Future directions in blood management and apheresis: the Dideco perspective

Abstract

Dideco has been present in the blood management field since 1979 with a centrifugal cell separator and filters for plasma production and treatments. The first apheresis system, Progress BT 790, was based on Latham bowl technology and dedicated to the production of hemocomponents and to therapeutic procedures (plasma exchange). The first European intraoperative blood salvage system for autologous washed blood reinfusion was directly derived from Progress and commercialized as Dideco Autotrans 795-A. This was a good example of the utilization of apheresis technology in a different application field. From the beginning of the 80s up to now the development of Dideco apheresis and auto-transfusion systems was oriented to improve the quality of the collected hemocomponents and to increase the global easiness of the systems for a wide and cost-effective usage. In the apheresis field this strategy brought to change the technology from the classical bowl system to a double stage soft belt that has been able to provide better results in terms of purity and efficiency. This new technology, together with the umbilical cord for closed system processing of blood, allows the continuous processing of blood with a small extracorporeal volume. The Dideco Excel Pro version 4.1 is the present expression of Dideco apheresis: a multipurpose closed system, for production of hemocomponents with high efficiency and purity, with an extremely low extracorporeal volume and the choice of a double or single needle operation. At the same time the system has been improved in order to perform therapeutic procedures such as plasma exchange and in the last years, stem cell collection, in a faster and more efficient way. The new clinical and economic concerns bring us to re-evaluate the apheresis systems in a different way: the system must be clinically efficient and at the same time the procedure must be cost-effective. A good example of the development in this direction is the dry platelet Excel procedure. In the latest version of the system, the user can collect platelets in a small volume of plasma, maintaining the good efficiency and purity of the system. This procedure brings two advantages: from a clinical standpoint the recipient is less subject to immunological reactions due to the reinfusion of plasma, and from an economic standpoint the simultaneous collection of apheresis platelets, real units of plasma and/or red cells is possible, going towards a total multicomponent procedure. In the therapeutic field, the development is even faster due to the not yet completely exploited potential of the systems in the stem cell field. Today the stem cell collection, the purification and the expansion are performed in three different steps and are considered as three different activities. More and more the integration of these phases will be important to increase the number of procedures and to reduce the handling required today for this processing. In particular the apheresis technology can help other fields, for instance, contributing to solve the problem of cord blood banking by reducing the volume of the product while maintaining a high stem cells recovery efficiency. The presence of several techniques for plasma treatments like plasma exchange, cascade filtration and immunoadsorption can be developed in order to find, once again, a good compromise between efficiency and costs. One direction Dideco is following is to guarantee the highest flexibility of the apheresis cell separator, in order to provide a performing system for all the different plasma treatment procedures allowing the blood center to choose patient by patient the best clinical strategy. Many other application fields can be evaluated, but only a direct and constant discussion between the industry and the scientific world can bring a fast development of these possibilities.