Increment Recovery Research Articles

Buffy coat pooled platelets a cost-effective alternative to single-donor apheresis platelets for hemato-oncology patients in the Indian scenario: A randomized cross-over study

Abstract BACKGROUND: Buffy coat pooled platelets (BCPP) have recently been licensed for clinical use in India and have merits of both the conventional platelet concentrates, i.e., random donor platelets and single-donor apheresis platelets (SDAPs). Repeatedly, finding a ABO-matched donor for hemato-oncology patients is a challenge. AIM: This study aimed to evaluate feasibility, efficacy, safety, and cost-effectiveness of BCPP in nonrefractory, hemato-oncological patients in comparison to SDAP. METHODS: In a randomized cross-over study design, 93 hemato-oncological patients were assigned either BCPP or SDAP as their first transfusion product. On subsequent requisition for the same patient, the other platelet product was issued for transfusion. Corrected count increment (CCI) and percentage platelet recovery (PPR) were calculated 1 h after the transfusion. Intertransfusion interval, posttransfusion platelet increment, and signs of any adverse transfusion reactions were also noted. A cost analysis was also done. RESULTS: Mean posttransfusion platelet increment was observed to be 37043/μL for BCPP and 30839/μL for SDAP. The mean CCI and PPR 1 h after transfusing was 15003 and 36.42% for BCPP and 15554 and 38.04% for SDAP. The median intertransfusion interval was 96 h after BCPP and 72 h after SDAP transfusion. Multivariate analysis shows that the BCPP is noninferior to SDAP for CCI (−549, 95% confidence interval [CI]: −1129–−30), PPR (−1.62, 95% CI: −3.02–−0.21), superior for platelet increment (6202, 95% CI: 4742–7661), and for intertransfusion interval (35, 95% CI: 10.5–59.5). No transfusion reactions were reported in any of the patients enrolled. BCPP costs 61% less than the SDAP in our setup. CONCLUSION: This study suggests that in nonrefractory, hemato-oncological patients BCPP is noninferior to SDAP in terms of 1-h posttransfusion CCI and PPR. BCPP costs significantly less and can act as a good alternative to SDAP in resource-constrained settings.

Defoliation level interacts with tree species and soil richness to determine volume increment reduction and recovery from simulated spruce budworm attack

Defoliation and tree species determine growth during spruce budworm outbreaks, with site showing inconsistent effects. We determined effects of artificial defoliation treatments (0%, 50%, 100%, 100%+bud) for 3 years on volume increment of 240 balsam fir, black spruce, and white spruce trees, initially 7–10 years old and 2.3–4.1 m tall, on four soil drainage/richness classes. Current annual increment was significantly affected by species × site and site × defoliation interactions, with DBH as covariate. Specific volume increment (SVI) was significantly affected by a species × site × defoliation treatment interaction. Combining species and sites, volume reductions after 3 years were 21%–28%, 43%–51%, and 55%–66% for 50% defoliation, 100% defoliation, and 100%+bud. SVI was negatively, linearly related to cumulative defoliation. Marginal r2 and conditional r2 showed that 64% of variance of SVI was explained by site, species, cumulative defoliation, and DBH, but 90% was explained by fixed and random variables. After 3 years of defoliation, SVI of white spruce was 21%–23% greater than balsam fir and black spruce, and SVI on rich was 55%–79% greater than on poor sites. Cumulative defoliation was a good predictor of growth, and soil richness had a stronger effect on growth after defoliation than in previous studies.

Aerodynamic efficiency analysis of the ridge integrated submerged inlet

In this study, a new ridge surface is proposed and its impact on the aerodynamic efficiency of a generic top-mounted submerged inlet is investigated at Mach 0.3 to 0.5. The concept is developed to investigate the possibility of vortex breakdown manipulation by the ridge surface to control the chaotic flow pattern after the breakdown, measuring the overall drag increment and total pressure recovery due to the ridge integration. For this purpose, a conceptual submerged inlet is designed with a semi-elliptic entrance for integration with a generic fuselage and ridge surfaces; then different study cases are modeled based on this configuration for numerical simulations by Ansys Fluent. Key factors such as the quality of the captured streamtube, vortex patterns on the fuselage, induced lift, and vortex breakdown patterns are investigated and compared by second order accuracy. Results indicate that the modified ridge surface improves the overall efficiency of the fuselage-inlet configuration both in the terms of lift over drag and pressure recovery.

Assessment of Platelet Crossmatch Results by Solid Phase Red Cell Adherence Assay among Pediatric Hemato-oncology Patients in a Tertiary Care Oncology Center

ABSTRACT Background and Objectives: This study employed platelets cross-matched by the solid-phase red cell adherence (SPRCA) method and oc-related it with posttransfusion platelet count increment in terms of corrected count increment (CCI) and percent platelet recovery (PPR) among pediatric hemato-oncology patients. It did not study subgroups of patients nor did it have a control group. This was an observational study. The objective of the study was to assess platelet crossmatch results by the SPRCA method and find its correlation with posttransfusion platelet count increment among pediatric hemato-oncology patients in a tertiary care oncology center. Methods: This was a prospective observational study performed on pediatric patients with hematological malignancies requiring platelet transfusions during August 2019–January 2020. An assessment of the response to platelet transfusion on the participants was analyzed against the crossmatch results using SPRCA to measure the response in terms of CCI and PPR. Results: A total of 80 pediatric multiply transfused patients of hematological malignancies were transfused with ABO-identical single donor platelet unit which was subsequently tested for compatibility SPRCA assay. Among a total of 80 platelet crossmatches, 86% (69/80) were found to be compatible. Among 69 patients with compatible platelet crossmatches, 91% (63/69) had adequate CCI (>7500). Among 11 patients with incompatible crossmatches, 73% (8/11) had adequate CCI, and 27% (3/11) had inadequate CCI. Statistically significant association was found between crossmatch compatibility and PPR. Conclusions: Transfusion of crossmatched platelets from the available inventory to multiply transfused patients of hematological malignancies can be an option. It is very important to assess the posttransfusion platelet responses in such patients in terms of CCI as well as PPR. The SPRCA assay is a rapid and effective method to select the compatible unit from the inventory and is feasible to implement in an oncology setup to cater the requirement of multiple platelet transfusions to patients with hematological malignancies.

Experimental Study on Enhanced Oil Recovery of the Heterogeneous System after Polymer Flooding

Daqing Oilfield faces increasing reservoir heterogeneity after years of polymer flooding, limiting further enhanced oil recovery. A novel preformed particle gel (PPG) was developed by Daqing Oilfield due to the limited profile control ability of polymer flooding. The preformed particle gel possesses strong deformation ability and the ability to pass through pore throats. The PPG was developed considering the in situ reservoir conditions and combined effects of plugging and flooding. Thus, a heterogeneous system was prepared by mixing polymers and the PPG. In this study, we measured the related properties of the system and assessed its profile control ability and oil displacement performance after polymer flooding. The experimental results demonstrate that typical polymer flooding cannot improve oil recovery under current reservoir conditions. Thus, deep profile control technology should be applied to remediate the highly heterogeneous reservoir issue. PPG can considerably increase the viscosity and stability of the system. The heterogeneous system has a strong plugging ability during the subsequent water flooding stage and is suitable to inject into the medium and high permeability layers. The water absorption profile of the core samples is significantly improved due to the impact of the PPG on the plugging of the layer with high permeability and the liquid flow direction. The system displays an excellent profile control effect in the core with a permeability ratio (high permeability/low permeability) of two under the conditions of a PPG concentration of 500 mg/L and an injection volume of 0.5 PV. In the oil displacement experiment, the recovery efficiency was raised by 16.56% using the polymer system, leading to significant swept volume increment and oil recovery improvement.

A Methodical Approach to Scrutinize the Role of Body Mass Index in Heart Rate Increment and Recovery

OBJECTIVES Heart rate (HR) is a crucial health indicator and is also one of the health factors we need to pay explicit attention to. Body Mass Index (BMI) is considered a cofactor in heart-related issues like heart rate increment and recovery. Thus a study was conducted to determine the relationship between BMI and the rate of heart rate increment and recovery. METHODOLOGY 24 participants aged 17-20 were examined during elliptical machine training once a week continuously for three months. Their regular resting heart rate and change in heart rate during and after the elliptical workout were recorded and compared with BMI. RESULTS The HR increments were noted alongside BMI for male participants below BMI 21.13, and female participants below BMI 20.16. The heart rate increment tempo decreases alongside the increased BMI for both sexes afterwards. The heart rate recovery (HRrecovery) for male participants falls with the BMI increase to ~25 and increases thereafter. The female participants show a differing trend: HRrecovery rates increase following BMI growth till BMI ~ 20 and then decrease parabolically till the maximum BMI among female participants. The findings suggest no linear and non-significant correlation between BMI and heart rate increment or HRrecovery. The coefficient of determination is too tiny (R2 = 0.1395 for males and R2 = 0.003 for females) to indicate the causation between BMIs and HRrecovry. CONCLUSION This is the first study scrutinizing the role of body mass index on heart rate increment and heart rate recovery. Thus BMI should not be used as the cofactor or risk for heart activity or impaired functions.

Effect of Donor and Patient Variables on the Platelet Increment and Percent Platelet Recovery

Background and Objectives: Platelet (PLT) deficiency is a common cause of bleeding and PLT transfusions are often indicated for the same. PLT refractoriness is a challenging complication in patients dependent on PLT transfusions. The present study aimed to find out any effect of the donor, recipient, and machine variables on PLT increment (PI) and percent PLT recovery. Patient and Methods: A total of 600 apheresis PLT donors and 600 patients were included in this study; however, the PI and percent platelet recovery (PPR) were analyzed for only 535 patients. The data were collected such as the donor's age, gender, preapheresis hemoglobin (Hb), PLT count, PLT product yield, patient's age, gender, weight, pre- and posttransfusion Hb, and PLT count. PI and PPR were calculated and compared across different groups. Results: Refractoriness was more seen in hematological disorders in comparison to nonhematological disorders (P = 0.00001). However, no significant association of donor and recipient characteristics with PI was seen. Conclusion: PI does not depend on recipient characteristics such as age, gender, pretransfusion PLT count, and Hb.

Platelet Refractory Cases after Transfusion of Fresh and Stored Platelet in all Children

Introduction: Acute leukemia is the most common form of cancer in children, platelet transfusion is needed for the chemotherapy of acute lymphoblastic leukaemia children. Platelets are transfused for therapeutic and prophylactic purposes. Transfusion of stored platelet concentrates (up to 5 days) has been demonstrated to be as effective as transfusion of fresh platelet concentrates (upto 24 hours). Platelet refractory cases were also observed in this study that was detected by Corrected Count Increment (CCI) and Percent Platelet Recovery (PPI) at 1hour and 24 hours. Aim of the study: The aim of this study was to observe the platelet refractory cases after transfusion of fresh and stored platelet in acute lymphoblastic leukemia (ALL) in a tertiary care hospital, Dhaka. Methods: A cross-sectional study was conducted in the Department of Clinical Pathology, Paediatric Haematolo- Oncology and transfusion Medicine BSMMU, Department of Haematology and Paediatric Haemato-Oncology in Dhaka Medical College Hospital from March 2010 to February 2011 where 81 children diagnosed with acute lymphoblastic leukaemia were taken as the study population. Non probability purposive sampling was used by fulfilling the inclusion criteria. Ethical consideration was taken by the BSMMU ethical review committee. A data sheet with two parts (Part A and Part B) was designed with a view to collect data from the patients to be enrolled in the study. Data were analyzed using the SPSS version 25.0. Results: Out of 81 in 47 children with acute lymphoblastic leukemia (ALL), fresh platelet concentrates (FPC) (upto 24 hours) or day-0 platelets were transfused. In 34 children, stored platelet concentrates (SPC) (days 1–5) were transfused. In 27 cases, platelet concentrates were transfused both fresh and stored. In FPC and SPC, the corrected count increment at one hour (CCI 1h) was 20.5×109/L and 18.9×109/L respectively. FPC and SPC values for the mean corrected count increment at 24 hours (CCI 24h) were 15.5×109/L and 13.8×109/L respectively. Platelet refractory cases were 15(18.5%) out of 81 cases transfused. Platelet refractory cases were 7(15%) out of 47 cases transfused with FPC and 8(23%) out of 34 cases transfused with stored platelet concentrate (SPC). There were no significant differences (P<0.05) between FPC and SPC according to platelet refractoriness. Conclusion: In vivo quality of freshly generated platelet (upto 24 hours) versus stored platelet concentrates (up to 5 days) were determined after 1 hour and 24 hours. 1-5 day’s stored PRP-PCs are as effective as fresh PRP-PCs for sufficient platelet increment.

A comparative study of the transfusion effect of single donor apheresis platelets versus random donor platelets in the management of severe dengue infection in children

Background: The national vector-borne diseases control programme (NVBDCP) dengue clinical care guidelines 2014 clearly specify the indications for platelet transfusion in dengue fever. The goal of the study was to see how successful guideline-driven platelet transfusion was, as well as whether single donor platelet (SDP) transfusion was superior to random donor platelet transfusion (RDP), which was widely thought but unproven.Methods: Two ml of the patient's blood were collected in EDTA tubes at two distinct times: once before the transfusion and the other 24 hours afterwards and the data were assessed using corrected count increments (CCI), percentage recovery (PR) and other criteria.Results: Platelet increments were substantially larger with SDP transfusions at 24 hours than with RDP transfusions (p<0.01 for 24 hours post-transfusion period). However, in both groups, the corrected count increment and percentage recovery were nearly identical and the difference was statistically insignificant.Conclusions: Although post-transfusion increments were considerably higher in SDP patients than in RDP patients, the CCI and PR were similar in both groups of patients. When it comes to the number of donors exposed to patient and leukoreduction, SDP is superior to RDP in terms of logistics. However, in developing countries, SDP may be advised only in selected patients based on accessibility and affordability, due to their high cost and higher technical competence required.

A Comparative Study between Fresh and Stored Platelet Concentrate after Transfusion in same ALL patients in a Tertiary Hospital

Background: Platelet transfusion is needed for the treatment of ALL children. Researchers have shown that transfusion of stored platelet concentrates (up to 5days) is as effective as fresh platelet concentrates (24 hours). Objectives: The present study was conducted to access the comparison between fresh and stored platelet concentrate after transfusion in same all patients in a tertiary hospital. Materials and methods: The study was a cross-sectional descriptive study which was conducted in department of Clinical Pathology, Paediatric Haemato-Oncology and transfusion Medicine BSMMU, and Department of Haematology and Paediatric Haemato-Oncology in Dhaka Medical College Hospital. Over a period of March 2010 to February 2011.The sample size was 81. A data sheet with two parts (Part A and Part B) was designed with a view to collect data from the patient to be enrolled in the study .The data were analyzed using the SPSS version 25.0. Results: Out of 81 patients fresh platelet concentrates (FPC) or day-0 platelets were transfused in 47 acute Lymphoblastic leukaemia (ALL) children. Stored platelet concentrates (day 1-5) were transfused in 34 children. In 27cases both fresh and stored platelet concentrates were transfused. Corrected count increment at 1 hour (CCI 1h) in FPC and SPC were 20.5 and 18.9 respectively. Mean corrected count increment at 24 hour (CCI 24h) FPC and SPC were 15.5 and 13.8 respectively. There were no significant differences between FPC and SPC P>0.05. Conclusions: It was observed that 1-5 day's stored platelet-rich-plasma platelet concentrate (PRP-PC) was as effective as fresh PC to obtain acceptable platelet increment in childhood acute lymphoblastic leukemia. Furthermore, corrected count increment and percentage platelet recovery are important tools to evaluate platelet refractoriness.

Comparison of in-vitro and in-vivo parameters of whole blood derived random donor platelets (RDP) after over-night hold with RDP prepared after 2-h hold: Single centre report from India

Random Donor Platelet (RDP) derived from whole blood is the major source of platelets in India. At our centre, we prepare RDPs by buffy coat method after a holding period of 2-hours (THRDP) as per current regulatory guidelines. Overnight hold of buffy coats before RDP preparation (OHRDP) would logistically optimise the manpower usage at our centre. The aim of this study was to compare both in-vitro as well as in-vivo parameters of OHRDPs with THRDPs.Hematological (Platelet, leucocyte counts), physical (pH and Swirling) and biochemical parameters (pO2, pCO2, lactate, bicarbonate and glucose) as well as platelet activation markers were tested in THRDPs and OHRDPs each at Day-1 and Day-5 as in-vitro studies. Separately, in-vivo study was done where Corrected count increment (CCI) and percentage platelet recovery (PPR) were considered. All parameters were expressed as Mean ± Standard deviation and were analysed using paired t-test with level of significance, p < 0.05.OHRDPs had higher platelet counts and lower leucocytes and CD62 P expression than THRDPs. All other markers were well within the quality control range in both groups. No significant differences were seen in the two groups when comparing CCI and PPR.OHRDPs were found to be as good or better as compared to the THRDPs in the in-vitro part of our study. Additionally, there were no significant differences between the two groups when they were compared in vivo. This makes us conclude that overnight hold of buffy coats may be implemented at our center.

Unveiling performance stability and its recovery mechanisms of one-stage partial nitritation-anammox process with airlift enhanced micro-granules

The performance stability and its recovery mechanisms of a partial nitritation-anammox process were investigated. A one-stage airlift enhanced micro-granules (AEM) system was operated for 650days continuously to treat 50mg-NH4/L wastewater. During the stable stage, a high nitrogen removal efficiency of 72.7±8.4% lasting for 230days was successfully achieved under 0.28L/min aeration rate and 0.10-0.20mg/L dissolved oxygen (DO) concentration. A microbial consortium with good granularity appeared in red. The specific activity of anammox and ammonia oxidation increased to 1.02 and 0.93g-N/g-VSS/d, respectively. Meanwhile, the microbial analysis showed the AEM system shifted the dominant microflora from Proteobacteria to Planctomycetes in which Candidatus Brocadia abundance reached a high of 35.0%. The results reveal that the long-term airlift-aeration promoted granulation and further enhanced activities, the abundances of anammox bacteria, and suppressed nitrite-oxidizing bacteria. Optimizing the DO control is also critical for stability increment and process recovery.

Real-time Electromyography-driven Functional Electrical Stimulation Cycling System for Chronic Stroke Rehabilitation.

Stroke-induced lower extremity dysfunction has become a severe medical problem nowadays and effective rehabilitation methods are in great demand. In this work, a new real-time Electromyography-driven Functional Electrical Stimulation (FES) cycling system was developed to help chronic stroke patients with lower limb rehabilitation training. To evaluate the feasibility and effectiveness of this system, 3 chronic stroke subjects were recruited and each received 20 training sessions where real-time Electromyography (EMG) was used to interact with the cycling system. During the training, two typical metrics, averaged Area Under Torque (AUT) and maximal EMG amplitude, were adopted to measure the muscle strength changes of hamstring (HS). The training results showed that the two measurements of HS both significantly increased, especially the maximal EMG amplitude in the last trial was twice as much as that in the first trial, indicating paretic limb strength increment and functional recovery, which suggested that our system is effective and helpful in the stroke rehabilitation.

Enhanced window increment and adaptive recovery TCP for multi‐hop wireless networks

In this Letter, a combined algorithm known as receiver-assisted slow start (RASS) and feedback-assisted recovery (FAR) proposed to address the joint optimisation problems of transmission control protocol (TCP) such as non-optimal initial window (IW) size, slower window growth and spurious window deflation under multi-hop wireless (MHW) networks. The RASS fix the sender's optimum IW size from the receiver's advertised value and replaces the conventional exponential window growth with enhanced window increment mechanism that significantly accelerates the transmission rate. The FAR uses relay router's feedback information to regulate false transmission rate reduction during packet drops. The simulation result reveals that the proposed algorithms had a substantial improvement in throughput and reduction in packet latency over the existing standard New Jersey and non-congestion events algorithms under MHW environment.

Determination in vivo viability of a transfused platelet product by corrected count increment and percentage platelet response.

IntroductionFor many years, platelet concentrates have been used for the prevention as well as treatment of bleeding disorders, especially in those patients with haematological problems involving platelet disorders as well as refractoriness, In addition, platelet concentrates (PCs) have been widely used to support patients undergoing bone marrow transplantation or who are receiving myelotoxic treatments. The aim of this study was to determine the quality of platelet concentrates by assessing platelet counts, volume, pH changes, swirling, residue of the red blood cells and white blood cell counts. Assess the in vivo viability of a transfused platelet product using the corrected count increment (CCI) and the percentage platelets response (PPR). This descriptive analysis study was done in Kenyatta National Hospital Blood Transfusion Unit between July 2016 and December 2016.MethodsThe in vitro Platelets concentrates quality was accurately determined and assessed using certain parameters. Platelet concentrates in ethylene diamine tetra acetic acid (EDTA) was used for analysis using Cell-Dyn 3700 analyser. The volume of PCs used was an average of 2mls of PCs, the pH was measured using digitalised Hanna edge pH kit. Agitation was done using Helmer agitator and centrifugation was done using Roto silenta 630 RS centrifuge. The in vivo viability of a transfused product was determined using corrected count increment (CCI) and percentage recovery (PR) between 1 and 20-hour after transfusion. Pre and post-transfused whole blood in EDTA collected from the recipients was analysed to access the functional platelets in the circulation. Data analysis was done using SPSS.ResultsA total of 384 platelet concentrates were analysed and used in transfusion. The majority 96, (40%) were O Rhesus D+ and the least being AB Rhesus D-at (1%).Centrifugation, separation and agitation was done according to standard procedure (n=384). Only (246 (65%) of the concentrates were found fit for use out of a total of (n=384) leaving 138 (35%) which did not meet the KNH/KNBTS criteria. The minimum specifications for platelet count are 5.5 x (109). The duration of 3 days of storage on average, the WBC count (109) was Mean ± SD 4.50 ± 3.50. Using the Hanna edge pH kit the pH Mean was ±SD 7.18 ± 8.82 and the used Volume (Mls) was at 55 ± 15. The concentrate was issued within 3 days of processing. After transfusion, the percentage platelet response (PPR) was 72% in male recipients at 1-hour and 30% at 20-hours while 69% in female recipients at 1-hour and 25% at 20-hours. The invivo viability of platelet product had a corrected count increment (CCI) of 75% ≥ 7500 at 1-hour and CCI of18% ≥ 30% at 20-hours in male recipients. In the same study, the female recipients had a CCI of 80% ≥ 7500 at 1-hour and a CCI of 25% ≥ 30% at 20-hours.ConclusionThe findings on platelets concentrates quality 65% met platelets transfusion criteria while 35% did not. On preparation of platelets concentrates there was high counts of white blood cells 4.5±3.5×109than recommended counts by Kenya National Blood Transfusion Services < 0.83×109. Both percentage platelet response (PPR) and corrected count increment (CCI) were very low at 20 hours compared to British committee for standards haematology criteria for successful increment of platelet products (PPR ≥ 30% and CCI ≥ 7500). Apheresis platelets transfusion can be introduced at KNH and use of leukoreduction performed on the platelet concentrates which are prepared within the Hospital. With such rate of refractoriness, additional tests to confirm the real cause of unviability of platelets in the patients need to be performed. Recipients should be done evaluation of the pattern of refractoriness followed by HLA compatibility testing. In addition, if there is a high, compatible cross-matched, selected apheresis platelet concentrate pint should be transfused. This unviability was due to recipients with either immune-mediated refractoriness or non-immune mediated refractoriness.

Mid- to long-term outcomes of posterior decompression with instrumented fusion for thoracic ossification of the posterior longitudinal ligament

Posterior decompression with instrumented fusion (PDF) surgery has been previously reported as a relatively safe surgical procedure for any type of thoracic ossification of the longitudinal ligament (OPLL). However, mid- to long-term outcomes are still unclear. The aim of the present study was to elucidate the mid- to long-term clinical outcome of PDF surgery for thoracic OPLL patients. The present study included 20 patients who had undergone PDF for thoracic OPLL and were followed for at least 5years. Increment change and recovery rate of the Japanese Orthopaedic Association (JOA) score were assessed. Revision surgery during the follow-up period was also recorded. Average JOA scores were 3.5 preoperatively and 7.1 at final follow-up. The average improvement in JOA score was 3.8 points and the average recovery rate was 47.0%. The JOA score showed gradual increase after surgery, and took 9months to reach peak recovery. As for neurological complications, two patients suffered postoperative paralysis, but both recovered without intervention. Six revision surgeries in four patients were related to OPLL. Additional anterior thoracic decompression for remaining ossification at the same level of PDF surgery was performed in one patient. Decompression surgery for deterioration of symptoms of pre-existing cervical OPLL was performed in three patients. One patient had undergone lumbar and cervical PDF surgery for de novo ossification foci of the lumbar and cervical spine. PDF surgery for thoracic OPLL is thus considered a relatively safe and stable surgical procedure considering the mid- to long-term outcomes.

Role of donor and recipient sex in platelet transfusion

H-Y proteins are ubiquitously expressed Y chromosome-encoded minor histocompatibility antigens, which are relevant in the transplantation of hematopoietic stem cells (HSCT) and solid organs. No studies have so far analyzed whether H-Y incompatibility influences the outcome of platelet (PLT) transfusion. We studied the effect of donor and recipient sex on outcome of 9038 single-donor PLT transfusions. Using standard corrected count increment or percent PLT recovery (PPR) calculations, male patients showed inferior recovery rates, irrespective of donor sex. Using an adjusted PPR, which takes into account differences in blood volume between males and females, neither donor nor recipient sex played any role in PLT recovery after transfusion. Similarly, the time to next PLT transfusion was unaffected by both donor and recipient sex. In a subgroup analysis of patients with graft-versus-host disease after allogeneic HSCT, male recipients of a female allograft-which may carry anti-H-Y T cells and antibodies-had significantly lower time to next PLT transfusion. However, this occurred after both male donor and female donor PLT transfusions, arguing against an involvement of alloreactivity against H-Y antigens on PLTs. This large analysis found no evidence that donor-recipient sex matching influences the outcome of PLT transfusion.

A prospective quality evaluation of single donor platelets (SDP) – An experience of a tertiary healthcare center in India

Quality assurance of single donor platelets (SDP) is incomplete unless clinical response to platelet transfusion is measured. The primary objective of the study was to evaluate the quality of SDP derived from plateletpheresis procedures and to evaluate the response to platelet transfusion. Procedures were performed on 2287 accepted donors while 271 donors were deferred. Platelet count <1.5 lac/μl and hemoglobin <12.5 g/dl were the leading cause of deferral. The median platelet yield in a SDP bag was found to be 3.1×10(11). The median corrected count increment (CCI) and post-transfusion platelet recovery (PPR) were found to be 10110×m(2)/μl and 24.5%, respectively. In India, the criteria for the selection of plateletpheresis donors should be revisited. Based on quality parameters, the Fresenius COM.TEC cell separator is comparable to other cell separators.

Lack of Efficacy of Prophylactic Platelet Transfusion for Severe Thrombocytopenia in Adults with Acute Uncomplicated Dengue Infection

Thrombocytopenia in dengue infection raises concerns about bleeding risk. Of 256 patients with dengue infection who developed thrombocytopenia (platelet count, < 20 x 10(3) platelets/microL) without prior bleeding, 188 were given platelet transfusion. Subsequent bleeding, platelet increment, and platelet recovery were similar between patients given transfusion and patients not given transfusion. Prophylactic platelet transfusion was ineffective in preventing bleeding in adult patients with dengue infection.

Therapeutic efficacy of different types of platelet concentrates in thrombocytopenic patients.

Platelet Rich Plasma-Platelet concentrate (PRP-PC), Buffy Coat poor-platelet concentrate (BCPC), and Apheresis - PC were prepared and their therapeutic efficacy were assessed in thrombocytopenic patients. PRP-PC and BC-PC were prepared from whole blood and Apheresis-PC by automated cell separator. The post transfusion efficacy of transfused platelets was assessed at 1 hour and 20 hours by corrected count increment (CCI) and percentage recovery (PR). A total of 60 patients' (20 each for PRP-PC, BC-PC and Apheresis-PC) were enrolled in this study. Forty one patients received therapeutic and nineteen received prophylactic transfusion support. Patients with aplastic anemia 43% (25/60) and acute leukemia 38% (23/60) formed a majority of study population. Platelet dosage of patients' received PRP-PC, BC-PC and apheresis-PC were 2.4±0.82 × 1011 (mean±SD), 2.2±0.83 × 1011 (mean±SD) and 4.14±1.82 × 1011 (mean±SD) and ranged from 1.16-4.11 × 1011, 1.04-4.20 × 1011 and 1.22-8.90 × 1011 respectively. There was significantly increase in inter-transfusion interval with Apheresis-PC than with PRP-PC and BC-PC recipients [(Mean±S.D.), 4.7±1.33 days Vs 2.7±0.82 days Vs 2.5±0.7 days respectively] (p < 0.05). Patients transfused with apheresis-PC had received higher platelet dosage than PRP-PC and BC-PC and this difference was statistically significant (p < 0.001). The post transfusion platelet counts and increments at 1 hour and 20 hours were significantly higher with apheresis-PC than PRP-PC and BC-PC (p < 0.001). However, the corrected count increment (CCI) and percentage recovery (PR) in all three groups were comparable. There was significantly increase in inter-transfusion interval with apheresis-PC than PRPPC and BC-PC (p < 0.05).