EVect of donor variables on yield in single donor plateletpheresis by continuous Xow cell separator

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1 Transfusion and Apheresis Science 34 (2006) intl.elsevierhealth.com/journals/tras EVect of donor variables on yield in single donor plateletpheresis by continuous Xow cell separator Rajendra Chaudhary, Sudipta Sekhar Das, Dheeraj Khetan, Pratul Sinha Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow , India Received 15 June 2005; received in revised form 15 August 2005; accepted 30 September 2005 Abstract The quality of single donor platelets (SDPs) in terms of yield inxuences platelet recovery in the recipient. Various donor factors such as pre-donation platelet count and hemoglobin (Hb) concentration avect the platelet yield. We studied the inxuence of pre-donation donor clinical and laboratory factors such as gender, age, weight of the donor, platelet count and Hb on the platelet yield. A total of 94 plateletpheresis procedures performed on continuous Xow cell separator (CS3000, Baxter Healthcare, Round Lake, IL, USA) were evaluated for platelet yield. A relationship between pre-donation donor variables and yield of platelets was studied using the Pearson correlation. The mean platelet yield was While a direct relationship was observed between pre-donation platelet count and yield (r D 0.50, p < 0.001), no such correlation was noticed with donor Hb concentration (r D 0.10, p > 0.005). Similarly, no correlation was observed between gender (r D 0.05), age (r D 0.11) and weight (r D 0.18) of the donor with yield. Optimization of platelet yield, which is inxuenced by pre-donation platelet count, is an emerging issue in blood transfusion services. IdentiWcation of such factors may help in selecting donors to obtain higher platelet yields and consequently better clinical outcome Elsevier Ltd. All rights reserved. Keywords: Donor platelet count; Single donor platelets; Donor hemoglobin; Plateletpheresis; Cell separator 1. Introduction * Corresponding author. Tel.: x2500; fax: address: rkcchaud@sgpgi.ac.in (R. Chaudhary). The developments in transfusion practice and introduction of advanced cell separators have dewned platelet therapy in terms of quality and productivity. Platelet recovery in the patient is inxuenced by the transfused dose of platelets, which in turn is dependent on the quality of the platelet product in terms of yield [1]. It has been shown that transfusion of high yield platelet products could reduce transfusion requirements of a thrombocytopenic patient [2]. Single donor platelet /$ - see front matter 2006 Elsevier Ltd. All rights reserved. doi: /j.transci

2 158 R. Chaudhary et al. / Transfusion and Apheresis Science 34 (2006) (SDP) products, unlike pooled platelet concentrates, lowers the risk of transfusion transmitted infections, alloimmunization and febrile nonhemolytic reactions [3,4]. Therefore, there is now more focus on the use of SDPs than pooled platelet concentrates. Automated apheresis techniques were Wrst developed in 1975 and since then have undergone a number of technical modiwcations and standardization to meet the platelet inventory needs of transfusion services which are supporting more patients with thrombocytopenia. With increasing use of SDPs, the need for potential plateletpheresis donors also increased. Although the collection of quality SDP is made easy with the new cell separators, donor related factors, both clinical and laboratory, might inxuence the platelet yield. Therefore, we investigated the inxuence of donor variables such as gender, age, weight, predonation platelet count and Hb concentration on the yield of platelets. 2. Materials and methods The study included 94 (87 males, 7 females; aged from 20 to 52 years) plateletpheresis procedures performed on continuous Xow cell separator (CS3000, Baxter Healthcare, Round Lake, IL, USA) using closed system apheresis kits (Code No. 4R2182) over a period from January to December 2004 at the Apheresis Unit, Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India. All the donors met the donor eligibility criteria as laid down by the Drugs Controller of India [5]. Hematological parameters such as platelet count and Hb% were measured on an automated analyzer (Micros 60, ABX Diagnostics, France). The plateletpheresis procedures were performed as per the standard operating procedure (SOP) using TNX-6 separation chamber with interface ovset (IO) of 6. Blood Xow rate for all collections was maintained at ml/min with anticoagulant (ACD-A) ratio of 12:1. The end point was the target yield of platelets per unit. After the procedure, it was ensured that the segment in the collected bag was kept approximately 15 cm for sampling to calculate the yield. Approximately 1 ml sample from each bag was collected in EDTA (K 2 EDTA) after thorough stripping the segment to ensure representative product of the bag. The samples were then mixed thoroughly by means of mechanized blood mixer (Techno FAB, India) for 15 min and then subjected to determination of platelet indices (count, MPV, PDW) and cellular contamination (RBC, WBC) after appropriate dilution (1:50) on automated analyzer to calculate the yield. InXuence of donor variables such as age, gender, weight, pre-donation platelet count and Hb% on the yield of platelets was studied by multiple linear regression analysis and calculating r value (Pearson correlation) using SPSS software version 9.0 for Windows. 3. Results A total of 94 healthy donors (mean age years) weighing kg underwent plateletpheresis on continuous Xow cell separator (CS3000, Baxter Healthcare, Round Lake, IL, USA). The mean blood volume processed was L over the mean duration of min using ml ACD-A. The volume of the product was consistent with mean of ml. The mean MPV of the unit was X while mean PDW was %. The mean cellular contamination in terms of white cells and red cells was /unit and ml/unit, respectively. Table 1 shows correlation between pre-donation platelet count and the yield of platelets in SDP. The mean platelet yield of all procedures was Fig. 1 shows a direct correlation between pre-donation platelet count and the yield (r D 0.50, p < 0.001). The yield was in >80% of procedures when the pre-donation platelet count was /mm. Table 2 shows predonation Hb concentration and the platelet yield, which was not found to be signiwcantly correlated (r D 0.10, p > 0.005). The SDPs obtained from three donors with Hb 716 g/dl had low platelet yield (mean /unit) compared to those having Hb <16 g/dl (mean yield /unit). Similarly, multiple linear regression analysis demonstrated no evect of donor gender (r D 0.05), age

3 R. Chaudhary et al. / Transfusion and Apheresis Science 34 (2006) Table 1 Correlation of pre-donation platelet count with yield Platelet yield /mm (n D 42) /mm (n D 40) /mm (n D 12) All (n D 94) Mean SD Median Range % Pearson correlation indicates good correlation between pre-donation platelet count and yield for all procedures (r D 0.50, p < 0.001) PLT yield x Donor PLT count (1000/mm) Fig. 1. The relationship between pre-donation platelet count and platelet yield (n D 94). Pearson correlation analysis indicated good correlation (r D 0.50, p < 0.001). Table 2 Correlation of pre-donation donor hemoglobin with yield Platelet yield /unit Donor Hb <14.5 g/dl mean PLT count /mm (n D 64) Mean SD Median Range % Donor Hb g/dl mean PLT count /mm (n D 30) Pearson correlation indicates signiwcant correlation between pre-donation Hb concentration and platelet yield for all procedures (r D 0.10, p >0.005). Table 3 EVect of diverent donor variables on platelet yield in plateletpheresis Variable CoeYcient Standardized coeycient p value Constant Pre Hb (g/dl) Pre platelet count Age Gender Weight Dependent variable: yield/bag ( ).

4 160 R. Chaudhary et al. / Transfusion and Apheresis Science 34 (2006) (r D 0.11) and weight (r D 0.18) on platelet yield (Table 3). 4. Discussion The last decade has witnessed an increase in the use of SDPs as opposed to platelets derived from whole blood. Such practice not only increased the purity of the product in terms of decreased cellular contamination but also increased the platelet collection yield. Various studies have demonstrated that the platelet yield is predominantly dependent on the donor platelet count [1,6,7]. Our results are also in agreement with these observations. There was a direct correlation between the platelet yield and the pre-donation platelet count (r D 0.50, p < 0.001). (Table 1 and Fig. 1). Out of 94 plateletpheresis procedures, the mean platelet yield was when the pre-donation platelet count was /mm, while the mean yield was when the pre-donation platelet count was < /mm. According to the American Association of Blood Banks (AABB) [8], 75% of the SDP must contain per unit while the European guidelines [9] recommend a platelet count per unit. Only 41.5% of our SDPs met the AABB criteria ( ). These levels have been determined to provide desired hemostatic platelet doses to the recipient. Goodnough et al. [10] studied 708 plateletpheresis procedures having a mean pre-donation platelet count of mm which resulted in a platelet product with mean yield of A direct linear correlation was observed with all the procedures. In 12% of their procedures the mean yield was < when the pre-donation count was < mm. Similarly, Hester et al. [11] could obtain high yield SDP on selected donors with a pre-donation platelet count of > /mm; however, such a practice considerably minimized the donor pool [12]. A large number (44.7%) of our eligible donors would be unsuitable for plateletpheresis if the criteria of a pre-donation platelet count > /mm is followed, as 42 of the 94 donors had platelet counts ranging from 150 to /mm (Table 1). Another donor factor that may have an inxuence on the platelet yield is the pre-donation Hb concentration of the donor. Although we found no such correlation in the present study (r D 0.10), there was a trend that a donor with a Hb >16 g/dl gave a comparatively lower platelet yield. However, no conclusive comment can be made in this regard as there were only three donors with Hb >16 g/dl in the present study. Ogata et al. [7] also observed no correlation between the pre-donation Hb concentration of the donor and the yield. However, Guerrero-Rivera et al. [1] demonstrated an inverse relationship of Hb with the yield (r D 0.554). SDPs from donors with a pre-donation Hb 716 g/dl had signiwcantly lower yields compared to SDPs obtained from donors with a Hb <16 g/dl. This may be related to the higher plasma volume processed in donors with low Hb concentration thereby giving a higher platelet yield. We also studied the evect of donor clinical variables such as gender, age and weight on yield. There was no signiwcant correlation observed (p > 0.005). Buchholz et al. [13], studied the quality of SDP in relation to low weight ( pound) of the donors and demonstrated no evect of donor weight on platelet yield. With regard to the gender of the donor, previous studies [14,15] have shown a direct correlation of female gender with yield. The possible explanation is a higher prevalence of iron dewciency among women with a consequent increase in platelet count. We found no such correlation in the present study. Optimization of platelet yield, which is inxuenced by pre-donation platelet count, is an emerging issue in blood transfusion services. Therefore, thrombopoietin is being tried in donors to increase the pre-donation platelet count [16]. However, this approach needs evaluation in terms of donor acceptability, its eycacy and cost. References [1] Guerrero-Rivera S, Gutierrez-Espindola G, Talavera JO, Meillon-Garcia LA, Pedraza-Echevarria M, Pizzuto- Chavez J. Hemoglobin and platelet count evect on platelet yields in plateletpheresis. Arch Med Res 2003;34: [2] Klumpp TR, Herman JH, Gaughan JP, Russo RR, Christman RA, Golberg SL, et al.. Clinical consequences of alter-

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