Volunteer Donor Apheresis

Abstract: Volunteer donor apheresis has evolved from early plasmapheresis procedures that collected single components into technically advanced multicomponent procedures that can produce combinations of red blood cells, platelets, and plasma units. Blood collection and utilization is increasing annually in the United States. The number of apheresis procedures is also increasing such that single donor platelet transfusions now exceed platelet concentrates from random donors. Donor qualifications for apheresis vary from those of whole blood. Depending on the procedure, the donor weight, donation interval, and platelet count must be taken into consideration. Adverse effects of apheresis are well known and fortunately occur in only a very small percentage of donors. The recruitment of volunteer donors is one of the most challenging aspects of a successful apheresis program. As multicomponent apheresis becomes more commonplace, it is important for collection centers to analyze the best methods to recruit and collect donors.     

Axillary vein thrombosis in a healthy donor following platelet apheresis

Platelet donation is a common and usually safe procedure accounting for almost half of the platelets donated in the UK. We describe a previously healthy female donor who developed an axillary vein thrombosis following an apheresis platelet donation.     

Persistent aggregates in apheresis platelet concentrates are commonly collected from donors with a history of aggregate donation

Platelet apheresis sometimes causes persistent aggregates (PA). This study (n = 211) shows that changing the apheresis settings to reach fixed product volumes instead of yields does not influence PA incidence, even though PA products on average contain more platelets than controls. Furthermore, logistic regression was used to model if PA can be predicted on the basis of certain predonation parameters. PA donation history was the only parameter retained, proving a strong determinant of predictability [AUC = 0.735 (SE = 0.022)]. Consequently, donations from a donor with previous PA history are 7.8 times more likely to contain PA than from a donor without preceding history.     

3种机采浓缩血小板临床疗效分析

目的：通过对3种机采浓缩血小板输注疗效的比较,寻找一种既能达到较好的临床输注效果又能满足急诊需要的血小板种类。方法：通过观察止血情况,输注前和输注后24h外周血血小板升高值来判断疗效。结果：K管道血小板与F管道血小板差异无统计学意义P〉0．05。冰冻血小板与K管道和F管道在血小板升高值方面差异有统计学意义,P〈0．01。结论：F管道血小板既有K管道的优点又克服了冰冻血小板的不足,应该广泛推广。     

机采血小板有效库存管理初探

<正>随着医疗新技术、新项目的快速推广应用以及各类医疗保险的完善与普及〔1〕,近年来我国机采血小板制品已被临床广泛应用,增长率呈逐年上升趋势。如何满足机采血小板制品的临床供给,同时减少不合理的过期报废,在国内许多地区仍然是一个难题。因此,采供血机构实施机采血小板的有效库存管理显得尤为重要,特别是构建一个有效库存管理的保障体系,来达到供给与需求的平衡是有效库存管理的基础。1机采血小板的供需矛盾     

The effect of apheresis on adhesion molecules

The adhesion molecules on the leukocytes and the endothelial cells mediate interaction between their cells. The plasma levels of soluble adhesion molecules increase in patients with ischemic heart disease, atherosclerotic aortic disease. Hypercholesterolemia is one of risk factors for atherosclerosis, and it is considered that the expression of adhesion molecules in endothelial cells is related to the development of atherosclerosis. Low-density lipoprotein (LDL) apheresis has been applied to patients with hypercholesterolemia. LDL apheresis may have an effect on adhesion molecules in patients with hypercholesterolemia.     

Selection and management of the lung donor

This article reviews recent developments in the selection, assessment, and management of the potential lung donor that aim to increase donor organ use. The scarcity of suitable donor organs results in long waiting times and significant mortality for those patients awaiting transplant. Strategies to expand the donor pool can substantially improve donor lung use rates. Although further long-term studies are required to confirm that long-term outcomes are not being compromised, the available evidence suggests that the traditional factors defining a lung as marginal or extended do not actually compromise outcomes within the framework of current donor management strategies.     

Apheresis technologies and clinical applications: the 2002 international apheresis registry

The developments in apheresis technologies and techniques and their clinical applications worldwide are technologically, sociologically, and economically motivated. In past apheresis surveys, the statistics have highlighted both the differences by geographic region in clinical practice and in the types of technologies utilized. While a national view of apheresis is very important, an international view may be more representative overall of this therapeutic modality than national results that are highly dependent on the local economics and the available technologies. These regional differences have provided a basis for scientific and clinical assessment of these apheresis technologies and their clinical outcomes and have impacted the marketing and business developments of new technologies worldwide. The results of the International Apheresis Registry for 2002, reporting on 33 centers on four continents, are presented. The survey collected data, predominantly via an internet website, on 811 patients for a total of 11 428 treatments. Information gathered included patient demographics, medical history, treatment diagnoses, treatment specifics (type, methodology, access type, anticoagulants, drugs, and equipment usage), side-effects, clinical response, and payment provider. As in the prior International Apheresis Registries for 1983 and 2000, the survey results highlight the regional differences in apheresis usage and treatment specifics, indicating that an international overview of apheresis may be more representative of the impact of this therapeutic modality.     

Therapeutic apheresis in the treatment of hemolytic uremic syndrome in view of pathophysiological aspects

Hemolytic-uremic syndrome (HUS) is a disease that can lead to acute kidney injury and often to other serious sequelae, including death. The disease is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury. In view of the different courses of HUS, a minimum of three different pathogenetic types leading to HUS can be subdivided as follows: HUS caused by infection, idiopathic HUS (non-Shiga toxin HUS), and HUS in systemic diseases and after toxin exposure. The etiology and pathogenesis of HUS are not completely understood and its therapy is complicated. After the introduction of therapeutic apheresis as a supportive therapy in HUS, several authors reported successful treatment in more than 87% of treated patients. The supportive therapy is indicated basically in severe courses of HUS and is superior to available therapy interventions.     

Indication of low-density lipoprotein apheresis in severe hypercholesterolemia and its atherosclerotic vascular complications: dextran sulfate cellulose low-density lipoprotein apheresis

Homozygous familial hypercholesterolemia (FH) and heterozygous FH, with or without elevation of Lp(a), or isolated massive elevation of Lp(a) with clinically relevant coronary heart disease are indications for low-density lipoprotein (LDL) apheresis, as long as maximal conventional lipid lowering drug therapy does not lead to a LDL cholesterol level below 100 mg/dL. Reduction of lipoproteins and Lp(a), of oxidation of LDL, improvement of disturbed vasomotion, the procoagulatory state and disturbed hemorheology associated with atherosclerosis, as well as the stabilization of plaques and the decrease of cytokines and adhesion molecules have been induced by apheresis and are thought to favorably influence regression of artherosclerosis. Several intervention studies point in this direction.     

Changes in oxidative stress and microcirculation by low-density lipoprotein apheresis

Low-density lipoprotein apheresis (LDLA) leads to an improvement of microcirculation during the very early stages of treatment, and continued treatment may produce antiatherogenic effects in patients with peripheral arterial disease (PAD). Suppression of oxidative stress, improvement of endothelial functions and alteration in the action of vasoactive compounds may occur with the improvement of the rheological property of blood as a result of aggressive removal of atherogenic factors including LDL, possibly resulting in the suppression of development of atherosclerosis. As these effects of LDLA may ameliorate not only PAD but also ischemia in other organs, it is suggested that repeated LDLA prevents the progression of atherosclerotic diseases and probably improves the long-term prognosis of patients with PAD.     

应用单套耗材同时施行治疗性白细胞及血小板单采术的临床研究

目的探讨应用单套耗材对白细胞、血小板两系均异常增高的慢性粒细胞白血病患者同时施行治疗性白细胞、血小板单采术的可行性。方法1997年12月至2006年11月在中山大学附属第一医院使用CS3000plus血细胞分离机对10例白细胞、血小板两系均异常增高的慢性粒细胞白血病患者用单套耗材同时进行治疗性白细胞及血小板单采,先进行一系细胞的单采,中途腾空产品袋,更换程序及相应的分离夹,再进行另一系细胞的单采。治疗后观察白细胞、血小板、红细胞、血红蛋白变化情况及临床症状与体征的改善情况。结果用此法单次治疗,白细胞下降(55.2±21.2)%,血小板下降(47.8±10.2)%,临床症状与体征均获缓解或改善,与单一的白细胞单采术及血小板单采术的单采效果比较差异无显著性意义(P>0.05)。结论利用单套耗材同时施行治疗性白细胞及血小板单采术是安全、有效、可行的,可大幅度降低医疗费用,是治疗白细胞、血小板两系均异常增高的慢性粒细胞白血病患者经济、快速、有效的综合治疗方法之一。     

Time-based analysis of the apheresis platelet supply chain in England

During 2009/2010 loss of platelets within NHS Blood and Transplant (NHSBT) due to time expiry was 9.3%. Hospitals remain reluctant to hold stocks of platelets due to the poor shelf life at issue. The purpose of this study was to identify areas for time compression in the apheresis platelet supply chain to extend the shelf life available for hospitals and reduce wastage in NHSBT. This was done within the context of NHSBT reconfiguring their supply chain and moving towards a consolidated and centralised approach. Time based process mapping was applied to identify value and non-value adding time in two manufacturing models. A large amount of the non-value adding time in the apheresis platelet supply chain is due to transportation and waiting for the next process in the manufacturing process to take place. Time based process mapping provides an effective 'lens' for supply chain professionals to identify opportunities for improvement in the platelet supply chain.     

红细胞单采在真性红细胞增多症治疗中的应用

目的:观察分析红细胞单采在真性红细胞增多症(PV)治疗中的应用方法及效果。方法:对符合国内PV诊断标准的19例患者,运用血细胞分离机进行异常增生红细胞单采,配合临床药物治疗。比较治疗前后患者血常规中Hb、RBC、Hct、WBC、PLT均值变化,采用SPSS17.0统计学软件统计分析。观察依患者公斤体重和Htc设定红细胞采集量,单次采集后Hct降低情况及首次采集前后Hb均值变化与再次采集前后Hb均值变化的差异。结果:治疗后血液Hb、RBC、Hct均值明显低于治疗前,差异有统计学意义(P0.01)。8例完全缓解,7例临床缓解,4例好转,有效率为100%;单次采集Hct平均降低幅度为16.11%。结论:红细胞单采在PV的治疗中具有显著的疗效,单次采集应考虑PV患者血容量绝对增加的情况,根据患者病情和对红细胞去除的耐受情况适当增加采集量。     

Low-density lipoprotein apheresis: an overview

Atherosclerosis with myocardial infarction, stroke, and peripheral cellular disease still maintains its position at the top of morbidity and mortality statistics in industrialized nations. Established risk factors widely accepted are smoking, arterial hypertension, diabetes mellitus, and central obesity. Furthermore, there is a strong correlation between hyperlipidemia and atherosclerosis. The prognosis of patients suffering from severe hyperlipidemia, sometimes combined with elevated lipoprotein (a) (Lpa) levels, and coronary heart disease (CHD) refractory to diet and lipid-lowering drugs is poor. For such patients, regular treatment with low-density lipoprotein (LDL) apheresis is the therapeutic option. Today, there are four different LDL apheresis systems available: immunoadsorption, heparin-induced extracorporeal LDL/fibrinogen precipitation, dextran sulfate LDL adsorption and LDL hemoperfusion. Regarding the different LDL apheresis systems used, there is no significant difference with respect to the clinical outcome or concerning total cholesterol, LDL, high-density lipoprotein (HDL), or triglyceride concentrations. With respect to elevated Lpa levels, however, the immunoadsorption method seems to be the most effective. In 45 patients (25 women, 20 men) suffering from familial hypercholesterolemia resistant to diet and lipid lowering drugs, low-density lipoprotein (LDL) apheresis was performed over 95.6 +/- 44.7 months. Four different systems (Liposorber, 32 of 45, Kaneka, Osaka, Japan; Therasorb, 6 of 45, Baxter, Munich, Germany; Lipopak, 2 of 45, Pocard, Moscow, Russia; and Dali, 5 of 45, Fresenius, St. Wendel, Germany) were used. With all methods, average reductions of 57% for total cholesterol, 55.9% for LDL, 75.8% for lipoprotein a (Lpa), and 45.9% for triglycerides, and an average increase of 14.3% for HDL were reached. Severe side-effects such as shock or allergic reactions were very rare (0.3%) in all methods. In the course of treatment, an improvement in general well-being and increased performance were experienced by 44 of 45 patients. The present data demonstrate that treatment with LDL apheresis of patients suffering from familial hypercholesterolemia resistant to maximum conservative therapy is very effective and safe even in long-term application.     

Granulocyte and monocyte adsorption apheresis for cutaneous allergic vasculitis

Cutaneous allergic vasculitis (CAV) is characterized clinically by purpuric patches with secondary ulcerations, and histologically by leukocytoclastic vasculitis with neutrophil infiltrates. Granulocyte and monocyte adsorption apheresis (GCAP) is an extracorporeal apheresis instrument using a column containing cellulose acetate beads designed to remove pathogenic granulocytes. Here we report our assessment of the efficacy of GCAP for recurrent leg ulcers in a 49-year-old woman with CAV. She underwent five GCAP treatments at one-week intervals. In each treatment session, 1800 mL of blood was processed. Her leg ulcers responded well and her white blood cell and neutrophil counts and the expression level of CD11b/CD18, a marker for activated neutrophils, on her peripheral neutrophils were reduced from 7500/microL to 6500/microL, 4350/microL to 3315/microL, and 64.9 MFI (mean fluorescence intensity) to 27.0 MFI (normal controls: 10.5 +/- 1.2 MFI) by GCAP, respectively. These results suggest that GCAP is useful for skin disorders with leucocytoclastic vasculitis.     

输注去白细胞血小板防止发热反应的细胞因子分析

<正>血小板输注为当前恶性肿瘤化疗和造血干细胞移植的患者最主要的支持治疗,去除白细胞单采血小板的推广应用,给需要多次输注血小板者,减少由制备与贮存过程中白细胞释放的细胞因子而引起非溶血性发热输血反应(febrile non-hemolytic transfusionreactions,FNHTR)〔1-2〕。本文对输注去白细胞单采血小板后恶性肿瘤化疗和造血干细胞移植患者细胞因子(IL-6、IL-8、TNF-β、