Donor Exposure Research Articles

Preventing sensitization with mycophenolate mofetil in a pediatric kidney recipient

Sensitization, as measured by panel reactive antibodies (PRAs), occurs as a result of previous organ transplantation, blood transfusions, or pregnancy. The high-PRA levels increase the risk of complications during transplantation and may result in long time duration for future transplants. Mycophenolate mofetil (MMF) has been shown to decrease lymphocyte proliferation and antibody formation. We report the use of prophylactic MMF in preventing the formation of PRAs in a pediatric renal transplant recipient with multiple donor exposures. A four-yr-old girl received an unsuccessful living-related renal transplant in February 2003 and was subject to multiple blood transfusions in the perioperative period. MMF, 500 mg/m2/day in two divided doses, achieved suppression of PRAs to less than 20% and allowed successful renal transplantation within nine months. No side effects occurred. This approach may reduce the risk of sensitization in future potential organ donor recipients in similar situations.

Donor selection criteria to maximize double platelet products (DPP) by platelet apheresis

Variant Creutzfeldt–Jakob disease brought us to perform a study to diminish donor exposure from transfusion of platelet concentrates. The current study aimed to develop donor selection criteria that maximize the likelihood of deriving single donor platelets and producing double platelet products (DPP). Donors were recruited among plasmapheresis donors and among other donors when the selected donors did not show up. Donor precount and body weight and haematocrit were examined as determinants of higher split-rates combined with procedure time. When the criterion was set on 225; 82% of the procedures ( n = 717) with a precount of >225 yielded DPP compared to 54% of the procedures with a precount <225 ( p < .01). Body weight >65 kg gave good results in split-rate. Procedure time showed an inverse correlation with the highest correlating precount ( r = −.14; p < .001). Eighty one percent of the donors reported a willingness to donate at least seven times a year and 75% accepted the mean procedure time. This confirmed logistical feasibility of the conversion to AP–PC although profits would be reduce 13% compared to platelets from pooled buffy coats.

Molecular characterization of microbial populations at two sites with differing reductive dechlorination abilities

This study compares three molecular techniques, including terminal restriction fragment length polymorphism (T-RFLP), RFLP analysis with clone sequencing, and quantitative PCR (Q-PCR) for surveying differences in microbial communities at two contaminated field sites that exhibit dissimilar chlorinated solvent degradation activities. At the Idaho National Engineering and Environmental Laboratory (INEEL), trichloroethene (TCE) was completely converted to ethene during biostimulation with lactate. At Seal Beach, California, perchloroethene (PCE) was degraded only to cis-dichloroethene (cDCE) during biostimulation but was degraded to ethene after bioaugmentation with a dechlorinating culture containing Dehalococcoides strains. T-RFLP analysis showed that microbial community composition differed significantly between the two sites, but was similar within each site among wells that had low or no electron donor exposure. Analysis of INEEL clone libraries by RFLP with clone sequencing revealed a complex microbial population but did not identify any Dehalococcoides strains. Q-PCR targeting the 16S rRNA gene of Dehalococcoides strains - known for their unique capability to dechlorinate solvents completely to ethene - revealed a significant population at INEEL, but no detectable population at Seal Beach prior to bioaugmentation. Detection of Dehalococcoides by Q-PCR correlated with observed dechlorination activity and ethene production at both sites. Q-PCR showed that Dehalococcoides was present in even the pristine well at INEEL, suggesting that the difference in dechlorination ability at the two sites was due to the initial absence of this genus at Seal Beach. Of the techniques tested, Q-PCR quantification of specific dechlorinating species provided the most effective and direct prediction of community dechlorinating potential.

Neonatal RBC Transfusions – Comparison of Two Patterns

Background: Red blood cell (RBC) transfusions performedover 5 years in a neonatal ward were retrospectivelyanalyzed. Despite the fact that ‘fresh’ RBC smallvolumetransfusions given to preterm infants are called‘traditional’ or even ‘historic’, this method of treatment isstill used in all neonatal wards in Poland. Patients andMethods: A total of 846 RBC units were transfused to216 patients, including 26 term and 190 pretermneonates. The transfusion rate and donor exposure ratewere calculated. The same parameters were calculatedfor hypothetical use of blood satellite packs for transfusionsin the analyzed patients and compared with theoriginal data. Results: Application of a limited donor programcould diminish the donor exposure rate more thantwofold, from 3.5 to 1.63, in the very-low-birth-weight infantsgroup and reduce the maximum number of donorsfrom 11 to 3, at the same transfusion rate of 5.35. Conclusion:Introduction of strict RBC transfusion guidelinesand a limited-donor blood program would improvetransfusion therapy.

Transfusion of blood products in paediatrics

The evidence base for transfusion in children is scanty, but all blood products should be used judiciously, regardless of age. Minimize transfusion by appropriate use of haematinics, antifibrinolytic agents and avoid excessive blood sampling. Children tolerate anaemia well and a postoperative haemoglobin of 6 g/dl is usually adequate in the normovolaemic patient, with a threshold of 7 g/dl for most patients in intensive care. Appropriate thresholds for neonates are less clear as this relates in part to gestational/post-gestational age and recent transfusion history. Red cells in additive solutions are suitable for most circumstances but not advised in massive transfusions in those under 6 months. Avoid the use of red cells that have been stored for more than a few days when large volumes will be given rapidly, for example priming of extracorporeal circuits or massive blood loss as hyperkalaemic cardiac arrest can occur. Fresh frozen plasma (FFP) should be used to correct a significant coagulopathy (coagulation times 1.5 or more times normal) in association with bleeding or an intended invasive procedure. In the UK, virus-inactivated FFP is provided for this age group. Suggested thresholds for prophylactic platelet transfusion include 30 × 109/litre for preterm infants or neonates with sepsis, 10 × 109/litre for older stable patients with marrow failure, and 50 × 109/litre for all children who are to undergo invasive procedures (100 × 109/litre for brain or eye surgery). Donor exposure can be reduced by the sequential use of aliquoted components form one donor and by recognizing that the plasma in a platelet unit may preclude the need for the additional administration of FFP.

The Charles Drew Program in Missouri: a description of a partnership among a blood center and several hospitals to address the care of patients with sickle cell disease

Abstract Sickle cell disease (SCD) is an inherited blood disorder which can be complicated by stroke in infancy and childhood. The primary and secondary prevention of stroke in this patient population is regular RBC transfusion therapy at least every three weeks, but there is no consensus on the ideal RBC transfusion therapy. The Charles Drew Program, a partnership among a blood center and several hospitals affiliated with academic medical centers in Missouri, provides RBCs for the care of patients with SCD. There are three basic aims: the RBC components are phenotypically matched on three minor RBC antigens, the units are less than 7 days old, and each patient has a limited number of dedicated donors, so that the donor exposure is minimized. This report describes the operational phases of this program and summarizes its performance with respect to each of these aims. Immunohematology 2006;22:112–116.

Transfusions of CPDA‐1 red blood cells stored for up to 28 days decrease donor exposures in very low‐birth‐weight premature infants

The goal of this research was to study the safety and the efficacy of transfusing citrate-phosphate-adenine anticoagulant-preservative (CPDA-1) RBC stored for up to 28 days to reduce donor exposures in premature infants. A prospective randomized two-group study was conducted with very low-birth-weight premature infants that received at least one RBC transfusion during hospital stay. Neonates randomly assigned to Group 1 (26 infants) were transfused with CPDA-1 RBC stored for up to 28 days; those assigned to Group 2 (26 infants) received CPDA-1 RBC stored for up to 3 days. Demographic and transfusion-related data were collected. Neonates from both groups showed similar demographics and clinical characteristics. The number of transfusions per infant transfused was 4.4 +/- 4.0 in Group 1 and 4.2 +/- 3.1 in Group 2, and the number of donors per infant transfused was 1.5 +/- 0.8 (Group 1) and 4.3 +/- 3.4 (Group 2), P < 0.001. RBC transfusions containing 29.7 +/- 18.3 mmol L(-1) of potassium (RBC stored for up to 28 days) did not cause clinical or biochemical changes and reduced donor exposures by 70.2%, compared to transfusions containing 19.8 +/- 12.3 mmol L(-1) of potassium (RBC stored for up to 3 days), P < 0.001. In conclusion, RBC stored for up to 28 days safely reduced donor exposures in premature infants.

An Isolated Limb Infusion Technique: A Guide for the Perfusionist

Isolated limb perfusion with the administration of cytotoxic drugs has been successfully used to treat melanomas of the extremity since it was first introduced in 1958. The use of hyperthermia (40°C) combined with chemotherapy agents, primarily melphalan, has resulted in greater cytotoxicity in laboratory studies, which led to the application of hyperthermia in clinical studies during the 1960s. The effectiveness of this regional technique and the absence of any good systemic therapy made hyperthermic-isolated limb perfusion (HILP) the main treatment for patients with regionally advanced melanoma. HILP involves open surgical dissection and cannulation of the peripheral vessels and is associated with moderate morbidity rates. Blood transfusions, systemic drug leak, infection, and damage to the blood vessels and nerves are all potential hazards associated with this technique. Recently, however, there has been increased interest in an alternative technique termed isolated limb infusion (ILI), which was first reported in 1994 from the Sydney Melanoma Unit in Australia. Based on a few single institution experiences, it was found that there are fewer morbidities associated with HILP than with ILI but no compromise in patient outcomes. ILI is a less invasive procedure involving the use of angiographically placed catheters inserted percutaneously through the femoral vessels that does not require blood donor exposure or use of a heart lung machine. Preliminary data suggest that the resultant local hypoxia and acidosis induced by this procedure potentiates the cytotoxic effects of melphalan. Response rates comparing ILI to HILP seem similar, and both are markedly better than systemic chemotherapy. ILI may be a more desirable option because morbidity is greatly reduced and outcomes appear similar. There is a potential role for the perfusionist in the application of ILI, an evolving area of cancer therapy.

A Multicenter, Randomized, Controlled Clinical Pilot Trial of the Feasibility of an Intensive RBC Transfusion Policy for Patients with Acute Leukemia Treated with Induction Chemotherapy or Stem Cell Transplant.

Introduction: Patients with AML or ALL undergoing induction chemotherapy or SCT are at risk for hemorrhage. Hemoglobin (Hb) concentration may affect bleeding risk in thrombocytopenic patients. We performed a single-blinded pilot RCT to evaluate the feasibility of conducting a larger RCT to determine the effect of Hb on bleeding risk in thrombocytopenic patients. Objectives of the pilot RCT were: (1) to estimate the rate and variability of bleeding during the period of thrombocytopenia; (2) to confirm feasibility of the larger trial by demonstrating that: (a) it is possible to maintain patients' Hb within the targeted range; (b) patients assigned to the intensive threshold do not have increased donor exposure; (c) it will be feasible to enroll the required number of patients; and (d) bleeding can be systematically documented.Methods: Adults with AML or ALL undergoing induction chemotherapy or HLA-matched myeloablative allogeneic SCT were eligible. Consecutive eligible patients were randomly assigned to one of 2 treatment groups: standard RBC transfusion strategy (control group) and intensive RBC transfusion strategy (experimental group). Groups were stratified by treatment centre and diagnosis. Patients in the control group were transfused 2 RBC units when their Hb was <8g/dL to maintain their Hb between 8–10g/dL. Patients in the experimental group were transfused 2 RBC units when their Hb was <12g/dL to maintain their Hb above this threshold. Bleeding was documented daily by a blinded study assessor using a standardized form and protocol. Primary outcomes included: bleeding estimates; proportion of days with a Hb within targeted range; blood product utilization (RBC and platelets [plt]); and hospital length of stay (LOS). Secondary outcomes included the ability to document bleeding using the standardized protocol. Two-sided t-tests were used to compare blood product utilization and LOS between groups.Results: 60 patients were enrolled: 29 (control group) and 31 (experimental group). The mean age was 47.9 (range 18–77) years. 30 patients had newly diagnosed AML, 9 had relapsed AML, 5 had ALL, and 16 were undergoing SCT. Patients in the control group had Hb of 8–10g/dL on 56.4% of days. Patients in the experimental group had Hb>12g/dL 56.5% of days. The control group received fewer RBC transfusions (units/day) than the experimental group (0.167 vs 0.320, p<0.0001). The mean number of plts transfused (units/day) was not different for control and experimental groups (0.851 vs 1.063, p=0.383). The mean number of donor exposures (plt and RBC transfusions) was not different between control and experimental groups (26.9 vs 27.5, p=0.923). There was a nonsignificant trend towards a shorter LOS in the experimental group (27.9 vs 23.7, p=0.112). Bleeding data are undergoing blinded adjudication.Conclusions: It is feasible to enroll the required number of patients for a large RCT to investigate the effect of Hb on bleeding risk. Patients assigned to the intensive strategy had increased RBC utilization but no increase in total donor exposures. Funded by a grant from Canadian Blood Services.

Extracorporeal membrane oxygenation to cardiopulmonary bypass with a single circuit exposure

Due to the short supply of donor organs available, many patients decompensate or die while waiting for transplantation. Options for mechanical support for infants and pediatrics with congenital heart disease are limited because of the patient's size and device availability. Extracorporeal membrane oxygenation (ECMO) is the most common means of cardiac and respiratory support for these patients. One of the many indications for ECMO use in cardiac patients is as a bridge to transplantation, with patients being transported to the operating room (OR) on ECMO support. Converting the ECMO circuit to an open cardiopulmonary bypass system in the OR minimizes the patient's exposure to new circuitry, decreases further donor exposures and provides continuous support for patients in cardiac and/or respiratory failure. In addition, the ability to use modified ultrafiltration post-bypass aids in reducing extracellular fluid, increasing the hematocrit and improving hemodynamic stability following an extended duration of ECMO and bypass support. The integrity of the ECMO circuit is maintained and can be converted back to ECMO for support postoperatively if needed.

Randomized Trial of Liberal Versus Restrictive Guidelines for Red Blood Cell Transfusion in Preterm Infants

Although many centers have introduced more restrictive transfusion policies for preterm infants in recent years, the benefits and adverse consequences of allowing lower hematocrit levels have not been systematically evaluated. The objective of this study was to determine if restrictive guidelines for red blood cell (RBC) transfusions for preterm infants can reduce the number of transfusions without adverse consequences. We enrolled 100 hospitalized preterm infants with birth weights of 500 to 1300 g into a randomized clinical trial comparing 2 levels of hematocrit threshold for RBC transfusion. The infants were assigned randomly to either the liberal- or the restrictive-transfusion group. For each group, transfusions were given only when the hematocrit level fell below the assigned value. In each group, the transfusion threshold levels decreased with improving clinical status. We recorded the number of transfusions, the number of donor exposures, and various clinical and physiologic outcomes. Infants in the liberal-transfusion group received more RBC transfusions (5.2 +/- 4.5 [mean +/- SD] vs 3.3 +/- 2.9 in the restrictive-transfusion group). However, the number of donors to whom the infants were exposed was not significantly different (2.8 +/- 2.5 vs 2.2 +/- 2.0). There was no difference between the groups in the percentage of infants who avoided transfusions altogether (12% in the liberal-transfusion group versus 10% in the restrictive-transfusion group). Infants in the restrictive-transfusion group were more likely to have intraparenchymal brain hemorrhage or periventricular leukomalacia, and they had more frequent episodes of apnea, including both mild and severe episodes. Although both transfusion programs were well tolerated, our finding of more frequent major adverse neurologic events in the restrictive RBC-transfusion group suggests that the practice of restrictive transfusions may be harmful to preterm infants.

Erythropoietin: an update on the therapeutic use in newborn infants and children

Recombinant human erythropoietin (epoetin) has become the most widely used cytokine in the world. Following the success of its use in patients with end-stage renal disease, the usefulness of epoetin in other anaemias was assessed, including paediatric patients, mainly newborns. The treatment or prevention of anaemia of prematurity with epoetin resulted in a significant reduction in the number of transfusions and donor exposure. A clear definition of which premature babies must receive therapy is yet to be established. Other indications in neonatal period include hyporegenerative and haemolytic anaemias. The potential for use of the nonhaematopoietic effects of epoetin in newborn infants is a novel and exciting issue. The role of epoetin as a tissue-protective factor for the CNS and intestinal mucosa is under exhaustive investigation. With the exception of chronic renal failure, in older children the efficacy of epoetin has not been evaluated as in adults. Although an impressive amount of studies were carried out during recent years in adult patients with cancer-related or HIV-infection-related anaemias, thus allowing clear conclusions to be established on its efficacy, only a few trials with a small number of patients have been reported in children. Up-to-date, results in paediatric patients suggest that epoetin therapy is as useful as in adult patients, but prospective, randomised trials including large number of patients are essential to achieve definitive conclusions.

Preoperative use of enoxaparin increases the risk of postoperative bleeding and re-exploration in cardiac surgery patients

The purpose of this study was to investigate if the preoperative use of new platelet inhibitors and low-molecular-weight heparins may contribute to bleeding after cardiac surgery. Retrospective data review. University teaching hospital. One hundred eleven patients divided in 5 groups. Patients were grouped according to preoperative antithrombotic regimen: group 1, control, no agents (n=55); group 2, clopidogrel (n=9); group 3, enoxaparin (n=17); group 4, any GP IIb/IIIa inhibitor (n=14); and group 5, any drug combination (n=15). Data included cumulative mediastinal chest tube drainage, allogeneic blood transfusions, total blood donor exposures, and re-exploration. Use of any drug (groups 2-5) resulted in greater total blood transfusions and donor exposure (p=0.0003) than control, especially red cells (p=0.002) and platelets (p=0.006). A greater percentage of patients on enoxaparin required mediastinal re-exploration for nonsurgical bleeding versus control (3/17 v 0/55, p=0.001). The use of enoxaparin was associated with significantly higher chest tube output after the first 24 hours postoperatively (p=0.048). Newer antithrombotic agents were associated with greater transfusion rates and total donor exposures. Enoxaparin use was associated with greater overall blood loss and with higher incidence of mediastinal re-exploration. The relative risk-benefit ratio of reduced periprocedure morbidity versus increased bleeding complications has yet to be determined.

An Increase in the Immature Platelet Fraction Predicts Reconstitution of the Platelet Count and May Reduce Prophylactic Platelet Transfusions after Stem Cell Transplantation.

A new automated method to reliably quantitate reticulated platelets, expressed as the immature platelet fraction (IPF), has been developed on an automated cell counter (XE-2100, Sysmex). The IPF is identified by flow cytometery using a polymethine dye, staining platelet RNA, in the reticulocyte channel; the results are available at the same time as the CBC. The IPF normal range is 1.1–6.1%, mean 3.4%, 2 SD 2.3%. Reproducibility and stability results over 48 hours were acceptable. The IPF is raised when there is increased peripheral consumption/destruction. In untreated idopathic thrombocytopenic purpura, n = 12, mean 22.3%, range 9.2–33.1% and active thrombotic thrombocytopenic purpura, n = 5, mean 17.2%, range 11.2–30.9%. Patients who may require prophylactic platelet transfusion, usually at threshold counts less than 10 x 109/L, to support periods of marrow aplasia were monitored daily for platelet count and IPF%. The recovery phase of thrombocytopenia in most chemotherapy (n=13) and stem cell/bone marrow transplant patients (n=15) was preceded by a rise in IPF% several days prior to platelet recovery, mean IPF 13.7%, range 7–27.3%. In particular, patients undergoing autologous transplantation (n=8) using peripherally collected stem cells have a very characteristic IPF% motif, with a rise 1 day prior to engraftment for all patients except one where it was 2 days prior. For bone marrow derived transplant patients the increase in IPF was more variable, the rise preceded the rise in platelet count by 2–7days. These patients suffer more septic episodes where there is a rise in the IPF with no immediate increase in the platelet count, and require more regular platelet transfusions. Following a platelet transfusion there is a 24-hour transitory fall in the IPF response, which may impede platelet recovery. A parameter that could predict the timing of platelet recovery could be used clinically to reduce the use of prophylactic platelet transfusion in these patients, thus minimising donor exposure, infection risk and allowing substantial financial savings. The IPF is a useful parameter in the evaluation of the thrombocytopenic patient and has the potential to allow more optimal transfusion of platelet concentrates.

Recombinant Human Erythropoietin to Treat the Anemia of Prematurity

SummaryBecause plasma levels of erythropoietin are low in infants with the anemia of prematurity, it is logical to hypothesize that treatment with recombinant human erythropoietin (rHuEPO) would increase erythropoiesis and markedly diminish need for transfusions. Despite a large number of controlled clinical trials, the role of rHuEPO in neonatology practice is controversial. Clearly, it increases erythropoiesis in neonates and infants, but its efficacy in diminishing transfusions has been inconsistent, particularly in sick premature infants sustaining large phlebotomy loss for laboratory testing. Moreover, the ability to limit transfusions and donor exposures via modern transfusion practices coupled with concerns that the complete potential for adverse effects of rHuEPO is undefined have dissuaded widespread acceptance of rHuEPO as standard therapy to prevent or treat the anemia of prematurity.

Neonatal red blood cell transfusions.

Red blood cell and blood product transfusion in the fetus, neonate, and premature infant are often administered with poorly defined indications and unintentional adverse consequences. Products may be altered in an effort to limit potential adverse events or may be specially selected to meet the unique needs of a specific diagnosis. One area of particular concern to neonatologists is selection blood for small volume (5-15 mL/kg) transfusions in premature infants. For infants, use of red blood cells collected in anticoagulant-additive solutions and administered in small aliquots over the shelf life of the product to decrease donor exposure has supplanted the use of fresh red blood cells with each transfusion resulting in a donor exposure. The safety of this practice has been documented and procedures established to aid a transfusion service in making these products available. Less well established are the indications for transfusion in this population; hemoglobin or Hematocrit alone are likely insufficient unless clinical findings like oxygen desaturation, apnea, and bradycardia are part of the criteria used to define transfusion need. The comorbidities that increase oxygen demands in these infants, like bronchopulmonary dysplasia and increased oxygen consumption to accommodate growth, must be part of the decision to transfuse. Noninvasive methods or assays that will reflect the unique pathophysiology of oxygen delivery and peripheral oxygen offloading are needed.

Cost effective use of satellite packs in neonates: importance of birth weight

<b>Background:</b> Blood banks split an adult packed red cell bag (usually 250 ml) into 30 ml bags, making a total of eight neonatal “satellite” packs per donor. These packs are then “allocated”/“committed” to be used to serially transfuse a newborn. <b>Aim:</b> To study transfusion requirements of premature infants in relation to their birth weight and thereby attempt to rationalise the method of dispensing satellite blood packs. <b>Method:</b> Data on the distribution of neonatal transfusions with respect to weight were obtained retrospectively from unit A (51 infants, 168 transfusions) and unit B (46 infants, 151 transfusions). These data were used to model the effect of different policies on donor exposure and number of unused packs. <b>Results:</b> Infants weighing less than 1000 g at birth have significantly higher transfusion requirements than those weighing1000 g or more (p = 0.001 (unit A), p = 0.004 (unit B)). Our model predicted a significant reduction in donor exposure if eight packs/infant were allocated to those weighing &lt; 1000 g, and a significant cut in the number of unused packs if four satellite packs/infant were allocated to those weighing ⩾ 1000 g. <b>Conclusions:</b> It would be safer and cost effective to allocate eight packs/infant to those with birth weights &lt; 1000 g and four packs/infant to those with birth weights ⩾ 1000 g.

Fresh frozen plasma in the pediatric pump prime: a prospective, randomized trial

Background The aim of this study was to determine whether the use of fresh frozen plasma (FFP) in the infant pump prime can avoid dilution of fibrinogen, decrease the need for blood product transfusion after bypass, and decrease exposure to donor blood products. Methods Twenty infants weighing less than 8 kg were prospectively randomized to receive either 1 U of FFP (10 patients) or no FFP (10 patients) in the pump prime. Mean age (4.2 ± 2.8 months), weight (4.3 ± 1.1 kg), total prime volume (641 ± 96 ml), cardiopulmonary bypass time, cross-clamp time, lowest temperature on bypass, and preoperative coagulation parameters did not differ between the two groups. Results At the end of bypass, the mean fibrinogen level was significantly higher in the FFP than the no FFP group (123 ± 20 versus 58 ± 17 mg/dL; p < 0.0001), whereas the mean platelet count did not differ (60 ± 25 versus 52 ± 26 K/mm 3; p = 0.5). Patients in the FFP group received significantly fewer units of cryoprecipitate (0.4 ± 0.8 versus 2.0 ± 0.9 U/patient; p < 0.001), and had a mean total donor exposure of 4.1 ± 1.5 U/patient versus 5.4 ± 1.4 U/patient in the no FFP group ( p = 0.06). The mean chest tube output over the first 24 hours did not differ between groups. Conclusions The use of FFP in the pump prime significantly limited dilutional hypofibrinogenemia, decreased the transfusion of cryoprecipitate after bypass, and tended to decrease the overall mean patient exposure to blood products.

Comparative study of plateletpheresis using Baxter CS 3000 plus and Haemonetics MCS 3P

Platelet concentrates made from cell separators are used more frequently due to less donor exposure and leucodepletion. This retrospective study was done to compare plateletpheresis done on two cell separators: Baxter CS 3000 plus and Haemonetics MCS 3p. Plateletpheresis procedures, done from January 1997 to April 2002, were included in the study. One hundred and seven procedures were done on Haemonetics MCS 3p using SDP protocol, 49 procedures were done on Haemonetics MCS 3p using PLP protocol, and 107 were done on Baxter CS 3000 plus. Pre-procedure donor's platelet count and haemoglobin were comparable in all the groups. Platelet yield was comparable in PLP (6.44 x 10(11) platelets) and SDP (5.27 x 10(11)) protocols, but significantly less in Baxter (4.05 x 10(11) platelets, P < 0.001 for PLP and P < 0.05 for SDP). Efficiency of platelet removal was statistically significantly different in all the groups (P < 0.0001), however it was more in PLP (PLP-55.02%, SDP-47.38%, Baxter 38.98%). A significant number of products (19.51%) of Baxter failed to comply platelet count of product < or = 2,435 x 10(9)/l compared to 5.13% in PLP and 1.23% in SDP group; 36.96% of units from PLP and 28% from SDP qualified for split products compared to 1.18% of Baxter. PLP protocol of Haemonetics MCS 3p gives better platelet yield compared to Baxter CS 3000 plus and SDP protocol of Haemonetics MCS 3p.

Donor exposure rate to transfusion ratio: a better discriminator of improvement in neonatal transfusion practice.

This study identifies the benefit of using donor exposure rate (DER) to transfusion rate (TR) ratio as a discriminative index for assessing improvement in practice pattern in multiple-transfused neonates. It provides a methodology to demonstrate reduction in donor exposure that is not evident from the use of DER alone. Two time points, one 12-month period (1996-1997) before and one 12-month period (1999-2000) following the introduction of a paedipack system, were reviewed. Blood issued and wasted was quantified. The 1994 BSCH guidelines to define transfusion were used for both time periods, and recombinant erythropoietin (EPO) was not used. Following implementation of paedipack system, 186 donor units were made into satellite bags and kept for 35 days. A dramatic decrease in DER : TR ratio was noted for 79 transfused infants. The DER : TR ratio was 1 : 1 before and 1 : 3.2 after introduction of paedipacks, giving a 70.5% reduction in donor exposure risk. This was not evident from the use of DER alone, which remained the same (2.4) in the historical and study groups. High transfusions per donor unit (TPDU) correlated with the reduction in DER : TR ratio. Red cell wastage per transfusion was 190 +/- 30 mL before and 24.5 +/- 10 mL after intervention.