Abstract:Over the last 15 years, there has been a trend in the United States towards the increasing use of apheresis platelet (AP) concentrates over whole-blood-derived platelets (WBP). Although 1-h- and 24-h-corrected count increments tend to be higher with AP, this does not translate into improved haemostatic efficiency when used to prevent bleeding in haematology/oncology patients. WBP expose the recipient to more donors than apheresis products. However, recent studies have shown no significant differences in the ra… Show more
“…Since the introduction of mandatory universal pathogen inactivation of all PC in 2011 [2], AP-PC and BC-PC are considered clinically equivalent. However, some differences exist between both types of PC, such as the extent of residual contaminating red blood cells (RBC), which has been shown to be considerably lower for AP-PC (0.00017-0.009 ml) compared to BC-PC (0.036-0.59 ml) [3,4,5,6,7,8]. …”
Background: Platelet concentrates (PC) contain residual contaminating red blood cells (RBC), being higher in pooled buffy coat PC (BC-PC) than in apheresis units (AP-PC). Data about PC-induced alloimmunization against non-D Rhesus (Rh) antigens are limited. Methods: For all newly detected RhD and non-D alloantibodies between August 2015 and September /2017 we prospectively evaluated if they were triggered through PC by analyzing for incompatible RBC and/or PC transfusions. Results: We found 5,799 positive results in 89,190 antibody screening tests. We identified 13 newly detectable Rh antibodies through incompatible PCs in 11 patients: 6× anti-D, 4× anti-E, 2× anti-c, 1× anti-f. They received a total of 156 PC (83 BC-PC; 73 AP-PC): 5 patients received incompatible BC-PC only, 1 patient received incompatible AP-PC only, 5 patients received incompatible BC-PC and AP-PC. Quality control showed a mean (range) of 0.304 (0.152-1.662) and 0.014 (0.003-0.080) × 109 RBC/l for BC-PC and AP-PC, respectively. Ten of the 11 patients received RBC transfusions, all of them being antigen-negative for the alloantibodies identified. Conclusions: PC transfusions may not only induce RhD alloimmunization, but also immunization against further Rh antigens such as c, E, and f. The risk seems higher for BC-PC than for AP-PC. The results may have impact on future recommendations of PC transfusion with respect to Rh compatibility and upper limits of RBC contamination.
“…Since the introduction of mandatory universal pathogen inactivation of all PC in 2011 [2], AP-PC and BC-PC are considered clinically equivalent. However, some differences exist between both types of PC, such as the extent of residual contaminating red blood cells (RBC), which has been shown to be considerably lower for AP-PC (0.00017-0.009 ml) compared to BC-PC (0.036-0.59 ml) [3,4,5,6,7,8]. …”
Background: Platelet concentrates (PC) contain residual contaminating red blood cells (RBC), being higher in pooled buffy coat PC (BC-PC) than in apheresis units (AP-PC). Data about PC-induced alloimmunization against non-D Rhesus (Rh) antigens are limited. Methods: For all newly detected RhD and non-D alloantibodies between August 2015 and September /2017 we prospectively evaluated if they were triggered through PC by analyzing for incompatible RBC and/or PC transfusions. Results: We found 5,799 positive results in 89,190 antibody screening tests. We identified 13 newly detectable Rh antibodies through incompatible PCs in 11 patients: 6× anti-D, 4× anti-E, 2× anti-c, 1× anti-f. They received a total of 156 PC (83 BC-PC; 73 AP-PC): 5 patients received incompatible BC-PC only, 1 patient received incompatible AP-PC only, 5 patients received incompatible BC-PC and AP-PC. Quality control showed a mean (range) of 0.304 (0.152-1.662) and 0.014 (0.003-0.080) × 109 RBC/l for BC-PC and AP-PC, respectively. Ten of the 11 patients received RBC transfusions, all of them being antigen-negative for the alloantibodies identified. Conclusions: PC transfusions may not only induce RhD alloimmunization, but also immunization against further Rh antigens such as c, E, and f. The risk seems higher for BC-PC than for AP-PC. The results may have impact on future recommendations of PC transfusion with respect to Rh compatibility and upper limits of RBC contamination.
“…No anti‐D alloimmunization was reported in three studies using only apheresis PCs . RBC levels are generally two orders of magnitude higher in PCs prepared from whole blood than in apheresis PCs . They may therefore exceed the threshold required to induce anti‐D antibody production, although recent reports suggest that microparticles present in apheresis PCs may also induce RBC alloimmunization …”
Section: Discussionmentioning
confidence: 97%
“…[26][27][28] RBC levels are generally two orders of magnitude higher in PCs prepared from whole blood than in apheresis PCs. 3,29 They may therefore exceed the threshold required to induce anti-D antibody production, although recent reports suggest that microparticles present in apheresis PCs may also induce RBC alloimmunization. 30 Third, disease status probably plays a role in the higher rate of alloimmunization observed in this study than in recent studies of hematology and oncology patients.…”
BACKGROUND
Recent reports have indicated that the risk of anti‐D alloimmunization following D‐incompatible platelet (PLT) transfusion is low in hematology and oncology patients. We investigated the rate of anti‐D alloimmunization in RhD‐negative (D−) patients with chronic liver disease transfused with D+ platelet concentrates (PCs) and the factors involved, at a liver transplant (LT) center.
STUDY DESIGN AND METHODS
We reviewed the blood bank database from January 2003 to October 2016.
D− patients who had received D+ PLT transfusions were eligible if they had undergone antibody screening at least 28 days after the first D+ PC transfusion, had no previous or concomitant exposure to D+ blood products, and had not received anti‐D immunoglobulins.
RESULTS
Six of the 56 eligible patients (10.7%) had anti‐D antibodies. All had received whole blood‐derived PCs. Four of 20 patients (20%) untransplanted or transfused before LT and only two of 36 patients (5.6%) transfused during or after LT produced anti‐D antibodies. These two patients were on maintenance immunosuppression based on low‐dose steroids and tacrolimus. The factors identified as significantly associated with anti‐D immune response were the presence of red blood cell immune alloantibodies before D+ PLT transfusion (p = 0.003), and D+ PLT transfusion outside the operative and postoperative (5 days) periods for LT (p = 0.023).
CONCLUSION
D− patients with chronic liver disease transfused with D+ PLTs before LT are at high risk of developing anti‐D antibodies. Preventive measures should be considered for these patients.
“…Nabiha Huq Saifee , 1,2 Rebecca Haley, 2 and Theresa Nester 1,2 Whole blood-derived platelet (WBDP) distribution has declined dramatically in the United States from 32.3% in 2001 to only 7.6% in 2013. 1 This national trend is not reflected in the greater Seattle area where WBDPs still account for approximately 30% of platelet (PLT) distribution.…”
mentioning
confidence: 99%
“…Data have also shown that leukoreduced WBDPs have similar hemostatic efficacy and HLA alloimmunization rate compared to leukoreduced APs and that both products carry a low risk of transfusion-related adverse events in the era of viral nucleic acid testing and bacterial testing. 2 With increased regulations and national trends of decreased donations and increased PLT usage, maintenance of an adequate PLT supply is becoming more challenging. WBDPs maximize the whole blood donor's gift and may help mitigate PLT shortages.…”
Whole blood-derived platelet (WBDP) distribution has declined dramatically in the United States from 32.3% in 2001 to only 7.6% in 2013.1 This national trend is not reflected in the greater Seattle area where WBDPs still account for approximately 30% of platelet (PLT) distribution. The figures show our technique for manual extraction of plasma from the PLT button created after hard spin of PLT-rich plasma. Applying the Lean manufacturing premise of "right the first time," our product manufacturing department drilled two screws into each manual extractor and determined optimal positioning of these screws to leave approximately 55 mL of plasma in each WBDP (see figure, left). Furthermore, the satellite bag is placed on a raised shelf behind the plasma extractors to allow controlled flow of extracted plasma (see figure, middle). With this technique, one employee can make at least 12 WBDPs at once (see figure, right). The Acrodose PL system is then used to create leukoreduced prestorage PLT pools (PSPPs) composed of five WBDPs. The PSPPs provide equivalent PLT dose, bacterial contamination testing, and rapidity of issue as apheresis PLTs (APs). Data have also shown that leukoreduced WBDPs have similar hemostatic efficacy and HLA alloimmunization rate compared to leukoreduced APs and that both products carry a low risk of transfusion-related adverse events in the era of viral nucleic acid testing and bacterial testing. 2 With increased regulations and national trends of decreased donations and increased PLT usage, maintenance of an adequate PLT supply is becoming more challenging. WBDPs maximize the whole blood donor's gift and may help mitigate PLT shortages.
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