Analysis of pre- and post-donation haematological values in plateletpheresis donors

Original Article

Analysis of [30_TD$DIFF]pre- and post-donation haematologicalvalues in plateletpheresis donors

Vandana Gite [31_TD$DIFF]a,*, Maruti Dhakane b

aAssociate [32_TD$DIFF]Consultant, Apollo Hospitals, Pathology, Seepat Road, Bilaspur 495006, Chhattisgarh, IndiabApollo Hospitals, [33_TD$DIFF]Bilaspur, India

1. Introduction

Thedemand for plateletpheresis componentshas been steadilyincreasing[51_TD$DIFF], because these have been considered superior for anumber of reasons. Technical advances in automated cell

separators have substantially improved the productivity andquality of the collection of apheresis platelets. Various studieson automated plateletpheresis have been conducted to investi-gate the quality of platelet concentrates and its relation to thebiological contribution (platelet count and total mass) of thedonor. [52_TD$DIFF][53_TD$DIFF]However, post-procedure platelet counts, haemoglobin

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a r t i c l e i n f o

Article history:

Received 28 March 2015

Accepted 1 May 2015

Available online 11 June 2015

Keywords:

Platelets

Plateletpheresis

[50_TD$DIFF]Thrombocytopenia

a b s t r a c t

The post [35_TD$DIFF]-procedure haematological values of donor in plateletpheresis have received

relatively little attention. The present study is aimed to study reductions in haematological

values after plateletpheresis. The total 100 successful plateletpheresis procedures were

performed with Haemonetics [36_TD$DIFF]® MCS® LN09000 – 220E/ED system at apheresis unit of tertiary

care centre. To measure the pre- and post-donation [37_TD$DIFF]haematological values, whole blood

samples were collected in EDTA vials just before and within 30 min [38_TD$DIFF]after the procedure.

Parameters [39_TD$DIFF], including Hb concentration, haematocrit, platelet and WBC counts, mean

platelet volume (MPV), platelet distribution width (PDW [40_TD$DIFF]), etc. were measured.

The total mean reduction of 81.980 � 109 per litre in platelet count is noticed with mean

pre-donation platelet count 312 � 109 per litre and mean post [41_TD$DIFF]-donation platelet count

230 � 109 per litre. The total mean reduction of 0.85 g [42_TD$DIFF]/dL in total haemoglobin, decrease

of 1.22% in HCT and reduction of 0.561 in [43_TD$DIFF]�109 per litre totalWBC count [44_TD$DIFF]are noticed. The total

mean reduction of 0.2 � 1012 per [45_TD$DIFF]litre in total RBC count, decrease of 0.57 pg inMCH, decrease

of 0.82 g/ [46_TD$DIFF]dL in MCHC is noticed. P-value is statistically significant and [47_TD$DIFF]<0.05.

So it is recommended that apheresis donors with low normal pre-procedure platelet

counts (150–200 � 10 [48_TD$DIFF]9 per litre) and Hb concentration (12.5–13 g/dL) should be examined for

post-donation decrease in the platelet and other haematological parameters. Donors with

significant decrements should be reviewed subsequently to exclude or, if necessary, treat

thrombocytopenia and iatrogenic [49_TD$DIFF]anaemia.

# 2015 Indraprastha Medical Corporation Ltd. Published by Elsevier B.V. All rights

reserved.

* Corresponding author [34_TD$DIFF]. Tel.: +91 7752248300.E-mail address: vandanagite@gmail.com (V. Gite).

Available online at www.sciencedirect.com

ScienceDirect

journal homepage: www.elsevier.com/locate/apme

http://dx.doi.org/10.1016/j.apme.2015.05.0110976-0016/# 2015 Indraprastha Medical Corporation Ltd. Published by Elsevier B.V. All rights reserved.

concentration and/or other haematological decrements indonors undergoing plateletpheresis have been only minimallyexplored. A literature search on this subject provided contro-versial data, in that increases in Hb concentration, haematocritand white blood cell count were found after plateletpheresis inone study, whereas others described significant falls in theseparameters.1–3 As far as [54_TD$DIFF]India is concerned, early studies onplateletpheresis recorded pre[55_TD$DIFF]-donation low platelet and Hbvalues among most of the donors.3,4 With the notion thatplateletpheresis in these donors could cause significant decre-ments in [37_TD$DIFF]haematological values, thepresent study is carriedoutto observe the effect of automated plateletpheresis on the [37_TD$DIFF]

haematological values of donor population and the significanceof such [37_TD$DIFF]haematological alterations.

2. Materials and [56_TD$DIFF]methods

Plateletpheresis is a procedure used to remove platelets fromthe blood. During this procedure, blood is removed and sentthrough tubing that is connected to an apheresismachine. Themachine spins the blood and separates the part of the blood tobe removed. After the platelets are removed, the remainingblood is returned to body. This procedure needs two intrave-nous needles placed. One is used to remove the blood and theother is used to return the blood. This can be done by puttingan IV needle in each arm or by using a special central venouscatheter that has two lumensor ports. This procedure can take [57_TD$DIFF]2–6 h to complete. A blood anticoagulant is slowly added to theblood during the procedure. Side effects from the bloodanticoagulant may include slight tingling around mouth,chest vibrations [58_TD$DIFF]and a cold or chilled feeling. Calcium is givento prevent these symptoms.

The present prospective study is conducted on 100 healthyvoluntary and replacement plateletpheresis donors agedbetween 18 [59_TD$DIFF]and 60 years over a period from [60_TD$DIFF]August 2008 toDecember 2009 at apheresis unit of tertiary care centre. Theaim is to investigate changes of [61_TD$DIFF]pre- and post-donationplatelet values and other [37_TD$DIFF]haematological parameters with theadverse effects of plateletpheresis in healthy and volunteerdonors. The Drugs and Cosmetics Act of India, which controlsthe licensing of blood transfusion services, does not provideclear guidelines regarding plateletpheresis procedure. We,therefore, established our own departmental standard oper-ating procedure (SOP) and operational flow chart for platelet-pheresis. The total 100 successful plateletpheresis procedureswere performed with [62_TD$DIFF]Haemonetics® MCS® LN09000 – 220E/EDsystem at apheresis unit of tertiary care centre. All platelet-pheresis procedures were performed using closed systemapheresis kits and ACD-A anticoagulant in the proportion of1:9. The end-point of each procedure was based on the targetyield of 3 � 1011 platelets per unitmaintaining a bloodflow ratefor all collections at 50–80 mL/min[63_TD$DIFF]. Then, platelet sample wasstored at 22–24 8C under continuous agitation in a plateletincubator. [64_TD$DIFF]Respective blood samples were obtained from eachdonor[65_TD$DIFF], and tested by using the standard blood born pathogentest panel (HIV, HBsAg, HCV, Malaria and VDRL). To measurethe pre- and post-donation [37_TD$DIFF]haematological values, wholeblood samples were collected in EDTA vials just before andwithin 30 min [38_TD$DIFF]after the procedure. Parameters [66_TD$DIFF]including Hb

concentration, haematocrit, platelet and WBC counts, meanplatelet volume (MPV), platelet distribution width (PDW[40_TD$DIFF]), etc.weremeasured on a calibrated automated analyzer (MYTHIC [67_TD$DIFF]–

Analytical Automation Pvt. Ltd.). Internal quality control withavailable Eight checks [68_TD$DIFF]3WP reagents was performed. All datawere compared by using statistical analysis software programSPSS (Statistical Package for the Social Sciences). The resultswere tested for normal distribution. For statistical analysis[69_TD$DIFF],paired t-test was performed. A P-value <0.05 was consideredsignificant.

3. Results

It was decided to focus primarily on pre[70_TD$DIFF]-donation and post-donation platelet counts reductions. There was a significantdifference [71_TD$DIFF]in P-value < 0.05 between means for pre[72_TD$DIFF]- and post-donation values of platelet, [52_TD$DIFF]haemoglobin, haematocrit, RBCand WBCs.

The totalmean reduction of 81.980 � 109 per litre in plateletcount is noticed with mean pre-donation platelet count312 � 109 per litre and mean post[41_TD$DIFF]-donation platelet count230 � 109 per litre. Thus the mean percent reduction in theplatelet counts is 26.28%. The total mean increase of 0.07 fl inMPV, decrease of 0.19% in PCT [73_TD$DIFF]and decrease of 0.11% in PDWare [44_TD$DIFF]noticed.

The total mean reduction of 0.85 g[42_TD$DIFF]/dL in total haemoglobin,decrease of 1.22% in HCT and reduction of 0.561 in [43_TD$DIFF]�109 perlitre total WBC count is noticed. The total mean reduction of0.2 � 1012 per [45_TD$DIFF]litre in total RBC count, decrease of 0.57 pg inMCH and decrease of 0.82 g/dL in MCHC are noticed. P-value isstatistically significant and [75_TD$DIFF]<0.05. Nausea (2 donors) andperioral tingling (3 donors) were the commonly observedadverse reactions [76_TD$DIFF](Table 1).

4. Discussion

During the last [77_TD$DIFF]few decades, there have been significantimprovements in the productivity and quality of plateletconcentrates by apheresis. Although automated cell separa-tors have undergone a lot of technical refinements, attentionhas been focused more on the quality of platelet concentratesthan on post-procedure platelet counts, [52_TD$DIFF]haemoglobin concen-tration or other [78_TD$DIFF]haematological decrements. Only selected [79_TD$DIFF]

centres have donor follow-up and routine quality pro-grammes. Donors undergoing intensive plateletpheresis dem-onstrate transient but significant decrease in platelet countlasting for a day [80_TD$DIFF]after apheresis. Like Love et al.1 it was noticedsubstantial drops in platelet count and it could be a concern inour population in which approximately 36% of the healthydonors had a pre-donation platelet count of <200 � 109 [81_TD$DIFF]perlitre and were, therefore, predisposed to clinical thrombocy-topenia.3 Although such reductions could be expected, it isnecessary that [37_TD$DIFF]haematological parameters should be moni-tored carefully in donors who are supposed to undergoplateletpheresis to prevent the occurrence of an artificialthrombocytopenia and [49_TD$DIFF]anaemia, which is likely to happen.The greatest concern regards those donors with a low normalpre-donation platelet count (150–200 � 10[82_TD$DIFF]9 per litre).

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Rogers practiced to defer donors with blood platelet (PLT)counts of<180 � 10[83_TD$DIFF]9 per litre, because PLT yields are low,whencompared to PLT units collected from donors with highercounts.5 Significant reductions in donors haematologicalvalues after plateletpheresis, albeit without clinical manifes-tations, have also been reported by other researchers.6,7 In ouropinion these donors could be re-called and screened on asubsequent date to ensure their well-being. A cautiousapproach is recommended in these groups of donors. Moreprospective studies on this aspect are required in order toestablish guidelines for platelet donation in apheresis. Thisinformation is of value in establishing post-donation referenceranges which could be utilized when reviewing the suitabilityof donors for subsequent donations.

For safety reasons, voluntary whole blood donationrequires a minimal Hb concentration of [84_TD$DIFF]>125 g/L. It is wellestablished that the first generation apheresis devices causedsignificantly greater losses of red cells during plateletpheresisas compared to more recent versions. These losses have beenattributed to several factors[85_TD$DIFF], such as the blood loss in the voidvolume of the apheresis kit, the technique applied andmechanical haemolysis by the pressure pumps.8 Like Daset al.,[86_TD$DIFF]3 Hb and HCT decreased significantly in the donors( [87_TD$DIFF]P < 0.01). Plausible reasons for this might be higher volume ofACD-A infused during plateletpheresis. Anaemia in platelet-pheresis donors, as a result of haemodilution due to infusionsof citrate solutions and saline, has also been reportedpreviously.8 However Love [88_TD$DIFF]et al.1 found significant increasein [52_TD$DIFF]haemoglobin (3.14%) and haematocrit (2.97%) values after [89_TD$DIFF]

plateletpheresis without any explanation.Theproceduresmaypresentadverseeffectswhich,although

mostly mild, require specialized personnel for identificationand management. It is recommended that apheresis donorswith low normal pre-procedure platelet counts (150–200 � 10[48_TD$DIFF]9

per litre) and Hb concentration (12.5–13 g/dL) should beexamined for post-donation decrease in the platelet andother haematological parameters, donors with significant

decrements should be reviewed subsequently to exclude or,if necessary, treat thrombocytopenia and iatrogenic [91_TD$DIFF]anaemia.

Conflicts of interest

All authors have none to declare.

r e f e r e n c e s

1. Love E, Pendry K, Hunt L. Analysis of pre and post donationhaematological values in plateletpheresis donors. Vox Sang.1993;65(October):209–211.

2. Das SS, Chaudhary R, Verma SK, Ojha S, Khetan D. Pre- andpost-donation haematological values in healthy donorsundergoing plateletpheresis with five different systems. BloodTransfus. 2009;7(July (3)):188–192.

3. Das SS, Chaudhary RK, Shukla JS. Factors influencing yield ofplateletpheresis using intermittent flow cell separator. ClinLab Haematol. 2005;27:316–319.

4. Chaudhary R, Das SS, Khetan D, Sinha P. Effect of donorvariables on yield in single donor plateletpheresis bycontinuous flow cell separator. Transfus Apher Sci.2006;34:157–161.

5. Rogers RL, Johnson H, Ludwig G, Winegarden D, Randels M,Strauss R. Efficacy and safety of plateletpheresis by donorswithlow-normal platelet counts. J Clin Apher. 1995;10(4):194–197.

6. Beyan C, Cetin T, Kaptan K, Nevruz O. Effect ofplateletpheresis on complete blood count values using threedifferent cell separator systems in healthy donors. TransfusApher Sci. 2003;29:45–47.

7. Ferreira G, Masson G, Costa E, Lima D, Oliveira G, Soares F.Plateletcrit, ‘‘Mean Platelet Volume and Platelet DistributionWidth.’’ Available from: http://www.vin.com/proceedings/Proceedings.plx?CID=WSAVA2009&Category=8082&PID=53882&Print= 1&O=Generic.

8. Howard JE, Perkins HA. Lysis of donor RBC duringplateletpheresis with a blood processor. JAMA. 1976;236(July (3)):289–290.

Table 1 – [1_TD$DIFF]Haematological values before and after plateletpheresis ( [2_TD$DIFF]n = 100) parameters.

Parameter Pre-donation Post-donation Difference[3_TD$DIFF],mean � SD

Differencemean in %

P-value

Mean � SD Range Mean � SD Range

Platelet count [4_TD$DIFF](�109 per litre) 312.18 � 57.74 [5_TD$DIFF]203–563 230.20 � 42.25 [6_TD$DIFF]136–369 81.98 � 36.670 26.28% Decrease <0.0001MPV (fl) 7.309 � 0.7601 [7_TD$DIFF]3.4–9.8 7.378 � 0.6616 [8_TD$DIFF]5.9–9.1 0.069 � 0.5862 0.96% Increase 0.239PCT (%) 0.36242 � 1.3377 [9_TD$DIFF]0.144–0.409 0.16851 � 0.0347 [10_TD$DIFF]0.104–0.289 0.1939 � 1.3348 52.78% Decrease <0.0001PDW (%) 13.992 � 1.9326 [11_TD$DIFF]10.5–17.9 13.881 � 1.1920 [12_TD$DIFF]11.3–17.3 0.1114 � 2.0876 0.79% Decrease 0.595[13_TD$DIFF]Haemoglobin (g/dL) 13.731 � 1.2204 [14_TD$DIFF]11.2–18.6 12.880 � 1.2176 [15_TD$DIFF]10.2–16.6 0.8510 � 1.1216 06.19% [16_TD$DIFF]Decrease <0.0001HCT (%) 40.975 � 2.3790 34.3–47.4 39.76 � 2.738 [17_TD$DIFF]31.2–44.9 1.2190 � 2.3414 02.98% Decrease <0.0001RBC [18_TD$DIFF](�1012 per litre) 5.0674 � 0.4466 [19_TD$DIFF]4.09–6.46 4.8700 � 0.5695 [20_TD$DIFF]1.78–6.12 0.1974 � 0.4969 03.90% Decrease <0.0001RDW (%) 12.795 � 1.1439 [21_TD$DIFF]11–17.8 13.058 � 1.3273 [22_TD$DIFF]11.3–18.1 �0.2630 � 1.1475 02.03% Increase 0.024MCV (fl) 81.307 � 5.8764 [23_TD$DIFF]60.1–93.7 81.715 � 5.8574 [24_TD$DIFF]60.1–94.6 �0.4076 � 3.9484 0.50% Increase 0.304MCH (pg) 27.084 � 2.4103 [25_TD$DIFF]19.1–34.9 26.513 � 2.6488 17.4–35.3 0.5710 � 1.7249 02.37% Decrease <0.0001MCHC (g/ [26_TD$DIFF]dL) 33.287 � 1.7841 [27_TD$DIFF]30.3–40.2 32.466 � 2.2289 27.8–39.6 0.8210 � 1.4339 02.46% Decrease <0.0001WBC [28_TD$DIFF](�109 per litre) 6.643 � 1.7169 3.1–13.5 6.082 � 1.6617 [29_TD$DIFF]2.7–12.5 0.561 � 0.7751 09.45% Decrease <0.0001

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