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Donor Blood-Count Changes During and After Plateletpheresis

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Donor Blood-Count Changes During and After Plateletpheresis Donor blood-count changes during and after plateletpheresis Comparison of two cell-separator techniques1 Susan M. Bator, M.D. Thirty-two platelet donors at the Cleveland Clinic Foundation Gerald A. Hoeltge, M.D. were monitored for white blood cell count, leukocyte differential, red blood cell count, and platelet count before, during, and after the collection of platelets. Counts were performed at 15-minute intervals during plateletpheresis using the Fenwal CS 3000 cell separator and at the beginning of each draw cycle using the Haemonetics V50 cell separator. Red blood cell concentration declined significantly (p < 0.05). Leukocyte counts decreased ini- tially^ < 0.05), followed by a secondary rise, and reached a plateau below the initial value. Platelet counts declined steadily with a net loss comparable to the platelet yield. Platelet collection efficiencies on the two machines were not significantly different. * Index terms: Blood component removal • Blood donors • Blood platelets Cleve Clin J Med 54:411-416, Sep/Oct 1987 Apheresis is the removal of whole blood from an individ- ual, the separation of that blood into its components, retention of one or more components, and return of the 1 Division of Laboratory Medicine (S.M.B.) and remaining constituents to the individual. The terms plate- Department of Blood Banking, (G.A.H.), Cleveland letpheresis, leukapheresis, and plasmapheresis refer to the Clinic Foundation. Submitted for publication Nov selective removal of platelets, white blood cells, and plasma, 1986; accepted Jan 1987. respectively. Apheresis has been demonstrated to be an See also the editorial by Warkentin effective form of treatment in various diseases and may be (pp 381-383). used to obtain appropriate blood components for infusion into patients with a deficiency of that blood constituent. 0891-1150/87/05/0411/06/$2.50/0 Centrifugation and membrane filtration have been used Copyright © 1987, The Cleveland Clinic Foun- as separation methods. Discontinuous- and continuous-flow dation systems are currently the most commonly used techniques. 411 Downloaded from www.ccjm.org on September 28, 2021. For personal use only. All other uses require permission. 412 Cleveland Clinic Journal of Medicine Voi. 54, No. 5 Table 1. Age and sex of platelet donors blood components are returned to the donor in Haemonetics V50 Fenwal CS 3000 plateletpheresis, blood cell count studies are of Males Females Males Females interest to demonstrate donor safety. The pres- (y) (yr) (yr) (yr) ent study measures alterations in donor blood 26 29 24 22 cell counts during plateletpheresis using a contin- 26 32 26 24 uous-flow system and a discontinuous-flow sys- 27 34 26 tem. 30 41 28 30 44 30 36 48 30 Materials and methods 41 52 47 48 50 Thirty-two healthy donors at The Cleveland 50 54 Clinic Foundation were studied with respect to 52 red blood cell count, white blood cell count, 52 platelet count, and leukocyte differential before 56 plateletpheresis, at regular intervals during the 60 ? collection, and following the termination of the procedure. The age and sex of donors are re- corded in Table 1. A minimum of 3 X 1011 platelets per unit was obtained from each donor.5 A discontinuous-flow system requires one veni- Continuous-flow plateletpheresis using the Fen- puncture site, using a low-gauge needle. A small wal CS 3000 cell separator (Fenwal Laboratories, volume of whole blood is removed from the Inc., Deerfield, IL) (n = 16) and discontinuous- donor, blood flow stops, the whole blood is sep- flow plateletpheresis using the Haemonetics V50 arated into its components via the centrifuge, cell separator (Haemonetics Corp., Braintree, and undesired components are returned to the MA) (n = 16) were compared. Samples from the donor. The process is repeated. A continuous- Fenwal CS 3000 group were collected at the flow system requires two venipunctures, a draw beginning of the procedure and at 15-minute line, and a return line, and uses higher-gauge intervals thereafter, with the final sample collec- needles. Removal of blood from the donor, sep- tion just before termination of the donation. aration of whole blood into its components, and Samples from the Haemonetics V50 group were infusion of undesired components are continuous collected at the beginning of each draw cycle and throughout the procedure. A "surge pump" col- at the end of the procedure. Blood samples were lection system, which is a modified centrifuga- collected via a Y connector placed just above the tional device, has been used experimentally in point of addition of adenosine-citrate-dextrose plateletpheresis.1,2 Flat- and hollow-fiber filtra- solution. A total of 2 to 3 mL of blood was tion devices are promising for the removal of collected per specimen. specific plasma components, however, these tech- The means of the platelet count, red blood cell niques are not yet routinely used for component count, total white blood cell count, and percent- preparation. ages of granulocytes and lymphocytes were cal- Risks associated with apheresis include hypo- culated per time interval or draw cycle for each volemia, citrate reactions, blood loss, red cell group. The data gathered on the Haemonetics hemolysis, air embolism, hepatitis, and depletion V50 and Fenwal CS 3000 were compared, match- of plasma constituents.3 Complications are more ing draw cycle and interval for each of the five frequent during therapeutic apheresis than dur- variables. An unpaired two-tailed t test was used ing component preparation, due to the morbid to compare the data. The limit of statistical sig- condition of the patient. The study of dynamic nificance was set at p < 0.003 obtained by the changes in cellular and solute concentrations dur- Bonferroni method, a multiple comparison pro- ing apheresis is straightforward in healthy blood cedure.6 donors. Such studies are important to maximize The early and overall variations in the cell the safety of the apheresis process. counts were measured for each of the five vari- Increasing demand for platelet transfusion im- ables using the previously calculated means. The plies the need to recruit greater numbers of early changes within groups for each machine donors,4 and ensuring the safety of the donors is were calculated using the differences noted be- a crucial factor in recruitment. Although most tween the first and second or first and third Downloaded from www.ccjm.org on September 28, 2021. For personal use only. All other uses require permission. September/October 1987 Cleveland Clinic Journal of Medicine 413 Table 2. RBC, WBC, and platelet counts (mean ± SD) for Fenwal CS-3000 Volume (mL) Granulocyte Lymphocyte Platelets (Time, min) RBC(xlO'VL) WBC(xl09/L) (%) (%) (X109/L) 0(0) 4.67 ± .34 7.03 ± 2.30 62 ± 7 32 ±6 290 ± 88 650(15) 4.47 + .29 6.27 ± 2.19 67 + 7 29 ±6 263 + 76 1300 (30) 4.52 ± .32 6.22 ± 1.92 66 ± 4 27 ±6 242 ± 63 1950 (45) 4.50 ± .36 6.38 ± 2.13 67 ± 6 27 ± 6 235 ± 68 2600 (60) 4.46 ± .31 6.42 ± 2.11 69 ±6 26 ± 6 220 ± 66 3250 (75) 4.45 ± .32 6.66 ± 2.06 68 ± 8 27 ± 7 206 ± 54 3900 (90) 4.49 ± .37 6.74 ± 2.23 66 + 6 27 + 6 201 ± 54 4550 (105) 4.42 ± .49 6.83 ± 2.45 66 ± 7 28 ± 7 191 ± 48 Table 3. RBC, WBC, and platelet counts (mean ± SD) for Haemonetics V50 Volume (mL) Granulocyte Lymphocyte Platelets (Cycle) RBC(XIO'7L) WBC(X109/L) (%) (%) (X109/L) 0(1) 4.82 ± .37 6.47 ± 1.47 64 + 12 30+ 12 287 ± 65 450 (2) 4.64 ± .38 5.79 ± 1.34 64 ± 10 30 ± 12 262 ± 64 900 (3) 4.77 ± .35 5.76 ± 1.33 66 ± 13 28+ 12 251 ± 65 1350 (4) 4.63 ± .49 5.81 ± 1.34 67 ± 10 27 ± 11 241 ± 59 1800 (5) 4.75 ± .38 6.06+ 1.12 64 ± 12 28 ± 12 242 ± 57 2250 (6) 4.66 ± .43 5.95 ± 1.25 66 ± 12 28 ± 12 224 ± 49 2700 (7) 4.62 ± .29 5.97 ± 0.87 67 + 10 26 ±9 231 ± 46 3150 (8) 4.62 ± .43 6.11 ± 1.06 70 ± 10 24 ± 8 233 ± 61 specimens. The initial change utilized the first Paired two-tailed t-test analyses were used to and third specimens if the difference between the test for differences in initial and overall changes second and third specimens was greater than that for each blood component, and to test for a between the first and second specimens. The difference between machines for collection effi- early variations were calculated to determine if ciencies. Differences were considered statistically significant changes in blood count occurred early significant for each of these analyses if the p value or late in the donation process. The predonation- was <0.05. postdonation difference was also calculated within each group. Results Platelet yield was measured for each of the 32 Of the 16 donations using the Fenwal CS 3000, donations. The total blood volume processed was 13 lasted the complete 105 minutes. Of the re- measured for each donor in the Fenwal CS 3000 maining three, two lasted 90 minutes and one group. In the Haemonetics V50 group, a calcu- was terminated at 75 minutes. Samples at 15, 45, lated value was recorded for the total blood vol- and 60 minutes clotted in one case and counts ume processed, using 500 mL as the blood vol- were unattainable. The 30-minute sample differ- ume per pass. The actual blood volume processed ential was unavailable for one donor. was calculated by subtracting the volume of an- The results for the Fenwal CS 3000 group are ticoagulant added from the total blood volume shown in Table 2.
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