instruments or modifications to existing equipment.

STUDY DESIGN AND METHODS

With the same 8 donors for double (DDC) and triple-dose PLT collection (TDC), the Baxter Amicus (AM), the Haemonetics MCS Plus (MCS+), and the Gambro Trima Accel (TA) were evaluated focusing on yield, duration, and citrate donor load. Target endpoints were set at 5.5 x 10(11) to 6.0 x 10(11) PLTs (DDC) and 7.5 x 10(11) to 8.0 x 10(11) PLTs (TDC) in up to 100 and 120 minutes' donation time, respectively.

RESULTS

TA was the most efficient system (74.5 +/- 3.9%) with significant differences from AM (71.1 +/- 3.9%; p = 0.028) and MCS+ (64.0 +/- 7.7%; p = 0.002). TA had advantages over AM for collection rate (10.9 x 10(9) +/- 2.2 x 10(9) vs. 10.1 x 10(9) +/- 1.5 x 10(9) PLTs/min; p = 0.382), whole blood processed (3928 +/- 611 mL vs. 4219 +/- 727 mL; p = 0.382), and time to obtain an established standard dose (TSD 2.5(EU), 30.2 +/- 5.6 vs. 37.7 +/- 5.5 min; TSD 3.5(US), 42.2 +/- 7.8 min vs. 52.7 +/- 7.7 min; p = 0.015), whereas AM was slightly superior in PLT yield (2.81 x 10(11) +/- 0.21 x 10(11) vs. 2.76 x 10(11) +/- 0.31 x 10(11)/unit; p = 0.645). Owing to the lowest draw (42.3 +/- 3.2 mL/min; p < 0.001) and collection rates (6.0 x 10(11) +/- 1.5 x 10(11)/min; p = 0.021), MCS+ was the slowest significantly (p < 0.001) but compensated with fewer citrate reactions owing to lower citrate infusion rates (0.78 +/- 0.11 mL/min/L; p = 0.028).

CONCLUSION

High-dose plateletpheresis was performed efficiently and safely with all three instruments. AM had advantages in PLT yield, and MCS+, in donor comfort. TA was the fastest in obtaining an established standard dose and, because of this advantage, the machine with the highest practical impact in routine use.

Blood component collection by apheresis

Apheresis component collection is a rapidly growing area in the blood collection field. Several instruments with varying capabilities are available. This is a brief review of the equipment available for granulocyte and apheresis component collection and indications for their use. In the United States, granulocytes are collected with the Fenwal CS3000, Fenwal CS3000 Plus, COBE (Gambro) Spectra, Haemonetics LN9000, and Fresenius AS 104. The use of hetastarch for sedimenting agent and stimulation with G-CSF and G-CSF plus dexamethasone have substantially increased granulocyte yields. Plateletapheresis is performed in the United States on the Fenwal CS3000, Fenwal CS3000 Plus, Fenwal Amicus, COBE (Gambro) Spectra, Gambro Trima Version 4, Gambro Trima Accel (Version 5), and Haemonetics LN9000. Automated red blood cell (RBC) collections are performed with the Haemonetics MCS+LN8150, Gambro Trima Version 4, Gambro Trima Accel (Version 5), Amicus, and Baxter Alyx. The RBC can be collected concurrently (with other components) in some instruments or separately in others. Plasma is collected concurrently on several instruments. Plasmapheresis for plasma only is performed on the Fenwal Autopheresis C and Haemonetics PCS2. Granulocyte yields range from 0.46 x 10(10) to 1.0 x 10(10) for unstimulated donors and 2.1 x 10(10) to 2.6 x 10(10) for donors stimulated with dexamethasone or prednisone. The use of G-CSF and G-CSF with dexamethasone has substantially increased granulocyte yields with yields of 4.1 x 10(10) to 10.8 x 10(10) reported. Platelet collection rates of 0.045-0.115 x 10(11) plt/min have been reported. Collection efficiencies of 46-85.7% have been reported. Automated (apheresis) component collection has the advantages of controlled volumes or doses of component, efficient use of the donor, multiple components from the same donor, better inventory control, and better quality control due to less manipulation of the individual components. Disadvantages of automated component collection include the use of expensive equipment and disposables, the need for specially trained machine operators, and lower capacity to collect large volumes of blood compared to whole blood donation. The use of apheresis component collection is rapidly growing to provide the best blood components in the most efficient manner.

Automated red cell collection--quality and value

Automated red cell collection was initially used largely for therapeutic purposes. New technology has rendered the procedure safer for donors and easier for machine operators. Optimal additive solution can be automatically added and the red cells filtered to provide a leucodepleted product. Two units of red cells may be collected during a single procedure from individuals who have a high enough red cell mass, whilst a single unit of red cells plus platelets or plasma can be collected from smaller donors. In vitro studies suggested that red cells collected by automated methods would be of better quality than those collected by gravity. This was not confirmed in vivo, but red cells collected by automated methods have the major advantage of consistency in terms of haemoglobin content, volume and haematocrit, compared with red cells collected by gravity. This standardised product is of particular value for transfusion dependent patients as the patient's haemoglobin can be maintained within narrow limits. The use of a double dose red cell product for transfusion to a single patient also confers benefit in terms of reduction in donor exposure.

Variation of platelet production and discard rates in 17 blood centers representing 10 European countries from 2000 to 2002

BACKGROUND

New blood safety regulations raise costs and pressure blood centers to improve their efficiency. Evaluation of platelet (PLT) production and discards between centers of different size and nationality may provide a basis for more efficient PLT inventory management.

STUDY DESIGN AND METHODS

Data were gathered retrospectively for 2000 to 2002 from 17 blood centers in 10 European countries. The descriptive analyses comprised evaluation of PLT production methods and volumes. Discard rates were surveyed also for 2003 to 2004. The number of cellular blood components produced per working hour was expressed as an arbitrary labor index.

RESULTS

Seven hospital blood banks and 10 centers with other administrative systems participated in the study. Buffy coat (BC) and apheresis PLTs were used by all centers except two preparing all PLTs by apheresis. In 2002, 73 percent of all PLTs were produced by the BC method, and PLTs were utilized from 41 percent of whole-blood donations. One center also produced PLTs by the PLT-rich plasma method. Mean annual production volume of PLTs varied greatly, from 3,345 to 103,643 units, with an increase of 5.6 percent from 2000 to 2002. Three-year mean discard rates varied between 6.7 and 25 percent, and yearly mean discard rates remained at 13 percent in 2000 to 2002 and also in 2003 to 2004. Arbitrary labor index varied from 2.4 to 7.3 between centers.

CONCLUSIONS

PLT discard rates were relatively high in the European blood centers. Detailed information on specific causes for high discard rates would help improve the efficiency of PLT management, because blood centers cannot regulate demand. Use of labor resources in component preparation also remains an important target for further research.

Two red blood cell units collected in SAG-M additive solution with the ALYX component collection system

The first protocol available for the new ALYX component system (Baxter Healthcare Inc.) allows automated collection of two Red Blood Cell (RBC) units from one donor. The primary objective of our evaluation was to assess donor safety, comfort and to check the quality of blood products collected. 30 procedures were performed on eligible donors according to French best donation practices. Eligibility criteria were defined in order to ensure a post donation hemoglobin concentration of 11 g/dL minimum. Pre donation ferritin level was also checked. 360 ml of absolute RBC were collected from each donor. Donors physiological parameters and haematological profile were measured immediately before and after donation. Adverse events and donors were observed during the procedure and followed daily during 5 days after donation. Hemolysis in RBC was followed until of shelf life (<0.8% on 42 days storage). The evaluation of different parameters during storage show no difference if we compare with the manual technique. The concentration of hemoglobin is good and all ou concentrates are conform. No serious adverse effects were reported during and after donation. All donors confirmed they would agree to donate 2 RBC units again with this system. We have seen a good quality of RBC products. This evaluation indicates that 2 RBC donation is feasible on the ALYX system, comfortable and safe for eligible donors.