Continuous-flow Cell Separator Research Articles

Experiences of Therapeutic Plasma Exchange in geriatric patients at a tertiary care hospital in western Maharashtra: An observational study

BackgroundGeriatric patients undergo Therapeutic Plasma Exchange (TPE) for variety of indications that poses its unique challenges and complications. We present our experience with TPE in geriatric patients in terms of diseases encountered and adverse events, if any, witnessed during the procedure. MethodsA prospective analysis of TPE procedures was done for a period of 01 year. Patients above 60 years of age with a range of 01–02 volume exchange per procedure were enrolled in the study. Baseline procedure investigations such as complete blood count, serum electrolytes, coagulation profile, and transfusion-transmitted infection screening were carried out before the TPE procedure. All TPE procedures were performed using a continuous-flow cell separator. All these patients were followed-up, and findings related to patients and procedures were documented. ResultsA total of 21 eligible enrolled patients underwent 85 procedures in the present study. Neurological disorders (80.9%, n = 17) were most common indication, with Guillain–Barre syndrome (42.8%, n = 9) being tthe most replaced by second common, followed by myasthenia gravis (23.8%, n = 5). Barring one, all other patients showed significant clinical response. The overall incidence of complications during the study was 80.9% (n = 17), among which majority were patient-related (94.11%, n = 16). However, only one procedure was terminated due to a machine error, and there were no procedure-related deaths. ConclusionThe current study showed that TPE in geriatric patients gives substantial results in terms of clinical improvement but is fraught with multiple complications. However, in trained and expert hands, these complications can be managed effectively.

A study on beneficial impact of the use of medium-molecular-weight hydroxyethyl starch in granulocyte apheresis using continuous-flow cell separator Spectra Optia: A retrospective single-center study at a tertiary care oncology center.

Granulocyte transfusion is one of the best therapeutic modalities in prolonged neutropenic patients with severe bacterial/fungal infections. Granulocyte harvest using conventional acid citrate dextrose (ACD) anticoagulant (ACD-A) by apheresis is not satisfactory in comparison to the use of hydroxyethyl starch (HES), but the latter is associated with various adverse events, especially with high-molecular-weight HES. This study aimed to assess the beneficial impact of the use of medium-molecular-weight (MMW)-HES and trisodium citrate combination over ACD-A in granulocyte apheresis when using Spectra Optia. This was a retrospective study comparing granulocyte harvest results with the use of ACD or HES and trisodium citrate combination. All the donors in both the groups received single 600 μg of granulocyte colony-stimulating factor subcutaneous injection followed by 8 mg of dexamethasone tablet 10-12 h and omnacortil 60 mg orally 3 h before harvest. A number of adverse incidents, if any, were observed and noted. Donor/procedure parameters were compared using Mann-Whitney U-test/unpaired t-test. Granulocyte yield (mean: 3.29 × 1010/unit vs. 4.5 × 1010/unit in the ACD and HES groups, respectively, P ≤ 0.0001) was significantly better in the HES group. The collection efficiency was also better in the HES group (mean: 15.86% vs. 26.70% in the ACD and HES groups, respectively, P ≤ 0.0001) in the ACD and HES groups, respectively. There was no significant adverse event noted in any of these two groups. In our study, granulocytes with optimum yield can be easily harvested with Spectra Optia cell separator using 6% HES (MMW) and trisodium citrate combination with standard 12-h interval gap between mobilization and harvest. This strategy can also have no or minimal extra cost burden to patients.

Effect of plateletpheresis on haematological values in voluntary donors: a retrospective data analysis over an eight-month period

<p><strong>Aim</strong> <br />To analyse changes in haematological values after plateletpheresis in donor population with regard to donor safety.<br /><strong>Methods</strong> <br />A retrospective study was conducted on first time and repeated healthy donors over a period of eight months in the Blood<br />Transfusion Institute in the Federation of Bosnia and Herzegovina in Sarajevo. A total of 75 plateletpheresis procedures performed using Amicus continuous flow cell separator were evaluated. Various pre- and post-donation haematological values were measured in all donors: haemoglobin concentration (Hb), haematocrit (Hct), red blood cell count (RBC), platelet count (PLT), white blood cell count (WBC), mean platelet volume (MPV), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC).<br /><strong>Results</strong> <br />A significant decrease in post-donation Hb, Hct, RBC, PLT, MCHC (p<0.000) and WBC (p=0.003), and a significant<br />increase in MPV (p=0.011) and MCV (p<0.000) was found. Percentage reduction of haematological parameters Hb, Hct, RBC, PLT, WBC and MCHC decrease of 6.6%, 6.5%, 5.9%, 24%, 4.6% and 0.3%, respectively, in their respective count was noted postdonation. Eight (11%) donors had a post-procedure platelet count less than 150x10e9/L. Twenty two donors (29%) experienced mild side effects due to hypocalcaemia.<br /><strong>Conclusion </strong><br />Plateletpheresis procedures are generally safe and well tolerated, without evident associated clinical manifestations<br />on healthy donors. </p>

Plateletpheresis: A comparison between two blood cell separators at a tertiary care facility.

Objective: Platelet concentrate is an invaluable support product in the management patients presenting with thrombocytopenia. Collection of high quality, single donor platelets depends upon efficient cell separators at the plateletapheresis facility. We evaluated the performance of two different cell separators used for plateletpheresis at our facility. This evaluation was done to ascertain which cell separator performed better in terms of various product parameters. Study Design: Cross Sectional study. Setting: Chughtai Stat Lab, National Hospital. Period: July to December 2020. Material & Methods: A total of 100 plateletapheresis procedures were done, 50 on Cobe Spectra and 50 on Haemonetics MCS900. Male donors were selected after detailed medical history, screening and informed consent. For each cell separator, the total procedure time, collection rate and platelet yield of the final product (single donor platelets) was noted and compared. The predonation platelet count of each donor was also recorded. Results: Donor turnaround time was better for the Cobe 60.1 + 2.757 min vs 81.1 + 3.311 min on Heamonetics (p value < 0.0001). Cobe had a superior collection rate 0.065+0.0088 (PLT×10 11/min) than Heamonetics 0.0519 + 0.007 (PLT×10 11/min) (p value< 0.0001). For both cell separators, the final product was similar in terms of platelet yield (p value = 0.56). Overall, donor predonation platelet counts ranged from 220-480x109 /L. Pearson correlation test showed positive correlation (r = 0811, p value; < 0.0001) between platelet yield and donor platelet count. Conclusion: Continuous flow cell separators, like the Cobe spectra, offer a high quality platelet product with greater efficiency when compared to intermittent flow cell separators like the Haemonetics.

Type of Cell Separator, Fenwal Amicus Vs COBE Spectra LRS, May Influence the Corpuscular Elements Value of the Donor`s Blood (SN-ICFC Procedure)

Background: During the plateletpheresis procedure the number of thrombocytes in the donor’s blood significantly decreases, and the levels of the hematocrit, hemoglobin, and leukocyte diminish as well. Influence of the cell separator is one of the factors that affects the levels of HCT, Hgb and WBC. Objective: In this study, the goal was to determine the value difference of HCT, Hgb, WBC, and platelets after the platelet pheresis process between performance on Fenwal AMICUS and on COBE Spectra LRS Methods: The criteria for participation: male in the age range of 25-45. We have formed two groups: group I–180 separation were performed on 60 participants were the values of hematocrits, concentration of hemoglobin and number of leukocytes ware established before and after separation using the single-needle intermitent flow cell separation (SN-IFCS) on the Fenwal AMICUS device. Group II – presented 180 separation that were performed on 60 participants, were the values of hematocrits, concentration of hemoglobin and number of leukocytes ware established before and after separation using double-needle continuous flow cell separation (SN-IFCS) on the COBE Spectra LRS. device. To confirm the statistical differences we have used Student t-test for independent or dependent samples, as well as Mann-Whitney U test as non-parametric alternative. To compare differences between the values of four parameters (P1-P2) from two groups (using two devices–Fenwal AMICUS and Fresenius Com Tec) we have performed the ANOVA variance analyze. The possibility of errors were accepted for α<0,05, and the difference between groups as statistical relevant were accepted for p<0,05. Results Statistically significant lower values were noted for all researched parameters after separation on both devices (Fenwal AMICUS and COBE Spectra LRS). Comparing the parameters of hematocrit, leukocytes and hemoglobin’s, we found a statistical significant difference in the decrease of the parameter’s value after separation, there was a significant decrease change in using COBE Spectra LRS cell separator compared to using Fenwal AMICUS cell separator with the same procedure. For the platelets (Plt) there was no statistical significant difference (p> 0,05-α=0,05), between average level obtained using either Fenwal AMICUS or COBE Spectra LRS. Conclusion: The type of cell separator had the influence on the decrease value of the observed parameters.

Therapeutic apheresis and non‐blood donor related apheresis current practices at various blood centres of healthcare organisations of India: A brief online survey

AbstractObjectivesTo determine the variability in therapeutic apheresis (TA) and non‐blood donor related apheresis practices, and the extent of expertise and knowledge of blood centre staff.BackgroundApheresis activity that was earlier limited to therapeutic plasma exchange (TPE) and donor apheresis at few centres in India has seen remarkable surge involving many centres practising TA and non‐blood donor related apheresis. The decentralised transfusion medicine practice in country has resulted in wide variability of knowledge and practice of TA. An online survey was conducted to achieve study objectives.Study design and methodsA 22 questionnaire survey was sent to the 215 blood centres through e‐mail link focussing on three aspects; basic information of the participating centres, details of TA procedures and education and training levels of the staff.ResultsMajority (71.9%) of centres were teaching institutions among analysed 57 centres. TPE (85.9%) and therapeutic cytapheresis (71.9%) were the most common TA procedures. The clinical haematology (68.4%) followed by neurology (64.9%) were the specialities utilising TA. The 64.9% centres used continuous flow cell separator and central venous access (52%) was preferred vascular access. A combination of normal saline, fresh frozen plasma and 5% albumin replacement fluid was first choice. Doctors involved in TA were trained in apheresis during their MD/DNB degree, but no structured training program existed for other category of staff.ConclusionThere was a wide variability in TA practice in India and a dedicated training program for all categories of staff was emphasised by majority of participants.

Honoring Emil J. Freireich: A Visionary Medical Cancer Researcher-March 21, 1927-February 1, 2021.

![][1] Dr. Emil Freireich at MD Anderson in 2018, in conversation with Lauren Gobert, a leukemia physician assistant who had childhood acute lymphoblastic leukemia cured by combination therapy developed as a result of Dr. Freireich's research. Emil J, Freireich, a founding father of

Acquired factor XIII deficiency in patients under therapeutic plasma exchange: A poorly explored etiology.

Factor XIII (FXIII) deficiency may cause bleeding under certain clinical circumstances. Therapeutic plasma exchange (TPE) may lead to a transient deficiency. To describe the clinical evolution of patients with acquired FXIII deficiency secondary to TPE. We respectively studied a cohort of consecutive patients from 2014 to 2019 who were treated with TPE with FXIII levels <50%. The FXIII was measured after the start of the TPE course, on days between the TPE sessions, due to suspected acquired deficiency. All TPE were performed using continuous flow cell separator. In all cases, the initial replacement fluid applied was albumin. Apheresis procedures were held at 24to 48 hours intervals. Eighteen patients were included, 13 of them were recipients of kidney transplants. The main TPE prescription was humoral rejection. Median FXIII at diagnosis (measured on days between sessions of the TPE course) was 19%(IQR17-25). The median of apheresis procedures before measurement of FXIII was 3(IQR2-4). Among the total cohort, 10 patients suffered hemorrhages. None of the patients without history of kidney transplants had bleeding (n = 5), however, 10/13 with kidney transplants did. Five kidney transplant patients received therapy with FXIII concentrate because of life-threatening bleeding. In all cases, the bleeding stopped within the first 24 hours. All patients had their FXIII levels measured again after finishing the TPE course, with normal results. TPE is an under-diagnosed cause of acquired FXIII deficiency since routine coagulation tests remain unaltered. It might cause major bleeding, particularly in patients with a recent history of surgery like kidney transplants.

SUN-358 INDICATIONS, EFFICACY AND SAFETY OF THERAPEUTIC APHERESIS IN NEPHROLOGY PATIENTS

Therapeutic Apheresis (TA) serves as a rescue therapy in many patients with kidney diseases and these indications have expanded dramatically in the past few years. Rapid removal of undesirable antibodies and immune complexes remains the prime rationale for adopting plasmapheresis as a therapy. However, there is limited data available regarding the indications, efficacy and safety of TA in nephrology patients. This was a retrospective analysis of TA performed in adult and pediatric nephrology patients at a tertiary healthcare centre from January 2011 to December 2018. The study population included all consecutive patients admitted in the Department of Nephrology; both adult and pediatric, who were thought to benefit from TPE. All the procedures were performed on a continuous flow cell separator Com.Tec (Fresenius Kabi, Germany) with PL1 or P1R kit using central venous access. Conventional therapeutic plasma exchange was performed using PL1 kit whereas cascade plasmapheresis and immunoadsorption were performed using P1R kit. For cascade, Evaflux plasma fractionator (Kawasumi Laboratories, Japan) was used and for immunoadsorption, Glycosorb – ABO (Glycorex Transplantation AB, Sweden) or Adsopak (Pocard, Moscow) adsorbers were used. Informed consent was obtained from the patient or guardians prior to each procedure. Demographic details, clinical condition, ASFA category and clinical response were noted. Procedure parameters such as blood and plasma volume processed, anticoagulant used, time taken for the procedure, volume and type of replacement fluid administered and adverse reaction events were noted. All procedures and adverse reaction management were done according to departmental standard operating procedures. A total of 190 patients (63 females and 127 males) underwent 842 sessions of TA for different indications. 184 and 658 procedures were performed for 24 pediatric and 166 adult patients respectively. Mean age of presentation in pediatric age group was 9.21±1.22 years while in adults it was 43.08±3.41 years. 639 procedures (75.89%) were conventional plasma exchanges, 182 were cascade plasmapheresis (21.61%) and 21 were immunoadsorption (2.49%). Mean blood urea and serum creatinine prior to initiation of plasmapheresis of all indications except desensitization was 158.78±5.65mg/dl and 4.95±1.08mg/dl while at the time of termination it was 73.05±3.42mg/dl and 3.34±1.15mg/dl respectively. Replacement fluid was plasma in 303 procedures (35.98%), 5% albumin in 412 (48.93%) and combination of plasma and 5% albumin in 127 procedures (15.08%). Acid Citrate Dextrose was the preferred anticoagulant. As per departmental standard operating procedure, patients with body weight <20 kg i.e. 25 procedures (2.96%) required priming of kit with albumin or red cells. Patient outcome in terms of survival was 76.84%; 79.16% in pediatric and 74.69% in adult age group. Thirty-nine procedures (4.63%); 12 in pediatric and 27 in adults were associated with adverse events in the form of shivering(12), urticaria(3) and catheter related complications(6). Findings of this study highlight the efficacy and safety of TA in different nephrological indications for pediatric and adult nephrology patients.

A retrospective study of autologous stem cell mobilization by G-CSF in combination with chemotherapy in patients with multiple myeloma and lymphoma.

Factors affecting peripheral blood hematopoietic stem cell (PBSC) mobilization and collection were investigated in patients with multiple myeloma (MM) and lymphoma who were undergoing chemotherapy. Clinical data from 128 patients, including 53 MM and 75 malignant lymphoma (7 Hodgkin's lymphoma and 68 non-Hodgkin's lymphoma) cases were retrospectively analyzed. Autologous PBSCs were mobilized using granulocyte-colony stimulating factor (G-CSF) during chemotherapy, and collected using a continuous flow cell separation instrument. The yields of CD34+ cells per kilogram of patient body weight <2.0×106/kg, >2.0×106/kg or >5.0×106/kg were defined as a failure, a success or ideal mobilization, respectively. In MM and lymphoma patients, the success rates of CD34+ cell acquisition were 73.6 (39/53) and 58.7% (44/75), the ideal rates were 43.4 (23/53) and 30.7% (23/75), and the failure rates were 26.4 (14/53) and 41.3% (31/75), respectively. Univariate and multivariate statistical analysis revealed that negative factors for PBSC mobilization in patients with MM were lenalidomide treatment, multiple chemotherapies, incomplete disease remission and low-level blood hemoglobin; in patients with lymphoma, the negative factors were the histological disease type, incomplete disease remission, being beyond the first-line of previous chemotherapy, multiple chemotherapies, chemotherapy with the HyperCVAD-B mobilization scheme, high-dose MTX/Ara-c (methotrexate/cytarabine) treatment, prolonged administration of G-CSF and low-hematocrit levels. In the present study, different factors influencing PBSC mobilization and collection in MM and lymphoma cases were identified. PBSC mobilization yielded sufficient CD34+ cell counts both in MM and lymphoma patients; however, the failure rates were relatively high.

Which Is the Best Mobilizing Regimen in POEMS Syndrome? a Retrospective Italian Study of Two Haematological Centres

Introduction. POEMS syndrome is a rare paraneoplastic condition associated to an underlying plasmacellular dyscrasia. The use of alkylating agents and autologous peripheral blood stem cell transplantation (aPBSCT) seem to be the best strategy.At present aPBSCT should be considered the first line therapy in young patients with POEMS, eligible for high-dose Melphalan (HD-Mel), in absence of organ dysfunction. The best protocol to collect PBSC in patients affected by POEMS remains to be defined, because of the disease rarity and the heterogeneity of published case series.We therefore decided to combine the case series of our two institutions to describe and compare results and outcomes in order to contribute to the definition of the best CD34+ cell mobilization strategy.Patients and methods. We collected clinical and laboratory data of patients affected by POEMS syndrome undergoing hematopoietic stem cells (HSC) mobilization for aPBSCT from 2003 to 2018. Data were organized in order to perform a statistical analysis using “GraphPad Prism” GraphPad Software Inc., (5755 Oberlin Drive, #110, San Diego, CA 92121, USA). The COBE Spectra continuous flow cell separator (Terumo BCT, Shinagawa, Tokyo) was used for leukapheresis.Results. Our data set consisted of 25 patients, of whom 11 were mobilized using cyclophosphamide (CY) 4 g/m2 followed by granulocyte colony-stimulating factor (G-CSF) 5 μg/kg and 14 patients were mobilized using G-CSF 10 μg/kg for 5 days. All patients submitted to mobilization underwent collection procedure. Three patients, because of low CD34+ cells after the administration of G-CSF alone, were submitted to plerixafor infusion achieving a median pre-apheresis CD34+cell count of 28 cells collecting a median of 4.5 CD34+cell/kg body weight. All patient underwent aPBSCT after HD-Mel conditioning regimen receiving an infusion of 4.7 CD34+cell/kg body weight (range 1.5-8.4) and achieved a successful engraftment. At present all the patients are alive and in remission.In order to compare mobilization schedule we performed a comparison analysis between 11 patients receiving chemotherapy as mobilizing regimen versus 14 patients receiving only G-CSF. Data analysis according to mobilization schedule was reported in Table 1.Analysing mobilization efficacy, chemo-mobilized patients achieved a higher pre-apheresis CD34+ cell count (57 vs 33 cells/µl, p<0.05). This result allowed a significantly shorter procedure (2.3 TBV vs 3 TBC, p<0001). Patients receiving only G-CSF showed a WBC count significantly higher than chemo-mobilized patients (40.000 vs 8.140, p<0.05). The incidence of poor mobilization was low (3 out of 25 patients, 12%) and not statistically different between the two mobilization schedules.Discussion. The collection of these data allowed us to achieve one of the major series published in literature and to perform a comparison between two different approaches. The data suggest that both schemes (CY plus G-CSF vs. G-CSF alone) were able to harvest a sufficient CD34+ cell dose. DisclosuresNo relevant conflicts of interest to declare.

The effectiveness of phenobarbital in patients with refractory status epilepticus undergoing therapeutic plasma exchange.

This study aimed to elucidate the therapeutic concentration range of phenobarbital (PB) for adults, as well as the influence of therapeutic plasma exchange (TPE) on plasma concentration of PB. We retrospectively reviewed consecutive patients diagnosed with refractory status epileptic (RSE) and treated with a bolus injection of PB as well as TPE, admitted to our neurocritical care unit from November 2015 to October 2016. Continuous electroencephalographic monitoring was performed routinely for these patients. TPE was performed using a continuous-flow cell separator. PB concentrations in the plasma and cerebrospinal fluid were measured by gas chromatography-mass spectrometer analysis before and after TPE. A total of seven patients were included; among these, one patient had RSE related to anti-N-methyl-D-aspartate receptor encephalitis, another patient had Hashimoto encephalopathy, and five patients had undetermined etiology. For patients with clinical and electrographic control (n=6), the plasma concentration of PB ranged from 138 to 243.7 μg/ml. In addition, of six paired plasma samples (before and after TPE) obtained from three patients, no significant differences between the concentrations of PB were detected (P=0.6), suggesting that TPE may not significantly affect the plasma concentration of PB. This study confirmed that PB more than 100 µg/ml was effective for adults with RSE. Moreover, TPE may not have an influence on the plasma concentration of PB.Video abstract: http://links.lww.com/WNR/A489.

Significant correlation between peripheral blood CD34+ cell count in children prior to aphaeresis and CD34+ cell yield following aphaeresis: A single-center experience.

Numerous adults' studies demonstrated that preaphaeresis CD34+ cells significantly correlate with the number of CD34+ cells collected by the aphaeresis procedure. Equivalent studies in children are scarce. We studied retrospectively 92 aphaeresis procedures performed following chemotherapy (44) or in steady state (48) in 60 pediatric patients (40 males, 20 females), median age of 7.5years. Aphaeresis procedures were performed using a SPECTRA Optica (TERUMOBCT) continuous flow cell separator. CD34+ cell concentrations were assessed using flow cytometry. A highly significant correlation between peripheral CD34 cell count on the day of aphaeresis and CD34 cell yield per kg (R2 =.824, P<.0001) was demonstrated. A higher preaphaeresis CD34 cell count was demonstrated in patients with higher preaphaeresis white blood cell count, in patients with brain tumors, and in patients who received chemotherapy as part of their mobilization protocol. A threshold number of 20 peripheral CD34+ cell/μL was found to predict harvesting of 3×106 stem cells/kg, and 30 peripheral CD34+ cell/μL for harvesting of 5×106 stem cells/kg. This significant correlation between peripheral CD34 cell count and CD34 cell yield, and the threshold number of peripheral CD34 found to predict adequate harvesting can be useful in planning the optimal time for aphaeresis in children.

Therapeutic plasma exchange in Gullian Barre Syndrome: an experience of our centre

Background: Therapeutic plasma exchange (TPE) has been used for the treatment of neurological diseases in which autoimmunity plays a major role. Although, there are several modes of plasmapheresis applicable to Gullian Barre Syndrome (GBS) but no definite guidelines for selecting an optimum mode have been established so far. The aim of the study was to analyze the clinical benefits of plasma exchange (PE) on the patients of GBS and compare the cost effectiveness of TPE over other modalities.Methods: Records of 36 patients who received TPE between March 2015 to September 2015 were analysed using continuous flow cell separator CS-3000. All the patients had undergone minimum 2 cycles of PE. One plasma volume was exchanged for each cycle.Results: Out of 36 patients, there were 28 (77.78%) male and 8 (22.22%) females. The mean age of patient was 28.23±1.23 years which range from 12 to 36 years. After TPE on 36 patients, 28 (77.78%) patients clinically improved after first cycle of PE and 5 (13.89%) patients improved after second cycle. Patients who received 4 and 3 cycle of PE experience no complications and &gt;75% and 55-60% patients showed improvement respectively.Conclusions: The treatment is cost effective in comparison to the available IV immunoglobulins. TPE is an easy and effective treatment in GBS.

Chemotherapy Combined with Granulocyte Colony Stimulating Factor (G-CSF) for Mobilization of CD34+ Cells in Lymphoma and Multiple Myeloma Patients

Objective: To investigate and analyze factors which effect autologous stem cell collection in patients with lymphoma and multiple myeloma (MM) during chemotherapy combined with G-CSF mobilization, for improving quality and effectiveness of autologous stem cell transplantation.Methods: A retrospective analysis was performed from April 1, 2006 to October 31, 2013 in our hospital and 128 lymphoma and MM patients whose autologous peripheral blood stem cells (PBSCs) were collected including 75 patients with malignant lymphoma,7 cases of Hodgkin's lymphoma and 68 non-Hodgkin's lymphoma (NHL) cases as well as 53 MM patients were enrolled. The stem cells of all patients were mobilized by chemotherapy combined with G-CSF and collected via a continuous flow cell separation instrument (COBE Spectra, Lakewood, CO). Mobilize failure was defined when the amount of CD34 + cells was less than 2.0 x 106 / kg, whereas ≥2.0 * 106 / kg was defined as successful mobilization. More than 5.0x 106 cells / kg or more was considrered as ideal mobilization. Univariate and multivariate regression analyses of factors for mobilization failure, successful mobilization and ideal mobilization acquisition were performed.Results: There were more CD34+ cells in MM patients than in lymphoma patients (P = 0.064). The collection rates of CD34 + cells in MM patients were ≥ 2.0 x106 / kg in 64.8% (83 cases) and ≥ 5.0 x 106 / kg in 35.2% (45 cases). MM patients with a success collection ratio was 73.6 % (39/53) and the ideal collection rate was 43.4% (23/53), which was higher than in the NHL group with a success rate and ideal rate of 58.7% (44/75) and 30.7% (23/75). A total of 35.2 % (45 cases, including 31MM cases and 14 lymphoma cases) a mobilization was not successful.Conclusion: In different chemotherapy regimens in patients with lymphoma, remission, ever use MTX and/or Ara-c treatment and collecting the outer peripheral hematocrit could significantly affect the success rate of stem cell collection; In MM patients, who received lenalidomide treatment and multiple courses of treatment, still not got CR, which these reasons were the factors of non- successful mobilization.Although Plerixafor and peripheral blood CD34-positive cell counts could help to improve the success collection rate and predict collection rate, but there is still a need for further improvement of the current mobilization protocols, recognizing the ideal stem cell collection dynamics, efficiency and cost in order to select the appropriate mobilization protocols. DisclosuresNo relevant conflicts of interest to declare.

Lab on a chip for continuous-flow magnetic cell separation.

Separation of cells is a key application area of lab-on-a-chip (LOC) devices. Among the various methods, magnetic separation of cells utilizing microfluidic devices offers the merits of biocompatibility, efficiency, and simplicity. This review discusses the fundamental physics involved in using magnetic force to separate particles, and identifies the optimisation parameters and corresponding methods for increasing the magnetic force. The paper then elaborates the design considerations of LOC devices for continuous-flow magnetic cell separation. Examples from the recently published literature illustrate these state-of-the-art techniques.

Assessment of factors affecting the platelet yield using continuous flow cell separator

Background: The quality of single donor platelets (SDP) in terms of yield influences the platelet recovery in the recipient. Various donor factors such as predonation platelet count and hemoglobin concentration may affect platelet yield. The aim of present study was to assess the effect of various donor factors on platelet yield and effect of plateletpheresis on hematological values of donors. Materials and methods : A total of 171 plateletpheresis procedures were performed using continuous flow cell separator (Amicus Automated Blood Collection System version 2.52/3.1) were evaluated for platelet yield. The pre and post donation hematological values such as platelet count, hemoglobin (Hb) concentration, mean platelet volume (MPV) and platelet distribution width (PDW) were measured in all blood donors. Results : The mean platelet yield was 3.8 + 1.65 X 10 11 /unit. The platelet yield correlated positively (r = 0.446, p < 0.001) with donor pre platelet count and negatively (r =- 0.004, p = 0.954) with donor pre-Hb. There was significant increase (p < 0.001) in Hb concentration and platelet count decreased significantly (p<0.001) after each procedure. While, there was no significant decease in MPV and PDW after each procedure. Conclusion: All transfusion centers should have their own plateletpheresis donor data based on demographic and hematological characteristics of the donor population. This will ensure donor safety, product quality and an effective donor registry.

Granulocyte Concentrates From a Single High-Yield Apheresis Can Be Split to Support Multiple Patients

AbstractAbstract 4373 IntroductionGranulocyte transfusion has evolved as an accepted therapeutic approach for immunocompromised, severely neutropenic, myelosuppressed leukemic patients or hematopoietic stem cell transplant (HSCT) with life-threatening infections despite appropriate antibiotic therapy. The combination of Growth-stimulating colony factor (G-CSF) and dexamethasone to stimulate granulopoiesis in normal donors has facilitated the collection of larger cell doses of granulocyte concentrations (GCs) via automated apheresis and the use of Hespan-sodium citrate/anticoagulant solution has enhanced the harvesting of GCs yield as high as 800–900 mL ready for infusion.To our knowledge GCs harvested via collection from G-CSF/dexamethasone stimulated donors have been transfused only to single patients. Here we describe the process in splitting the GCs for transfusion to 2 or more patients when the designated patient has volume restrictions. This practice is similar to the double and triple splitting of apheresis platelet concentrates a practice routinely performed at Blood Donor Centers in the USA. METHODSThis retrospective study was approved by the Institutional Review Board, written informed consent was obtained and all split GCs between 01/2010 and 12/2011 were reviewed.Donors were recruited from relatives/friends of patients or were community volunteers who underwent screening for infectious diseases according to current regulatory requirements for allogeneic donors. Other eligibility criteria included a biochemical profile (alanine aminotransferase, alkaline phosphatase, total bilirubin, hemoglobin S) and a urine pregnancy test for all female donors. Potential hematopoietic stem cell (HSC) donors were deferred.All eligible donors first underwent a platelet apheresis donation to evaluate their vascular access and to determine whether they could withstand a 2-hour collection via two-arm continuous-flow apheresis. GCs were collected via donor stimulation with a single subcutaneous injection of G-CSF (600 μg; Amgen) and in first-time donors an oral dose of dexamethasone (8 mg) 12 hours prior to the granulocyte collection was also given.GCs were harvested via Hespan-sodium citrate solution (6% hetastarch in 0.9% sodium chloride; Braun, Inc. containing 30 cc of triCitrasol anticoagulant sodium citrate concentrate (46.7% trisodium citrate; Citra Labs) 12 hours after stimulation. Approximately 1.5 × whole blood volumes from each donor was processed via a two-arm peripheral venous access procedure with a COBE Spectra continuous-flow cell separator (CaridianBCT) and COBE Spectra WBC tubing set (CaridianBCT).The decision to split each GC unit was made after determination of the total absolute WBC count upon completion of the granulocyte apheresis. Each GC unit was sterilely connected to a second 600 mL sterile bag via a Terumo sterile tubing welder (TSCD SC-201A, Terumo Medical Corporation) outfitted with TSCD wafers (Terumo Medical Corporation) and then half of the volume was expressed into the second 600-mL bag (Fenwal, Inc.) with the first half remaining in the original bag. The GC units with ABO incompatible red cells with the recipient were filtered via gravity drainage. All GCs were crossmatched, labeled, irradiated (2500 cGy, Cesium-I37 irradiator, IS Bio International) and released for transfusion. RESULTSGCs were collected from 93 donors [67 Males: 26 Females; median age 40 (19–73 years); total volume median 718 mL (range 538–860), original wbc yield median 9.7 10∧10e (range 5.1–17.2) and split GC yield, median 4.48 10∧10e (range 2.70–7.72)]. Split GCs were transfused to 51 patients [31 Males: 20 Females; median age 58 (range 19–83 years); diagnosis-AML/MDS 32 (63%), ALL/CLL 12 (24%), CML 5 (10%), others 2 (3%)]. The patients received median 3.5 split GCs (range 1–18) with a WBC increment median 0.02 × 10∧3/μL (range 0.00 to 8.3). Donors with post stimulation WBC counts 30 K/UL or greater were able to provide GCs volumes sufficient for splitting. DISCUSSIONThe practice of splitting GCs based on yield and WBC count is a safe process and the product transfused without any patient adverse effects. This approach has allowed maximum use of all collected GCs and has provided GCs to patients who otherwise would not have received GCs. The transfusion of GCs is a complex lengthy process which must be well organized by the blood bank/Blood Donor Center/Apheresis Unit and the oncology team. Disclosures:No relevant conflicts of interest to declare.

Use of granulocytes concentrates from a single high yield apheresis to support more than one patient.

6622 Background: Allogeneic granulocyte transfusion therapy is sometimes the only therapeutic option in immunocompromised neutropenic leukemic/HSCT patients with life threatening bacterial and fungal infections. Collection of larger cell doses of granulocyte concentrates (GC) by automated apheresis following G-CSF/steroids administration has renewed interest and its use has grown steadily. Methods: Donors were recruited from family/friends of the patients and informed consent was obtained. GCs were collected via donor stimulation with a single subcutaneous dose of G-CSF (600 mcg). First time donors received an oral dose of dexamethasone (8 mg). GCs were harvested by Hetastarch-assisted leukapheresis 12 hours later via peripheral venous access with the continuous flow cell separator Spectra (COBE Caridian BCT, Lakewood, CO). Results: GCs were collected from 93 donors (67M: 26F; age median 40 (19-73 years) and 1 ½ x blood volume processed median 7048 (3212-8085 mL). The pre/post wbc were median 8.1 (4.1-22.8)/ 42.7 (22.4-77.5). The volume collected was based on the post G-CSF wbc count (&gt; 35 K/UL - 800 mL; &lt;35 K/UL between 600-700 mL). The original yield (10 x10e) was median 9.7 (5.1-17.2 units), volume median 718 (538-860 mL) and WBC median 132.7 (84.2 -241.6 K/UL per bag). The Split GCs were median 4.48 (2.70-7.72 units), with neutrophils median 87% (54-97% per bag). GCs were transfused to 51 patients (31M: 20F; age median 58 [19-83 years]) who received median 3.5 (1-18 split units), containing wbcs median 10734.69 [5778-42 -162698.09 (x10^3/uL)/unit) and achieved a WBC increment median 0.2 (0.0-8.3K/UL). Conclusions: The GCs were split due to the primary care team's reluctance to transfuse the entire volume of the product due to volume restrictions or for some other medical reason. The same rationale to split platelets from high yield single apheresis was used to split our GC products. We found that GCs from each donor was utilized maximally and also brought partial relief to other patients who lacked donors. We would like to make the case that when adequate numbers of GCs are collected it may be feasible to split the unit. This may offer a glimmer of hope to other patients in need of GCs who lack a donor network support.

Intérêt des érythraphérèses à la phase initiale du traitement des hémochromatoses génétiques de type 1 : expérience à propos de 30 cas

Purpose of the study Weekly phlebotomy schedule is commonly recommended to achieve iron depletion in hereditary hemochromatosis (HH). However, in patients with severe iron overload, more than 2 years may be required, leading to fatigue and lack of compliance. For more than 10 years, we have used erythrocytapheresis (EA) as an alternative treatment. Patients and methods To assess the number of EA to achieve iron depletion and the duration of the iron depletion therapy as well of the tolerance, we retrospectively analysed the data of newly diagnosed hemochromatosis patients, homozygote for the C282Y mutation, followed in our department between 2001 and 2007. EA were performed using a discontinuous or a continuous flow cell separators. The protocol consisted in a bimonthly EA until normalisation of the serum ferritin, with the aim of reducing the patient's hematocrit between 32–35% at the end of each session. Then we performed monthly EA until complete desaturation, defined as serum ferritin concentration below 50 μg/L and transferrin saturation below 40%. Results Thirty patients were included (23 male, mean age 52 years, range 25–78) and 625 procedures analyzed. The mean volume of removed erythrocytes in each procedure was 416.4 mL (range 150–948), which equals to 374 mg of removed iron. Iron depletion (ferritin < 50 μg/L) was achieved after 11 months with 20 sessions (range 14–78). No serious adverse reactions or citrate toxicity were observed during and after the apheresis procedures. No specific fatigue was reported during the iron depletion therapy. Patient compliance was 100%. Clinical improvement was noted in 12 out of 18 of symptomatic patients. Conclusion We conclude that HH patients treated with bimonthly EA achieved iron depletion in less than 1 year under good condition of tolerance. These data support the use of EA in patients with a severe iron overload, since it may reduce the number of the procedures as well as the duration of the iron depletion therapy.