spectra optia mnc procedure: aiming for change 12/2/2015 spectra optia mnc collections at seattle...
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Spectra Optia MNC Procedure: AIMing for Change
Lindsay Palomino, BSN RN HP
12/2/2015 1
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No relevant disclosures for this presentation
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12/2/2015 3
Spectra Optia MNC Collections at Seattle Cancer Care Alliance
• MNC Collection Program Overview
• SCCA Experience with Optia MNC program
• CMNC Collection Program Overview
• SCCA Experience with Optia CMNC program
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Optia MNC Program Overview
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Optia MNC: Dual-stage Cell Collection
1. Whole blood IN
2. RBC OUT.
3. Plasma OUT.
4. MNCs accumulate in Chamber.
5. Chamber contents periodically
collected.
4
3
2
1
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MNC - Collection Status
The collection status screen provides current and historical information allowing the operator to monitor the status of the run
Collect Port graphic from AIM system
Collect Preference adjustment
Graphical display of the concentration of cells moving through
the collect port
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Spectra Optia MNC - Collection Preference
• A fine control of the depth at which cells are collected from within the buffy coat layer.
• Affects the concentration of cells that flow into the chamber and therefore how quickly the chamber fills.
• It replaces the COBE Spectra WBC Colorgram, providing extra consistency and less operator-dependency.
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SCCA Experience - Optia MNC
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Old Platform: COBE Spectra
COBE Spectra MNC Collection Parameters
Anticoagulant 10 u heparin / 1 mL ACD-A
AC Ratio 15:1 – 35:1
AC Infusion Rate 0.8 mL / min / LTBV
Collection Target - Autologous 6 x TBV
Collection Target - Donor 12 L
Inlet Flow Rate - Autologous 150 mL/min
Inlet Flow Rate - Donor 100 mL/min
Calcium Replacement* Calcium gluconate 1 g/hr
Ending +Fluid Balance Not to exceed 20% TBV
* Large-volume collections only
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New Platform: Spectra Optia
Spectra Optia MNC Collection Parameters – INITIAL
Anticoagulant 10 u heparin / 1 mL ACD-A
AC Ratio AC Ramping 20:1
AC Infusion Rate 1.2 – 1.5 mL/min/LTBV
Collection Target - Autologous 6 x TBV (up to 24 L)
Collection Target - Donor 12 L
Inlet Flow Rate - Autologous 125 mL/min
Inlet Flow Rate - Donor 125 mL/min
Calcium Replacement * Calcium gluconate 1 g/hr
Ending +Fluid Balance ** Not to exceed 20% TBV
Chamber Flush / Chase Default 16/4
* Large-volume collections only ** Donors – not to exceed 15% TBV
REG
IME C
HA
NG
E !
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Challenge: Platelet Clumping
10u heparin / 1mL ACD-A
Platelet clumping in centrifuge – mostly with normal WBC/PLT
Low AC Ratio – 15:1-20:1 patient, 8:1-15:1 donor
Increased calcium replacement + Long collections
Higher ending fluid balance
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Optia MNC – Take 2!
Spectra Optia MNC Collection Parameters – REVISED
Anticoagulant 5 u heparin / 1 mL ACD-A
Aspirin 81 mg – donors only PLT > 80,000
AC Ratio AC Ramping 20:1
AC Infusion Rate 1.2 – 1.5 mL/min/LTBV
Collection Target - Autologous 6 x TBV (up to 24 L)
Collection Target - Donor 12 L
Inlet Flow Rate - Autologous 125 mL/min
Inlet Flow Rate - Donor 125 mL/min
Calcium Replacement* Calcium gluconate 1 g/hr
Ending +Fluid Balance * Notify provider if 20% TBV
Chamber Flush / Chase Default 16/4
* ALL POPULATIONS
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35% reduction
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51% increase
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Revision Results
YAY!!! BOOOO!!!
Platelet clumping Slightly less calcium delivery
AC Ratio – patients 20:1 Slightly less fluid positive
AC Ratio – donors 15:1-20:1 Slightly shorter procedure
WB processed – donors
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Challenges: Non-mobilized MNC
Platelet clumping
• Normal PLT count
• Heparin likely aggravating PLT clumping
Unstable Interface
• Thin WBC layer / Normal PLT layer
Minimal chambers collected
• 1st chamber ~3000 mL
• 3-4 chambers for a 12L collection
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Non-mobilized MNC Optimization
• Aspirin 81mg – donors with PLT > 80,000
• 5 u heparin / 1 mL ACD-A
• Collection preference 30
• Collect 1st chamber by 2000 mL
• Inlet volume control @ 1200 mL
Upside – higher cellular yield
Equivocal – larger volume product
Downside – occasionally higher product HCT%
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Optia MNC: Lessons Learned
• Use less heparin
• Use Aspirin
• More calcium will be needed
• Ask Terumo for collection optimization assistance
• Estimate 45” longer than predicted procedure time
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Optia CMNC
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CMNC Cell Separation
1. Whole blood enters the channel.
2. Red blood cells (RBC) flow passively to the reservoir.
3. Plasma is pumped into the reservoir or it is collected.
4. Cells are continuously pumped into the collection bag.
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CMNC - Collection Preference (CP)
• The AIM system controls the concentration of cells flowing through the collect port (CP) by adjusting the plasma pump flow rate
• CP will always default to 50 at the beginning of each procedure to minimize RBC contamination
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CMNC - Collection Status
The collection status screen provides current and historical information allowing the operator to monitor the status of the run
Collect port graphic from AIM system
Collection Preference (CP) adjustment
Graphical display of the concentration of cells moving through the collect port
Ability to return cells to patient to minimize cross-cellular contamination
System warns operator if cells are not being collected.
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Collect Line From the Centrifuge
Collect line exiting centrifuge is always visible to operator
Color in the line can easily be monitored
Decrease
Co
llection
Preferen
ce In
crea
se C
olle
ctio
n P
refe
ren
ce
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SCCA Experience - CMNC
Spectra Optia CMNC Collection Parameters
Anticoagulant 5 u heparin / 1 mL ACD-A
Aspirin 81 mg – donors only PLT > 80,000
AC Ratio 15:1 – 35:1
AC Infusion Rate – 12L 0.8 mL/min/LTBV
AC Infusion Rate – Large vol. 1.2 mL/min/LTBV
Collect Pump Flow Rate 1.5 mL/min
Inlet Flow Rate - Autologous 142 mL/min
Inlet Flow Rate - Donor 100 mL/min
Calcium Replacement* Calcium gluconate 1 g/hr
* Large Volume collections only
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SCCA Experience - CMNC
• No PLT clumping
• Achieved AC Ratios of 25:1 – 35:1
• CE:
– DLI 83%
– Mobilized donors 53 – 65%
• Product HCT 2 – 4% correlated with operator target
• No citrate toxicity
• Fast!
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Thank you!