Cost accounting in plateletpheresis: comparison of two techniques

Cost comparison of two comparably effective techniques of plateletpheresis, a manual method and an automated discontinuous flow centrifugation technique, is presented using a hypothetical model. The former procedure costs $62.48 per pheresis for disposables and labour as opposed to $78.32 per pheresis for disposables and labour for the latter. The annual volume of plateletphereses at which the accumulated costs equal the total charges, i.e. the‘break-even’point, is calculated and found to be 63.7 for the automated technique and 10.9 for the manual method, if the charge for each is $200.00. For the manual method at a current charge of $80.00, the break even point is 85.8. The assumptions underlying this hypothetical model are examined, and the effects of deviation from these assumptions are analyzed in terms of the break even point. Cost accounting of plateletpheresis is shown to be dependent upon the choice of approach to allocation of costs, the assumptions of the cost accounting model, and the selection of an appropriate charge.     

治疗性血小板单采术在脾切除术后血小板异常增多患者中的应用

目的探讨治疗性血小板单采术对脾切除术后血小板异常增多患者的疗效。方法使用CS 3000 Plus血细胞分离机对12例脾切除术后血小板异常增多的患者进行治疗性血小板单采,同时配合抗血小板凝聚或抑制血小板生成治疗。治疗后查血常规,观察患者治疗前后血小板计数的变化情况及临床症状、体征缓解情况。结果血小板单采术后患者血小板计数由治疗前的(1704±546)×109/L下降至(499±77)×109/L(P<0.05);临床症状、体征得到明显改善,无1例患者出现出血或血栓形成。结论治疗性血小板单采术可安全、有效地清除患者异常增多的血小板,是治疗脾切除术后血小板异常增多患者的有效治疗方法之一。     

自体血小板分离在Stanford A型主动脉夹层手术中的应用

摘要：急性主动脉夹层手术创面大、时间长、失血多,围术期异体血液制品需求量大。自体血小板分离（autologous plateletpheresis,APP）可减少术中体外循环等多种因素对血液的破坏,减少异体血的使用。经APP分离后的富血小板血浆（platelet-rich plasma,PRP）具有促进组织生长、抑制细菌繁殖和加速伤口愈合的作用。近年来,由于APP技术相对其他血液保护措施能减少体外循环中血小板的破坏而被广泛关注,在需体外循环的心脏手术中的应用逐渐增加。本文对APP在Stanford A型主动脉夹层手术的临床应用做一综述。     

多次机采血小板对献血员血常规的影响

目的：监测机采血小板献血者的血常规,评估多次机采血小板对献血者健康状况的影响。方法：分别检测献血者献血前和献血后1个月和6个月血常规,并进行对比分析。结果：白细胞计数、淋巴细胞比率、单核细胞比率、中性粒细胞比率、淋巴细胞计数、单核细胞计数和血小板计数等血液常规项目在机采血小板前后没有明显改变。结论：体检合格的血小板献血者,定期单采血小板对献血员的血常规和健康状况没有明显影响。     

Therapeutic plateletpheresis in a case of symptomatic thrombocytosis in chronic myeloid leukemia

Extreme thrombocytosis is a frequent feature in myeloproliferative disorders which can predispose a person to thrombotic complications. As opposed to other myeloproliferative disorders, symptomatic thrombocytosis is rare in chronic myeloid leukemia. We describe a second case report of chronic myeloid leukemia (Ph chromosome positive) in a patient in chronic phase on hydroxyurea who presented with sudden onset digital cyanosis of the left hand, giddiness, headache and malaise due to extreme thrombocytosis. A 67% global reduction in the platelet count from 1553 x 10(9)/L to 513 x 10(9)/L after two therapeutic plateletpheresis procedures was seen. There was simultaneous improvement in all symptoms except cyanosis on the tip of the middle finger that progressed to dry gangrene. Dramatic reduction in the platelet count and ablation of symptoms by therapeutic plateletpheresis is an effective therapy and should begin as soon as possible.     

The effects of warming methods on temperature, cardiac function and cytokines in plateletpheresis donors

Background and Objectives   Plateletpheresis is the most frequent type of apheresis, with demand for these products continuously increasing. Hypothermia is a common side-effect of apheresis, which may have an effect on the donor's body functions. The aim of this study was to examine the effects of warming methods on plateletpheresis donors' temperature, cardiac function and cytokines.
Materials and Methods   Fifty plateletpheresis donors were randomly assigned to a control group ( n  = 25) or a warming group ( n  = 25), with air and blood warmers during plateletpheresis. The effects of the treatment were examined by comparing body temperature, heart rate, blood pressure, Holter EKG pattern, serum interleukin-1β (IL-1β), interleukin-2 (IL-2), tumour necrosis factor-α (TNF-α) concentration, the white blood count, the white blood fraction, and the platelet count at a point in time between the two groups.
Results   In the control group, the tympanic temperature decreased more during apheresis compared to the warming group ( P  = 0·014). The decrease of diastolic blood pressure was significantly greater in the control group compared to the warming group ( P  = 0·010). As for cardiac function, the frequency of abnormal beats was generally higher in the control group, but the difference was not significant. IL-2 and TNF-α decreased significantly after plateletpheresis in the control group only, while there was no change in the warming group.
Conclusion   The decrease of temperature during plateletpheresis resulted in changes in haemodynamics and cytokines. The warming methods used in this study can prevent the decrease of temperature in donors, and may be helpful in maintaining the haemodynamic and cytokine balance.     

联合应用治疗性白细胞及血小板单采术治疗慢性粒细胞白血病的临床研究

目的 探讨对白细胞、血小板两系均异常增高的慢性粒细胞白血病(CML)患者联合应用治疗性白细胞、血小板单采术的可行性及方法 .方法使用CS 3000 plus血细胞分离机对10例CML患者用单套耗材进行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,更换程序及更换相应的分离夹.治疗后查血常规,观察治疗前后白细胞、血小板变化情况及临床症状缓解情况.结果 用此法单次治疗,白细胞计数下降(55.2±21.2)%;血小板计数下降(47.8±10.2)%;临床症状、体征改善.结论 利用单套耗材联合应用治疗性白细胞及血小板单采术可同时安全、有效地清除白细胞及血小板,是治疗白细胞、血小板同时异常增高CML患者有效的综合治疗方法之一.     

Endogenous serum levels of thrombopoietic cytokines in healthy whole-blood and platelet donors: implications for plateletpheresis

Serum concentrations of the thrombopoiesis-enhancing cytokines thrombopoietin (TPO), erythropoietin (EPO), interleukin (IL)-6 and IL-11 were determined in 119 healthy whole-blood (WBD) and 101 platelet donors (PD) prior to donation. The 90% TPO reference interval in WBD of 64-867 pg/ml (median 163, 100% range 45-7572) was significantly higher than in PD of 56-524 (median 122, range 44-801, P = 0.004), whereas their platelet counts were lower (P < 0.001). EPO levels were not different (WBD 7.7 +/- 3.8, PD 8.0 +/- 4.9 IU/l), IL-6 and IL-11 were below the detection limit in >/=90% of cases (IL-6 < 3.2 pg/ml, IL-11 < 31.2 pg/ml). None of the cytokines correlated with platelet counts, other blood parameters, or in the PD group with the frequency of platelet donations within the last 6 months. We conclude that plateletpheresis does not lead to a lasting increase of thrombopoietic cytokines and provide reference data for potential platelet mobilization strategies with recombinant growth factors.     

Megakaryocyte differentiation capacity of human pluripotent bone marrow progenitor cells CFU-GEMM in vitro after cryopreservation*

The effect of cryopreservation on the pluripotent haemopoietic progenitors CFU-GEMM as well as on the megakaryocyte (CFU-Mk), erythroid (BFU-E) and granulocytic-monocytic (CFU-GM) progenitor cells was analyzed. Progenitor cell recovery after freezing, as determined in 5 experiments, averaged 89% for CFU-GEMM (range: 63% - 194%), 85% for CFU-Mk (range: 62% - 96%), 92% for BFU-E (range: 43% - 174%) and 60% for CFU-GM (range: 31% - 93%). Immunological analysis of individual mixed colonies using a double labelling immunoalkaline phosphatase slide technique and monoclonal antibodies against megakaryocytic and granulocytic cells revealed megakaryocyte cells in more than 79% (range: 73% - 94%) and 84% (range: 75% - 87%) of mixed colonies before and after freezing, respectively. Our results indicate that cryopreservation of human bone marrow cells does not alter the megakaryocytic differentiation capacity of the haemopoietic progenitor cells CFU-GEMM and CFU-Mk in vitro.     

Splenic Platelet Kinetics and Platelet Production after Major Reconstructive Vascular Surgery

ABSTRACT By using ¹¹¹In-labelled platelets and dynamic gamma camera scintigraphy, platelet production rate and intrasplenic platelet kinetics were determined in 13 patients at 1 and 4 months after aortic reconstructive vascular surgery with implantation of dacron prostheses. A significant decrease in platelet production rate and venous platelet count was recorded over time after surgery. Irrespective of whether the exchangeable splenic platelet pool was estimated from initial recovery of platelet-bound radioactivity or from compartmental analysis, the size of this pool was significantly lower at the first study; a change in intrasplenic platelet transit time accounted for the observed difference. Platelet mean life-span increased over time after surgery but the difference between the duplicate studies was not statistically significant. It can be concluded that there is a reduction of platelet production rate and venous platelet count over time after major reconstructive vascular surgery. The early postoperative elevation in the platelet count is mainly the result of an increased platelet production and to a lesser degree due to redistribution of platelets between the splenic platelet pool and general circulation.     

Kinetics and distribution of platelets in man

⁵¹Cr sodium-chromate, though having been widely used in the last two decades for labeling platelets, suffers from several serious drawbacks, ie, low labeling efficiency, long physical half-life, and low gamma photon yields. ¹¹¹In-oxine and ¹¹¹In-tropolone overcome these shortcomings and have the potential of precise determination of platelet kinetics as well as visualization and in vivo quantification of the temporal and spatial distribution of platelets in man. Computer analysis of platelet kinetics reveals that the multiple-hit model fits the survival curve better than the linear or the exponential model. The multiple-hit model provides not only the mean platelet survival time but also information on the initial recovery and the shape of the survival curve. The application of these techniques in normal and disease states should greatly enhance our understanding of the physiology and pathophysiology of platelets.     

Practical guidance for the management of adults with immune thrombocytopenia during the COVID-19 pandemic

This document aims to provide practical guidance for the assessment and management of patients with thrombocytopenia, with a particular focus on immune thrombocytopenia (ITP), during the COVID-19 pandemic. The intention is to support clinicians and, although recommendations have been provided, it is not a formal guideline. Nor is there sufficient evidence base to conclude that alternative approaches to treatment are incorrect. Instead, it is a consensus written by clinicians with an interest in ITP or coagulation disorders and reviewed by members of the UK ITP forum.     

Evaluation of an automated bleeding time device in the newborn

Sick infants frequently developed impaired hemostasis as a secondary event. Abnormal platelet-vessel wall interaction contributes to the hemorrhagic side effects. Currently, the bleeding time is the best measure of in vivo platelet participation in small vessel hemostasis. Bleeding times in the newborn have been previously determined with an automated device designed for the adult or with nonautomated devices. The automated bleeding time device for the adult is not suitable for the infant (length 5 mm, depth 1 mm). We evaluated the performance of an automated bleeding time device designed specifically for the newborn making a cut 2.5 mm in length and 0.5 mm in depth. The results with the automated device showed a strong correlation with the modified template bleeding time device previously used for the newborn. The normal range was shorter and the sensitivity to abnormal vessel wall interaction was greater with the automated device. As well, the ease of determining the bleeding time with the automated device was considerably improved over the template device.     

Bone Marrow Megakaryocytes and Platelet Kinetics in Systemic Lupus Erythematosus

ABSTRACT. The megakaryocyte number and mean megakaryocyte area were determined in histological sections of sternal bone marrow from 26 patients with systemic lupus erythematosus (SLE). Also 20 platelet survival studies were carried out in these patients. The results were analyzed with respect to corticosteroid (CS) and CS+azathioprine (AT) therapy. The mean bone marrow megakaryocyte number was highest in untreated SLE patients, slightly lower in patients receiving CSs and lowest in those receiving CSs + AT. The difference was, however, not significant. The mean megakaryocyte areas were smallest in untreated SLE patients, slightly larger in those treated with CSs and significantly (p<0.05) larger in patients who received CSs + AT than in untreated patients. Platelet production rate was normal in all 3 groups of SLE patients. The results suggest that CS and AT therapy in SLE intervenes with the bone marrow megakaryopoiesis without affecting the production rate of platelets.     

自体血小板分离回输对复杂主动脉弓部手术患者围术期全身炎性反应的影响

目的:探讨自体血小板分离(a PRP)回输,对复杂主动脉弓部手术患者围术期全身炎性反应的影响。方法:选择A型主动脉夹层行象鼻术及全弓置换术患者41例,随机将患者分为对照组(n=11)和血小板分离组(n=30),于麻醉诱导前(T1)、血小板分离后(T2)、离开手术室前(T3)及术后24h(T4)记录两组患者白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、白细胞介素-10(IL-10)及肿瘤坏死因子-α(TNF-α)等炎性因子指标及Hb和血小板数等指标。同时记录患者CPB运转时间,术前左心室射血分数(LVEF),术中血浆输注量,术中出血量,ICU停留时间和住院时间。结果:两组患者麻醉诱导前人口组成、男女比例及术前心功能,均差异无统计学意义;两组患者T1~T4时,Hb与Plt呈逐渐降低趋势,差异有统计学意义(P=0.000);T2点,实验组Plt显著高于对照组(P=0.004),其余时间点差异无统计学意义,各时间点两组间Hb差异均无统计学意义。实验组和对照组离室前(T3)及术后24h(T4)血浆IL-6、8及TNF-α浓度等指标较麻醉诱导前(T1)呈逐渐下降趋势,离室前至术后24h,实验组血浆IL-8浓度较对照组显著降低,差异有统计学意义(P0.01),两组间IL-10血浆浓度变化不显著。实验组术中平均出血量、24h胸腔引流量、ICU停留时间及住院时间均明显少于对照组(均P0.01)。结论:主动脉弓部手术患者,自体血小板分离(aPRP)能减少输血量,并可以降低术后炎性介质水平,减轻炎性反应,从而减少术后并发症,降低患者的住院时间,降低医疗费用。     

Transient thrombopoietin peak after liver transplantation for end-stage liver disease

Knowledge about synthesis of thrombopoietin (TPO) by human liver cells is now well established and makes the study of TPO serum levels and interdependency with platelet concentrations important before and after liver transplantation. We followed these variables in 14 patients suffering from primary biliary cirrhosis (group A), 10 with hepatitis B (group B) and nine with hepatitis C (group C) infections, as well as 11 patients suffering from alcoholic cirrhosis (group D). In the pretransplant serum samples, TPO levels and platelet counts revealed median values (range) of 112.75 pg/ml (5.0-349.3) in group A, 67.8 pg/ml (14.8-249.9) in B, 68.6 pg/ml (31.4-147.3) in C and 57.9 pg/ml (25.2-264.2) in D for TPO, and 138 x 10(9)/l (36-243) in A, 48 x 10(9)/l (22-129) in B, 105 x 10(9)/l (32-176) in C and 109 x 10(9)/l (33-285) in D for platelets, the latter levels being abnormally reduced. Within 2-3 d of transplantation, the TPO levels started to increase to transient peaks of mostly 5-10 times baseline, which were followed by continuous correction of thrombocytopenia. Splenomegaly was identified to be an important co-factor of thrombocytopenia in groups A and D. We conclude that decreased TPO production in patients with end-stage liver diseases is reverted by orthotopic liver transplantation.     

Rapid Reduction of Platelet Numbers in Thrombocytosis

Abstract: Thrombocytosis has been reported during chemotherapy with gemcitabine (GEM). A 71‐year‐old male patient who developed asymptomatic thrombocytosis (1,749 × 10³/μl), secondary to GEM chemotherapy for lung carcinoma, was submitted to therapeutic plateletpheresis (TP). We adapted the software of the productive dual‐needle plateletpheresis of our cell separator in order to reduce the procedure time and the plasma volume harvested. With 2 low‐volume TP in 24 h, we achieved a 55% global reduction of the platelet count. While there are no accepted indications for prophylactic plateletpheresis in asymptomatic patients and the measured count should not, by itself, determine whether platelet reduction is indicated, a drastic reduction of an extremely high platelet count, especially if obtained with a relatively short procedure, can be important to prevent acute severe sequelae.     

Analysis of biological properties of selected elements of haemostasis after treatment with the oxidized form of homocysteine in vitro

The elevated level of homocysteine (Hcys; hyperhomocysteinemia, in relation to the total plasma Hcys concentration, >15?µM) is associated with different diseases in human, including cardiovascular diseases. In plasma, Hcys occurs in various forms (the reduced Hcys, the oxidized Hcys, homocysteine thiolactone (HTL) and a component of proteins as a result of N- or S-homocysteinylation). The mechanisms by which hyperhomocysteinemia contributes to changes of haemostasis are complex and unclear. The role of different forms of Hcys, which may be involved in the modulation of haemostatic process during hyperhomocysteinemia is also not yet well-known. Our previous works have shown that both Hcys in the reduced form and the most reactive form of Hcys—its thiolactone may modify fibrinolysis, coagulation process and biological activity of blood platelets. The mechanism by which the oxidized Hcys exerts the prothrombotic effect and influences on blood platelets or plasma remains unclear. The aim of our study in vitro was to establish and compare the influence of the oxidized Hcys (at final doses of 0.01–1?mM), the reduced Hcys (at final doses of 0.01–1?mM) and HTL (at final doses of 0.1–1?µM) on selected haemostatic properties of blood platelets (platelet aggregation and platelet microparticle formation measured by flow cytometry) and plasma (fibrin polymerization and lysis). Here, our results indicate that the oxidized Hcys, like the reduced Hcys or HTL-augmented blood platelet aggregation, stimulated polymerization of fibrinogen and reduced the fibrin lysis in plasma. But, we suggest that the most reactive form of Hcys may be HTL (at lower concentrations than Hcys) during hyperhomocysteinemia-induced cardiovascular diseases.