Apheresis Research Articles

10 Granulocyte/monocyte apheresis as maintenance therapy in crohn’s disease

Background Granulocyte, monocyte apheresis (GMA), extra-corporeal absorptive circuit used to treat acute ulcerative colitis (UC) and Crohn’s disease. Use in maintenance therapy following remission is uncertain. Aim To present the outcomes following treatment of 5 patients with maintenance GMA for Crohn’s disease. Method Notes review of patients. Assessed blood results (full blood count, albumin, c-reactive protein) faecal calprotectin (FC), imaging and subjective patient reporting to determine the response Results 5 patients (P) were included, of whom: 4 were male, mean age 37.4 (24–57) years. All received previous conventional therapies with no or limited effect or had lost response. All had 8 treatments at weekly intervals as acute therapy followed by maintenance at monthly intervals. P1 (30 year old male, small bowel (SB) Crohn’s), 40 columns, consistent normalisation in all markers and FC (from >600 to 248), reversal of temporary colostomy, improvement on MRE, subjective improvement. P 2 (46 year old male, SB Crohn’s) 12 columns, consistent improvement in bloods, subjectively in remission. P3 (24 year old male, Crohn’s colitis) 9 columns, initial subjective improvement, bloods unchanged from baseline but normal, switched to vedolizumab. P4 (30 year old male, SB Crohn’s) 5 columns, no subjective change, stopped. P5 (57 year old female, SB Crohn’s) 4 columns, improvement in C-reactive protein, others consistently normal, no change from baseline, subjective improvement but stopped. Conclusions Five patients received maintenance therapy. Consistent biochemical/subjective symptomatic remission was achieved in two (P1 and 2), subjective remission in a third (P5) but no response in P3 and 4. Remission appeared to continue in those with elevated baseline markers of inflammation. SB Crohn’s may respond better than colitis. GMA may have a role as maintenance therapy.

Long-interval Cytapheresis as a Novel Therapeutic Strategy Leading to Dosage Reduction and Discontinuation of Steroids in Steroid-dependent Ulcerative Colitis.

Objective This study was performed to confirm the efficacy of long-interval cytapheresis on steroid-dependent ulcerative colitis (UC). Methods To discontinue steroids in patients with steroid-dependent UC, we previously designed a novel regimen of cytapheresis (CAP), which we termed “long-interval cytapheresis (LI-CAP)”, in which CAP was performed as one session every two or three weeks and continued during the whole period of tapering steroid dosage. In this study, we performed LI-CAP therapy 20 times (11 male and 9 female; mean age 41.8 years) between April 2010 and April 2015 for 14 patients with steroid-dependent UC. We evaluated the effectiveness of LI-CAP by examining the improvement in Lichtiger's clinical activity index (CAI), the rate of clinical remission, and the rate of steroid discontinuation. We further examined the rate of sustained steroid-free clinical remission at 6 and 12 months after LI-CAP in patients who successfully discontinued steroid-use after LI-CAP. The primary endpoint was the rate of discontinuation of steroids after LI-CAP. Results The mean CAI score before LI-CAP (7.550) significantly decreased to 1.65 after LI-CAP (p<0.0001). The rate of clinical remission after LI-CAP was 80%. The rate of steroid discontinuation after LI-CAP was 60.0%. The mean dose of daily prednisolone was significantly decreased after LI-CAP (2.30 mg) compared with that before therapy (17.30 mg) (p=0.0003). The rate of sustained steroid-free clinical remission after LI-CAP was 66.7% at 6 months and 66.7% at 12 months. Conclusion We confirmed that LI-CAP has therapeutic effects on reducing the dosage and discontinuing steroids in patients with steroid-dependent UC.

Extended Storage of Refrigerated Platelets in Isoplate and Intersol PAS: An Evaluation of Two FDA-Approved Methods of Collection

▪Platelets (PLTs) are essential for effectively treating severe hemorrhage. While widely considered standard-of-care, storage at room temperature (RT) is limited to 5 days due to bacterial growth risk, loss of function, and increased metabolism. Cold storage (4oC, 4C) slows bacterial growth and better preserves PLT function but also causes increased PLT activation. Storing PLTs in the cold in 65% PLT additive solution (PAS)/35% plasma has been shown to reduce activation and preserve PLT function (Getz, et al. 2016). In the US, only 2 apheresis (AP) and PAS systems are FDA-approved: Trima and Isoplate-PAS (ISO-PAS; Terumo) and Amicus and Intersol-PAS (INT-PAS; Fenwal). Differences in collection processes and PAS composition warrant distinct regulation. The goal of this study was to perform a comprehensive analysis of long-term 4C-stored PLTs collected via FDA-approved AP/PAS methods.AP PLTs were collected (n=4-5) in 65% ISO-PAS using a Trima (ISO) or in 65% INT-PAS using an Amicus system (INT). All bags were stored for 15 days at 4C without agitation and assayed on Day 1 (baseline, BL), 5, 10, and 15 of storage. PLT count and mean platelet volume (MPV) were obtained using a Coulter counter. Lactate and pH were obtained with i-STAT. All PLT samples were adjusted to a count of 3x105/μl using pooled fresh frozen plasma prior to functional testing. Chrono-Log aggregation was performed with ADP (5 μM), collagen (2.5 μg/ml), TRAP (20 μM), and epinephrine (EPI; 2 μM). Clot strength was evaluated using rotational thromboelastometry (ROTEM). Flow cytometry was used to assess PLT marker abundance (% positive) for CD62P (P-selectin), lactadherin (surface phosphatidylserine [PS]), and CD42b (GPIb). An Amnis ImageStream cytometer was used to visualize PLT mitochondrial depolarization and CD41a expression. Data were reported as means±SEM and analyzed with 1-way ANOVA and student’s t-tests for multiple comparisons; significance at p<0.05.pH (Fig. 1A) was only higher in INT on Day 1 compared to ISO. More lactate production was seen in INT compared to ISO (Fig. 1B). PLT count (Fig. 1C) was significantly higher at all timepoints compared to ISO, no significant differences were observed after 15 days. ISO showed a slight advantage in terms of functional preservation (Fig. 1 D-G). Aggregation response to collagen (Fig. 1E) was preserved in ISO until Day 10, whereas INT showed a significant decrease as early as Day 5 (Day 5: 45±7% vs Day 1: 98±4%; p<.001). Though aggregation response to ADP was similar in both ISO and INT samples (Fig. 1D), increased spontaneous aggregation (Fig. 1F) was exhibited in INT by Day 10 compared to both BL-INT and Day 10-ISO (Day 10-INT: 13±2% vs BL-INT: 0%; p<.001; Day 10-INT vs Day 10-ISO: 4±%; p=0.02). Responses to TRAP and EPI were comparable for ISO and INT. While a significant change in MCF was observed at Day 15 in ISO compared to BL (Day 15: 45.5±1.6, BL: 55±1, p=.002), INT showed a significant decrease in function by Day 10 (Day 10: 45.1±1.3 vs BL: 57.1±0.9; p<.001). PS expression (Fig. 1H) increased at Day 10 in both ISO and INT compared to their respective BL levels.Producing a hemostatically effective PLT product with an extended shelf-life is of utmost importance due to recent epidemics of viruses such as Chikungunya and Zika and the concomitant increased risk of transfusion-transmitted disease. Storing PLTs at 4C in PAS offers preservation of PLT function for up to 15 days, potentially tripling the current shelf-life of PLT products. We have shown that PLTs collected with Trima in ISO offer better in vitro functional preservation over storage than PLTs collected with Amicus in INT. Implementation of 4C-PAS PLTs may allow for shipment of PLT products to epidemic disease areas and may enhance blood product support for trauma by increasing local inventories and PLT availability in remote locations. Further study and refinement of 4C-stored ISO and INT collection and storage techniques may result in additional improvements in PLT shelf-life and function. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Poster Session 1The imaging examination and quality assessmentP185Why did the normal values of the left and right atrial volumes increase in the recent chamber quantification guidelines update?P186Atrial electromechanical delay, Left Atrial mechanical functions and longitudinal left ventricular strain in pre-diabetic patientsP187A web-based platform for e-training in echocardiographyP188Righ atrial size as a marker of success in electrical cardioversion in patients with

Poster Session 1The imaging examination and quality assessmentP185Why did the normal values of the left and right atrial volumes increase in the recent chamber quantification guidelines update?P186Atrial electromechanical delay, Left Atrial mechanical functions and longitudinal left ventricular strain in pre-diabetic patientsP187A web-based platform for e-training in echocardiographyP188Righ atrial size as a marker of success in electrical cardioversion in patients with

Progress in mobilization of autologous hematopoietic stem cell transplantation in treatment of multiple myeloma

Several factors influence mobilization outcomes, including older age and disease state. The type of prior chemotherapy (melphalan), a higher number of prior treatment lines, prior irradiation or the CD34+ cell count in peripheral blood before apheresis was applied. Common mobilization regimens consist of monotherapy with G-CSF and chemotherapy +G-CSF. The HSC mobilization effect is enhanced in chemotherapy +G-CSF compared with G-CSF alone, while its incidence and severity of side effects are increased at the same time. The appropriate mobilization regimen is based on patients' disease state and physical condition. Plerixafor, a novel agent, can be used to enhance the HSC mobilization effect of G-CSF, especially in poor mobilizers after chemomobilization. Other novel regimens are currently being evaluated in different trials. Key words: Multiple myeloma; Autologous hematopoietic stem cell transplantation; Mobilization

Differences in levels of platelet-derived microparticles in platelet components prepared using the platelet rich plasma, buffy coat, and apheresis procedures

BackgroundThere has been an increased interest in platelet-derived microparticles (PMPs) in transfusion medicine. Little is known about PMP status during the preparation of platelet concentrates for transfusion. AimThe aim of this study is to compare the PMP levels in platelet components prepared using the buffy coat (BC), platelet-rich plasma platelet concentrate (PRP-PC), and apheresis (AP) processes. MethodsPlatelet components were prepared using the PRP-PC and BC processes. Apheresis platelets were prepared using the Trima Accel and Amicus instruments. The samples were incubated with annexin A5-FITC, CD41-PE, and CD62P-APC. At day 1 after processing, the PMPs and activated platelets were determined using flow cytometry. ResultsBoth the percentage and number of PMPs were higher in platelet components prepared using the Amicus instrument (2.6±1.8, 32802±19036 particles/μL) than in platelet components prepared using the Trima Accel instrument (0.5±0.4, 7568±5298 particles/μL), BC (1.2±0.6, 12,920±6426 particles/μL), and PRP-PC (0.9±0.6, 10731±5514 particles/μL). Both the percentage and number of activated platelets were higher in platelet components prepared using the Amicus instrument (33.2±13.9, 427553±196965 cells/μL) than in platelet components prepared using the Trima Accel instrument (16.2±6.1, 211209±87706 cells/μL), BC (12.9±3.2, 140624±41003 cells/μL), and PRP-PC (21.1±6.3, 265210±86257 cells/μL). ConclusionsThe study suggests high variability of PMPs and activated platelets in platelet components prepared using different processes. This result may be important in validating the instruments involved in platelet blood collection and processing.

Microparticle and mitochondrial release during extended storage of different types of platelet concentrates

On activation, platelets release vesicles called microparticles (MPs). MPs are heterogeneous with regard to the presence or absence of mitochondria. We quantified MPs in platelet concentrates (PCs) taking their mitochondrial content into account. Platelet-rich plasma (PRP), buffy coat (BC) and apheresis (AP) PCs were tested through 7 days of storage. A combination of flow cytometry and spanning-tree progression analysis of density-normalized events (SPADE) was used to determine MP and mitochondrial release during storage. All the PC biochemical parameters complied with transfusion standards at all times. Platelet activation markers increased during storage and were higher for PRP than other types of PCs. Concentrations of MPs and extracellular mitochondria interpreted by SPADE algorithm were significantly higher in PRP than other in PCs and were stable throughout storage. The mode of preparation, rather than storage duration, impacts the release of MPs and mitochondria in PCs.

Apheresis illustrated: I can see it now.

Apheresis illustrated: I can see it now.

The 1st and the 2nd Italian Consensus Conferences on low-density lipoprotein-apheresis. A practical synopsis and update.

The clinical indications and guidelines for low-density lipoprotein (LDL)-apheresis set by the 1st Italian Consensus Conference held in Ostuni in 1990 and completed in 1992, but never published, are reported schematically. In 1994, within the Project "Prevention and control of the factors of the disease (FATMA)" by the Italian National Research Council, subproject 8 "Control of cardiovascular disease", a "Hearing on therapeutic apheresis: need for a target-oriented project" was organised. The meeting was the last scientific initiative on LDL-apheresis supported by public funds in Italy. After roughly two decades of use of LDL-apheresis, new guidelines were required based on the latest scientific evidence. In 2006, the Italian multicentre study on LDL-apheresis Working Group (IMSLDLa-WP), a scientific initiative at national level, was developed. It initially gathered together 19 Italian centres qualified for the application of lipid apheresis and LDL-apheresis (2007-2008), then 23 in 2010, located in the north, south, centre of Italy and in Sicily and Sardinia. The multicentre study aimed to validate the protocol for selecting patients and to create a network between the Italian centres. A secondary objective was the creation of a database of patients with familial hypercholesterolaemia and other severe forms of dyslipidaemia undergoing treatment with LDL-apheresis using the available techniques. Since LDL-apheresis has multidisciplinary treatment indications, the agreement on the new guidelines was reached through a panel of experts, of different medical and surgical specialties, with scientific and medical interest in the treatment indications, application and development of LDL-apheresis. The initiatives of the IMSLDLa-WP led to the 2nd Italian Consensus Conference on LDL-apheresis held in Rome in 2009. The previous and most recent guidelines are reported here synoptically.

Changes of parathyroid hormone level and its impact on immune function in long-term apheresis platelet donors

Objective To explore the changes of levels of parathyroid hormone (PTH) and its impact on the immune function in the long-term apheresis platelet donors. Methods From 7th October 2015 to 5th December 2015, a total of 30 blood donors who donated apheresis platelet in Yantai Central Blood Station of Shandong province were included in this study as research objects, and put into the study group (n=30). The study group inclusion criteria were ① donated blood were apheresis platelet; ② donate apheresis platelet for 5 years and over 10 times for each year; ③ before blood donation, the results of physical examination and blood tests of each donor were in line with Donor Health Inspection Requirements (GB18467-2011). Exclusion criteria were ①any results of physical examination and blood tests before blood donation were incompatible with Donor Health Inspection Requirements (GB18467-2011); ② donors who did not want to participate in this trial. According to gender and age, a total of 30 donors who donated whole blood for the first time in the same period were included in control group (n=30). The control group inclusion criteria were ① donated blood were whole blood; ② the first blood donation; ③ before blood donation, the results of physical examination and blood tests of each donor were in line with Donor Health Inspection Requirements (GB18467-2011). Exclusion criteria were ①any results of physical examination and blood tests before blood donation were incompatible with Donor Health Inspection Requirements (GB18467-2011); ② donors who did not want to participate in this trial. Using enzyme-linked immunosorbent assay (ELISA) to detected the level of serum PTH and immunoglobulin (Ig) M, IgG and IgA of donors in study group before the blood supply, 1, 24 h and 7 d after blood supply, and those of control group before the blood supply. Using flow cytometry (FCM) detected CD3+ T cells absolute counts, CD4+ T cells, CD8+ T cells and CD4+ CD8+ T cells of donors in study group before blood supply, 1, 24 h and 7 d after blood supply, and those of control group before the blood supply. All these indicators mentioned above were analyzed and compared by statistical method. There were no significant differences of subjects' general features between two groups, such as age and gender ratio(P>0.05). Donors recognized the necessity of research on correlation between blood donation and health of donors, and informed consent was obtained from all participants. Results ① There were no significant differences in the levels of PTH, IgM, IgG and IgA between the study group donors and the controls before blood donation (P>0.05). Similarly compared with the control group, there were no significant differences in the absolute counts or the percentage of T cell subsets (CD3+ T cells, CD4+ T cells, CD8+ T cells and CD4+ CD8+ T cells) and the ratio of CD3+ CD4+ T cells/CD3+ CD8+ T cells at baseline. ②However, the PTH levels at 1 h after donation in the long-term apheresis platelet donors were significantly higher than both those before donation and the controls [(72.47±7.25) ng/L vs (54.70±6.59) ng/L, t=9.937, P 0.05). Furthermore, there were no significant differences in the levels of IgM, IgG and IgA at 1, 24 h and 7 d after donation of the apheresis platelet donors compared with those of the control group (P>0.05). ③ There were no significant differences in the absolute counts or the percentage of T cell subsets (CD3+ T cells、CD4+ T cells、CD8+ T cells和CD4+ CD8+ T cells) as well as the ratio of CD3+ CD4+ T cells /CD3+ CD8+ T cells, compared with those of control group (P>0.05). Conclusions The levels of PTH in long-term apheresis platelet donors had short-term changes, but had no impact on the immune function, and our current apheresis platelet donation mode dose not affect the health of unpaid blood donors. Key words: Blood platelets; Blood donors; Parathyroid hormone; Immunoglobulins; T-lymphocyte subsets

Lipoprotein apheresis for the treatment of elevated circulating levels of lipoprotein(a): a critical literature review.

Lipoprotein(a), which consists of a low-density lipoprotein (LDL) particle linked to an apolipoprotein(a) moiety, is currently considered an independent risk factor for cardiovascular disease due to its atherogenic (LDL-like) and prothrombotic (plasminogen-like) properties. The aim of this review is to provide an overview of the current and newer therapies for lowering increased lipoprotein(a) levels, focusing on lipoprotein apheresis. After a systematic literature search, we identified ten studies which, overall, documented that lipoprotein apheresis is effective in reducing increased lipoprotein(a) levels and cardiovascular events.

Clinical analysis of essential thrombocythemia and pregnancy: treatment and outcomes

Objectives To summarize the maternal and fetal outcomes of patients with essential thrombocythemia (ET), and tentatively propose possible solutions for different clinical scenarios. Methods We retrospectively studied the clinical data, treatment, outcomes and follow-up status in 18 consecutive cases of young women with ET visited Peking University People's Hospital, among whom 22 pregnancies occurred from March 2005 to January 2015. Rank-sum test, Chi-square test or Fisher exact test were applied for statistics. Results (1) Out of the total 22 pregnancies, 17 (77%) were successful (term live births) and five (23%) ended in miscarriages, among which four were spontaneous abortion in first trimester. (2) Six pregnancies did not received any therapy, while 16 received various treatments before and/or during pregnancy, including oral Aspirin(single/joint), Hydroxyurea, Interferon-α(IFN-α) and platelet apheresis. (3) Treatments before/during pregnancy improved the live birth rate significantly (15/16 vs 2/6, P=0.009). Platelet (PLT) count of the newborns were all normal till the time at follow-up. (4) The median PLT count in those patients before Aspirin therapy was 761×109/L[ (448-1 213) ×109/L, and 639×109/L[ (283-1 908) ×109/L] thereafter, which showed no significant difference (Z=-0.405, P=0.686) . (5) The PLT counts in those patients before combination therapy of Aspirin and IFN-α was 989×109/L[ (435-1 504) ×109/L], and 498×109/L[ (186-559) ×109/L] thereafter, which decreased significantly (Z=-2.366, P=0.018). Conclusions (1) First-trimester spontaneous abortion is the most common complication of ET in pregnancy. (2) A specific treatment strategy may improve the pregnant outcomes without long-term harmful effect up to now. (3) IFN-α and/or Aspirin might be the first-line therapy in women with ET during pregnancy. Key words: Pregnancy complications, hematologic; Thrombocythemia, essential; Aspirin; Interferon-alpha; Pregnancy outcome

Recolección de plaquetas mediante aféresis, rendimiento y el efecto de las variables de los donadores en el proceso

A retrospective study using records of aphaeresis platelet donors at the blood bank of the Hospital Mexico donations between 2011 and 2014, to evaluate the performance and characteristics of the donors which may influence this quality and efficiency of platelets concentrate collections. A total of 1 480 plateletpheresis collections were performed to 501 donors, 242 were a single product collection, 1013 were a double the product collection and 225 triple the product was collected, 34.9% of donors were female and 65.1% male donors. In the programmed collection procedures for single product (2.5X1011), double product (5x10n) and triples (7.5x10n) the real yields obtained were 3.04x10n, 5.12x10n and 7.73x10n in respective order. States that selecting donors over 220 x103 platelets and more than 60 kg weight were able to make the donation of double product in less than 69 minutes and if these parameters increase to 305 x103 platelets and 65 kg per donor, 94% of donors may make donations of triple product in less than 69 minutes so reducing the cost-effectiveness ratio of platelets donation using aphaeresis, without any additional risk and obtaining product of excellent yield ratio and quality.

Improving platelet transfusion safety: biomedical and technical considerations.

Platelet concentrates account for near 10% of all labile blood components but are responsible for more than 25% of the reported adverse events. Besides factors related to patients themselves, who may be particularly at risk of side effects because of their underlying illness, there are aspects of platelet collection and storage that predispose to adverse events. Platelets for transfusion are strongly activated by collection through disposal equipment, which can stress the cells, and by preservation at 22 °C with rotation or rocking, which likewise leads to platelet activation, perhaps more so than storage at 4 °C. Lastly, platelets constitutively possess a very large number of bioactive components that may elicit pro-inflammatory reactions when infused into a patient. This review aims to describe approaches that may be crucial to minimising side effects while optimising safety and quality. We suggest that platelet transfusion is complex, in part because of the complexity of the "material" itself: platelets are highly versatile cells and the transfusion process adds a myriad of variables that present many challenges for preserving basal platelet function and preventing dysfunctional activation of the platelets. The review also presents information showing--after years of exhaustive haemovigilance--that whole blood buffy coat pooled platelet components are extremely safe compared to the gold standard (i.e. apheresis platelet components), both in terms of acquired infections and of immunological/inflammatory hazards.

AB066. Pseudohomozygous familial hypercholesterolemia has better outcome than homozygous familial hypercholesterolemia

Background Homozygous familial hypercholesterolemia (HoFH), due to the LDLR gene defect, is very rare. Drugs are largely not effective enough for HoFH patients except LDL apheresis or liver transplantation combined with cholesterol-lowering drugs. However, pseudohomozygous familial hypercholesterolemia, also known as sitosterolemia, is a recessively inherited disorder that results from mutations in either ABCG5 or G8 proteins, with hyperabsorption of dietary sterols and decreased hepatic excretion of plant sterols and cholesterol. Ezetimibe appears to reduce plasma plant sterol concentrations in patients with sitosterolemia in previous studies. In this study, we compare the clinical manifestations and treatment outcome of these two diseases.

Effect of storage time on metabolic function of apheresis platelets

Objective To study the effect of storage time on metabolic function of apheresis platelets. Methods Selected a total of 30 bags of apheresis platelets which were collected from 30 cases of voluntary blood donors as research subjects. The volume of each bag of apheresis platelets was one therapeutic dose, and platelet count was (2.5~3.0)×1011/L. All of 30 bags of apheresis platelets would been stored in storage tank for 5 days at 22 ℃. The 30 bags of apheresis platelets were randomly divided into storage for 1 day group (n=10), storage for 3 days group and storage for 5 days group (n=10) equally by digital table method after being numbered. Content of lactic acid, lactate dehydrogenase (LDH), content of glucose and pH value were detected among 3 groups. Relationship of the metabolic function of apheresis platelets and storage time were analyzed by statistical method. Results The longer the storage duration time of apheresis platelets was, the lower of pH values and content of glucose in apheresis platelets were, and there were significant differences among 3 groups (P<0.05). At the same time, contents of LDH and lactic acid in apheresis platelets were gradually increased, and there also were significant differences among 3 groups (P<0.05). Conclusions There are marked changes for metabolic function of apheresis platelets in storage of 5 days at 22 ℃. The shorter the storage duration time of apheresis platelets is, the better quality of apheresis platelets is. Key words: Blood component transfusion; Platelets transfusion; Apheresis platelets; Metabolism; Platelet function tests; Blood preservation; Clinical blood transfusion

Clinical efficacy of platelet concentrates prepared by improved buffy-coat method

Objective To explore the clinical efficacy and safety of platelet concentrates prepared by improved buffy-coat method. Methods From October 2012 to February 2014, a total of 89 cases of hospitalized patients in a certain hospital in Zhengzhou City who needed platelet transfusion were collected into this study, they were divided into study group (n=49) and control group (n=40) according to different kinds of platelet preparations they transfused. Patients in study group were transfused with platelet concentrates prepared by improved buffy-coat method, and patients in control group were transfused with apheresis platelets. Platelet counts were detected at pre-transfusion, 1 hour after transfusion and 24 hours after transfusion, then corrected count increment (CCI) was calculated. The improvement of bleeding in patients and transfusion adverse events were observed and recorded before and after transfusion. The platelet counts, CCI, transfusion efficacy and the incidence of adverse reactions in two groups were compared with each other by statistical methods. The study protocol was approved by the Ethical Review Board of Investigation in a certain hospital in Zhengzhou City. Informed consent was obtained from all participants. There were no significant differences of the age, gender ratio, type of diseases and platelet counts before blood transfusion between two groups (P>0.05). Results ①There were no significant differences in platelet content, capacity and the residual of white blood cells and red blood cells between apheresis platelets and platelet concentrates prepared by improved buffy-coat method (P>0.05). ②Platelet counts were significantly increased 1 hour and 24 hours after transfusion compared with the platelet counts before transfusion in two groups, and the differences were statistically different (P 0.05). ③There was no significant difference in rate of adverse reactions after platelet transfusion between two groups (P>0.05). Conclusions Platelet concentrates prepared by improved buffy-coat method are safety and efficacy for patients, whether it is worth of clinical promotion and application, still needs large sample and multicenter randomized controlled trials to confirm. Key words: Platelet concentrates; Improved buffy-coat method; Apheresis platelets; Treatment outcome

Procoagulant impact of the plasmapheresis procedure on coagulation state of collected plasma.

Plasmapheresis is a group of extracorporeal techniques that involve removal of whole blood, separation of plasma from cellular elements and partial return of blood components (at least the red blood cells) into the circulation. It is widely used for therapy and plasma collection with the purpose of either further transfusion or manufacture of medicines. Plasmapheresis necessarily involves significant contact of blood with inner surfaces of the plasmapheresis kit, so the possibility of contact activation of coagulation is a concern with regards to both donor safety and quality of the product obtained. Although initial1 (and some recent2) studies did not detect any noteworthy coagulation changes in donors’ blood, this view was challenged by other reports. Using a more sensitive global assay of thromboelastography, hypercoagulation was found following various apheresis procedures3. Some researchers found that there could be additional pro-coagulant mechanisms for donors who often undergo apheresis4, while others did not detect any differences in intensive donors5. Dangerous or even fatal venous and arterial thromboses were reported in individual cases after large-volume donations, usually when donors had pre-disposing risk factors6,7. Nevertheless, existing screening processes that plasma donors undergo do not take into account blood coagulation. There is even less information about the effect of plasmapheresis on the coagulation status of the collected plasma. Although the composition of such plasma with regard to coagulation factors and activation markers has been evaluated by some researchers8–10, we are not aware of any attempts to systematically compare the coagulation system in collected plasma with that of the original donor plasma. Here we carried out such a comparison using three global assays of the coagulation system: thrombin generation, thromboelastography and thrombodynamics together with clotting assays and other methods. Global assays that are increasingly used these days aim to mimic coagulation in vivo better11 and are particularly noteworthy for their ability to detect pro-coagulant changes, unlike traditional clotting assays12–15. Using these assays we found significant changes in coagulation occurred as a result of the plasmapheresis procedure.

Quality of thawed hematopoietic progenitor cell grafts

Background : The appropriate dose of compatible and viable hematopoietic progenitor cells (HPC) is crucial for successful engraftment of transplanted cells within patients. In the study we therefore checked the viability of HPC in thawed HPC grafts which were transplanted into haematology patients in one year. Methods: We acquired HPC by apheresis and froze them in a programmable freezer in autologous plasma with 10 % DMSO and stored them in liquid nitrogen vapour . We thawed the bags with HPC in a water bath at the patient's bedside and in the eluate residues from the bags after the addition of saline solution we determined the viability ( 7 - AAD) of HPC ( CD34 + ) and lymphocytes by flow cytometry. Results: After the transplantation of HPC, the viability of HPC was 79.9 ± 12.4 % and of leukocytes 62.2 ± 12.2 % (paired t-test, P 0.5). Rinsing of HPC bags and storing cells after thawing in saline solution significantly ( n = 7 ; paired t - test, P < 0.01) increased the mortality of HPC , since the viability immediately after thawing was 84.1 ± 4.5 % and in samples diluted with saline solution 60.1 ± 15.7 % . Conclusions: In our laboratory, cca 20 % of HPC are lost during freezing and thawing of HPC grafts. Freezing HPC grafts 18 hours after cell collection does not affect the viability of thawed cells in comparison with grafts which are frozen immediately. Saline solution is not suitable for rinsing bags and storing HPC residuals after thawing HPC products.

Clinical Indications and Adverse Reactions of Platelet Apheresis.

To determine the clinical indications and adverse reactions of platelet apheresis procedure. Cross-sectional, observational study. Blood Bank of Pakistan Atomic Energy Commission General Hospital, Islamabad, from January 2010 to December 2014. Indications and adverse reaction verified for 200 consecutive platelet apheresis donations performed for 125 patients was included in this study. Data was analysed for descriptive variables using SPSS version 16. Donor deferral rate in the study was 63.83%. All the donors were males (100%) and replacement donors. Most prevalent blood type was B-positive (n=63, 31.5%), followed by O-positive (n=59, 29.5%). Rh negative groups constituted 13.5% (n=27) of all the donors. Average age of platelet apheresis donors was 28.56 ± 5.77 years. Maximum numbers of donors were in age range 20 - 30 years. Average weight of the donors was 73.96 ± 11.96 kg. Mean pre-procedure platelet count of donors was 268,000/µL. The postprocedure average platelet count was approximately 200,000/µL. The mean duration of a platelet apheresis session was 78.27 ± 26.07 minutes. Average volume of the final product was 412.53 ± 45.33 ml. Average volume of anti-coagulant acid citrate dextrose used per procedure was 300 ± 40 ml, 245 ml returned to donor along with returned blood while 55 ml used as anticoagulant in final concentrate. Of total 200, two (1%) final products were contaminated with red cells. Three (1.5%) products were not issued and finally expired. Of the 125 patients for which plateletpheresis procedures were performed, 54 (43.2%) patients were males and 71 (56.8%) were females (M: F=0.76:1). Six donors (3%) had adverse events: three donors (1.5%) had mild reactions, two (1%) moderate reaction, and one donor (0.5%) developing hematoma. None had severe or life-threatening reactions. Plateletpheresis procedure is relatively safe and forms an important adjuvant to blood bank inventory.