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Effect of Donor Variables on Platelet Yield Among Donor

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EFFECT OF DONOR VARIABLES ON PLATELET YIELD AMONG DONOR UNDERGOING PLATELETPHERESIS AT TRANSFUSION MEDICINE DEPARTMENT, DHAKA MEDICAL COLLEGE HOSPITAL (EXPERIENCE OF 350 PROCEDURES) KARIM S1, HOQUE MM2, HOQUE ME3, ISLAM K4, MAMUN ABM5 Abstract Background: The platelet transfusions help in prevention of bleeding related complications and thus prevents morbidity and mortality in thrombocytopenic patients. Platelet transfusion plays an important role in the treatment of haematological, oncological, surgical, and transplant patients. Platelets are transfused by two methods i) by fractionation of whole blood and ii) by platelet apheresis. Over the last decade there has been a trend towards the use of SDPs rather than pooled random donor platelets in thrombocytopenic patients. Optimization of platelet yield is an emerging issue to identify factors which may help in selecting donors to obtain higher platelet yields in shorter time and consequently better clinical outcome. Objective: The quality of single donor platelets (SDP) in terms of yield influences the platelet recovery in the recipient. The aim was to identify the SDP donor factors that influence platelet yield. Methods: The study was undertaken at transfusion medicine department, DMCH from 1st January 2017 to 31st December 2017. The study included 350 plateletpheresis procedures. All procedures were performed according to manufacturer’s manual and standard operating procedure. Results: During the period of study, 350 platelet pheresis donors were studied. All of the donors were male. Platelet yield showed high statistical significance with pre donation platelet count and its indices. (p=0.000). Statistical significant negative correlation was seen between pre donation Hb concentration and the platelet yield. (p =0.005). No statistical significance was seen height (p=0.933), weight (p=0.760) of donor on platelet yield. Conclusion: Platelet recovery in the patient is influenced by the transfused dose of platelets, which in turn is dependent on the quality of the platelet product in terms of yield. Various donor factors such as pre donation platelet count and haemoglobin concentration may affect platelet yield. Keywords: Single donor plateletpheresis; Cell separator, Platelet yield. J Dhaka Med Coll. 2019; 28(2) : 179-183 Introduction: Plateletpheresis (apheresis means to remove) is Platelet transfusion success depends on rational a procedure designed to collect large number use of platelet components and on the quality of of platelets from single donor thereby giving the component. Platelet recovery in a patient is more consistent product3 influenced by the transfused dose of platelets which in turn is dependent on the platelet yield.1 As per guidelines of American association of blood banks plateletpheresis (Single Platelet transfusions can be done either as i) a Donor Platelets) unit must have platelet count pool of 4 to 6 units of random donor platelet, of 3x 10 11which in turn raises platelet count by or ii) 1 unit of single donor platelet(SDP) is 30,000-60,000 per micro litre and is equivalent 2 transfused. to 4-6 units of random platelet concentrates 4 1. Dr. Shanaz Karim, Associate Professor, Department of Transfusion Medicine, Dhaka Medical College Hospital. 2. Dr. Md. Mazharul Hoque, Professor, Department of Transfusion Medicine, Dhaka Medical College Hospital. 3. Dr. Ehteshamul Hoque, Professor, Department of Oncology, Anwer Khan Modern Medical College Hospital. 4. Dr. Kashfia Islam, Assistant professor, Department of Transfusion Medicine, Dhaka Medical College Hospital. 5. Dr. A.B.M.AL-Mamun, Registrar, Department of Transfusion Medicine, Dhaka Medical College Hospital. Correspondence : Dr. Shanaz Karim, Associate Professor, Department of Transfusion Medicine, Dhaka Medical College Hospital, Dhaka, Mobile: 01715297287, E-mail: [email protected] Received: 02-03-2020 Revision: 05-04-2020 Accepted: 15-04-2020 J Dhaka Med Coll. Vol. 28, No. 2. October, 2019 The quality of the product is most important • Thus, a thorough history was taken and factor which will decide therapeutic benefit to samples were collected for complete blood patients. The American Association of Blood count as well as for Transfusion Transmitted Bank (AABB) standards requires that an Infection (TTI) testing. Samples from donor apheresis platelet component contain at least were evaluated for haemoglobin (Hb), total 3× 1011 platelets in 90% of sampled leukocyte count (TLC), haematocrit and units5 Leukocyte count of the apheresis platelet platelet indices (count, MPV, PDW) on an must be <5 × 106 as per AABB Standards and automated analyzer (Micros 60, Biomeriux). <1 × 106 as per European guidelines. The red Other donor variables such as age, gender, cell contamination should be <0.5 ml. Platelet weight and height were also documented. The increment in a patient is influenced by the donor blood should be cross match with transfused dose of platelets which in turn is patient’s blood. Before each procedure was dependent on the platelet yield6 obtaining higher undertaken Informed consent was obtained platelet yield has important clinical from donors. The plateletpheresis procedure implications: It reduces the frequency of platelet were performed using MCS plus Hemonetics transfusions and number of donor exposures intermittent flow cell separator. with important consequent clinical and Result: economic advantages. 7,8. During the study period, 350 plateletpheresis It has been shown that transfusion of high yield donors were studied. 256 donors were in the platelet products could reduce transfusion age group of 18-30 years; 93 donors were in requirements of a thrombocytopenic patient9. 31-50 years age group; 02 donors were in 51- Single donor platelet (SDP) products, unlike 65 years age group; Their mean age was pooled platelet concentrates lowers the risk of 28±8.06. transfusion transmitted infections, All of the donors were male. Female donors were alloimmunization and febrile non-hemolytic rejected due to low hemoglobin, difficulty in reactions10,11. Therefore, there is now more obtaining venous access because of lack of focus on the use of SDPs than pooled platelet prominent veins and increased subcutaneous fat. concentrates. Mean body weight of donors was 68.26±10.21 Methodology: The age, height, weight and haematological parameters of healthy donors is enlisted in The study was undertaken at transfusion Table-I. medicine department, DMCH from 1st January 2017 to 31st December 2018 The study included 350 plateletpheresis procedures. Donors were Table-I selected based on following criteria: Background information of donor Selection criteria were Parameter Range Mean±SD • Weight > 50 Kg Age 18-52 28±8.06 • Age 18-65 years Height (cm) 150-188 168.47 ±6.07 • Hemoglobin > 12.5 gm/dl Weight (kg) 50-108 68.26±10.21 • Platelet count >1.5 lac/ ìl. Hb (g/dl) 12.0-16.7 14.03±1.63 A gap of eight weeks from the last whole blood HCT 38.0-54.2 43.80±3.22 donation /three days from last plateletpheresis Platelets (103/µl) 150-437 275±53.84 • No intake of non-steroidal anti-infla- mmatory Table-II Shows statistical significant negative • Drugs in the last 36 hours. correlation was seen between pre donation Hb • Absence of any illness. concentration and the platelet yield (p =0.005). ABO identical donor for the patient. Out of 350/173 donors (49.42%) had Hb > 14 • Negative serology for HIV, HBsAg, HCV, gm/dl and 350/177 (50.57%) had Hb < 14 gm/ Syphilis and Malaria. dl. 180 Effect of Donor Variables On Platelet Yield Among Donor Undergoing Plateletpheresis Karim S et al Only 84 /173 (48.6%)of donors with pre Table-II donation Hb > 14 gm/dl had yield >3 × 1011/µl Correlation of pre-donation donor Hb with and 108 /177(61.0%)of donors with pre yield donation Hb <14 gm/dl had yield >3 × 1011/µl. Platelet yield *Percent of HB (g/dl) of donor Table-III Shows correlation between pre- 11 donation platelet count and the yield of platelets (10 /unit) Hb<14 Hb >14 Total in SDP. The mean platelet yield of all procedures < 2.5 4.0 (7) 10.4 (18) 7.1 (25) was 3.49±0.51. shows a direct correlation between pre-donation platelet count and the 2.5-3.5 35.0 (62) 41.0 (71) 38.0 (133) yield (p =0.000). >3.5 61.0 (108) 48.6 (84) 54. (192) 11 The yield was >3.5x 10 in >84.1% of N (Number 177 173 350 procedures when the pre-donation platelet count was >300 x103/µl of donor) However, no statistical significance was seen * Correlation between Hb and Platelet yield is 0.151. height (p=.0933), weight (p=0.760) of donor on There is Negative correlation between them. platelet yield in our study. (p-value 0.005) Table-III Correlation of pre-donation donor platelet count with yield Platelet yield(1011/unit) *Percent of pre-donation platelet count of donor <250 250-300 >300 Total < 2.5 20.5 (25) 0.0 (0) 0.0 (0) 7.1 (25) 2.5-3.5 63.9 (78) 32.2 (37) 15.9 (18) 38.0 (133) >3.5 15.6 (19) 67.8 (78) 84.1 (95) 54. (192) N (Number of donor) 122 115 113 350 *Correlation between Pre-donation platelet count and Platelet yield is 0.586. There is positive correlation between them. (p-value 0.000) Table-IV Linear Regression model of pre-donation donor background variable with yield Dependent variable Coefficient Standardized coefficient P-Value Age 0.003 0.075 0.211 Sex 0.284 0.114 0.057 Weight -0.001 -0.019 0.760 Height 0.000 0.005 0.933 Pre-donation platelet count 0.267 0.521 0.000 HCT -0.016 -0.030 0.627 Hb -0.034 -0.080 0.202 181 J Dhaka Med Coll. Vol. 28, No. 2. October, 2019 Discussion: Only 84/173 (48.6%) of donors with pre Platelet yield which is a measure of quality of donation Hb > 14gm/dl had yield >3 × 1011/ìl SDP, affects platelet recovery in the patients And 108/177 (61.0%) of donors with pre requiring platelet transfusion.
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