Adverse Events During Apheresis Procedures: Audit at a Tertiary Hospital

Abstract

Apheretic platelets are better quality blood components which reduce donor exposure and chances of TTIs to transfusion recipients when compared to the whole blood derived components. Though safe, these apheretic donations are associated with donor adverse events. We evaluated the incidence of such adverse events associated with the modern apheresis procedures that would provide an insight as well as help formulating preventive steps to avoid frequent occurrences of such events. This prospective audit-based observational study was conducted over 1 year. Donors for plateletpheresis were selected as per the standard operating procedure of the Apheresis Lab. The apheresis procedures were done on the MCS? (Haemonetics Corp.), Trima Accel (Terumo BCT) and COM.TEC (Fresenius Kabi AG). 1740 apheresis procedures were performed, out of which 1708 were plateletpheresis and 32 therapeutic plasma exchange (TPE) procedures for 7 patients. A total of 102 adverse events were noted; of which, 80 (78.43 %) events were associated with donors, 15 (14.71 %) were owed to equipment related problems and 7 (6.86 %) were technical aberrations. All the events associated with donors were mild. No adverse events were reported with any of the 32 TPEs. Apheresis procedures are associated with adverse events which can be reduced by meticulous donor-vigilance, superior training modules for the technical personnel and continued supervision of experienced transfusion medicine specialists. Continued efforts towards making the donor's experience with apheresis more pleasant give a forward thrust to the noble vision of preparing a voluntary apheresis donor pool in India.

Adverse Events Encountered in Platelet Aphaeresis Procedure and Their Management: A Retrospective Study

“…The procedure was terminated prematurely and donor was managed with intravenous calcium and saline administration. Theses citrate related complications are well documented and incidence in our study coincide with result of other studies [8].…”

“…We reported a high incidence (12.5%) of anxiety and fainting of donors during the procedure mainly because of more inexperienced directed donors as compared to voluntary donors which were well acquainted with the aphaeresis procedure. Similar results (12.73 % incidence of vasovagal reactions) were reported by Dogra et al [8], however , lower incidences have been reported in other studies [11]. The 3 donors in our study who experienced vasovagal symptoms like sweating and fainting, were managed conservatively and the procedure was completed after due encouragement and reassurance.…”

“… Although single use disposable kits for platelet aphaeresis procedure undergo strict quality control and are assumed to be devoid of any manufacturing defects, we encountered four such kits with two having punctures in tubing and two with leakage in bowl/separation chamber . Similar manufacturing defect in separation chamber, leading to a complication in the procedure, was also reported in other study [8]. In our donors, the leakage in separation chamber/ bowl was caught early in the procedures and was terminated without much blood loss of donors.…”

“…32, 2% 32, 2% donor platelets by platelet aphaeresis in patients careful monitoring can, to some extent, prevent such occurrences and lead to 100% success in platelet aphaeresis procedure, especially in technique and machine related faults. However, donor related adverse events are unavoidable and constitute majority of total adverse events encountered in platelet aphaeresis [8,9].…”

Study of Adverse Donor Reaction of Plateletpheresis in a Tertiary Care Centre of North India

“…During donation it was observed that out of 100 donors, only two donors had adverse effects during plateletphersis. Citrate toxicity was seen in one donor which may be due to the reason that platelet count of the donor was 250X10 9 /L and platelet yield was set as 6x10 11 platelets per unit on Trima accel. So, with respective platelet count and platelet yield, more amount of whole blood has to be processed so more ACD run in the blood circulation which caused citrate toxicity as tingling sensation around the mouth.…”