Plasmapheresis Donors Research Articles

Safety of Weekly Plasmapheresis

<h3>To the Editor.—</h3> We are writing concerning the response given to the question asked by Dr Seaton and answered by Dr Perkins (234:760, 1975). The question inquired about the effects on the health of plasmapheresis donors who give at weekly intervals for long periods of time, specifically the effects on serum protein concentration. In his reply, Dr Perkins cited an article (<i>Blood</i>23:647, 1964) that concluded that serum protein concentration remained essentially normal during weekly plasmapheresis programs. The serum protein concentrations were determined by electrophoresis. Our donor-center experience and a recently published article (<i>Transfusion</i>15:467, 1975) indicate that the picture is somewhat more complex. Often, the total protein level may be normal when γ-globulin levels by electrophoresis are quite often low-normal or even below accepted normal adult standards. By doing quantitative immunoglobulin determinations on these donors with low-normal or subnormal levels of γ-globulins, we quite often find depressed levels of

Plasmapheresis‐Induced Hemodilution and Its Effects on Serum Constituents

Samples were obtained from 23 plasmapheresis donors before, during, and after double plasmapheresis. Seventeen chemical analyses were performed on these specimens and the results were subjected to statistical analysis. Representative samples can be obtained from plasmapheresis donors before the procedure has begun, immediately after the first unit of whole blood has been removed, or 15 minutes after the completion of the entire procedure. The sample obtained after the first unit of whole blood has been removed will show dilutional lowering of the uric acid concentration, and the 15‐minute equilibration sample will show dilutional lowering of the inorganic phosphorus concentration. Short‐term donors and long‐term donors manifest a somewhat different hemodilutional response to plasmapheresis.

Plasmapheresis-induced hemodilution and its effects on serum constituents.

Samples were obtained from 23 plasmapheresis donors before, during, and after double plasmapheresis. Seventeen chemical analyses were performed on these specimens and the results were subjected to statistical analysis. Representative samples can be obtained from plasmapheresis donors before the procedure has begun, immediately after the first unit of whole blood has been removed, or 15 minutes after the completion of the entire procedure. The sample obtained after the first unit of whole blood has been removed will show dilutional lowering of the uric acid concentration and the 15-minute equilibration sample will show dilutional lowering of the inorganic phosphorus concentration. Short-term donors and long-term donors manifest a somewhat different hemodilutional response to plasmapheresis.

Short-term and long-term effects of plasmapheresis on serum proteins and immunoglobulins.

In order to evaluate the short-term and long-term effects of plasmaapheresis on serum proteins and immunoglobulins, the levels of alpha1, alpha2, beta, and gamma globulins, and IgG, IgA, and IgM were measured and statistically evaluated in 41 active plasmapheresis donors donating 500 to 1,000 ml of plasma weekly for up to three years. During the initial four months of plasmapheresis, the percentage of alpha1 and alpha2 globulins manifested a statistically significant rise and the IgG, IgA, and IgM concentrations declined. By the end of ten months, only the IgM continued to be depressed. Although the concentration of IgM continued to show a statistically significant decline for three years, it remained well within the normal range of values for our laboratory. Although no statistically significant difference existed between the baseline value of albumin and the level reached at the end of the third year, a gradual rise was followed by a decline in this interval. Most of the statistically significant alterations of serum protein and immunoglobulins occurring in plasmapheresis donors are seen in the initial six months of plasmapheresis. A falling serum protein in this time period is most likely an indication of declining immunoglobulins. It is feasible and appropriate to measure the donor's total serum protein at the time of each plasmapheresis. Any untoward reduction in this value necessitates quantification of the serum immunoglobulins. Routine measurement of the immunoglobulins in the face of normal total serum protein can be performed on a less frequent basis as is presently recommended by accrediting agencies, although this study should be performed more often during the first six months of a serial plasmapheresis program.

Safety and long-term effects of plasmapheresis.

No consistent clinical or laboratory value abnormalities were found during more than six years of plasmapheresis of donors who gave as much as the plasma equivalent of four units of whole blood per week. Potential hazards to the plasmapheresis donor, including hemoglobin depletion, protein depletion, iron depletion, and misidentification of blood returned to the donor are discussed. In addition to affording an economic and efficient opportunity to expand component therapy, repeated plasmapheresis of a small pool of preselected donors can provide a better quality product than that obtained from random donors.

Utilization of the Residual Plasma Following Preparation of Factor VIII Cryoprecipitate

The supernatant plasma remaining after factor VIII cryoprecipitate preparation is a most useful product and should not be returned to the plasmapheresis donor or to the refrigerator as factor VIII-poor whole blood. Stable coagulation factors are well preserved for up to 35 weeks at refrigerator temperature and for as long as one year in the frozen state. This enhances the usefulness of this product for treatment of patients with hemophilia B or with deficiencies of other stable coagulation factors. Preparation of the plasma from preselected donors of the type AB blood permits its use as a medium for reconstitution of packed cells for exchange transfusion, or as a volume expander. Moreover, use of this by-product reduces the cost of cryoprecipitate treatment for the patient with hemophilia A.