Multicomponent apheresis

Abstract

Introduction: An increasing demand for blood components is opposed by a decreasing donor availability for the collection of the required blood components. Furthermore, current stem cell transplantation regiments require the collection of more than one similar or different component from one donor or patient. One strategy for maintaining the patients' supply with the required blood components can be the concurrent collection of more than one component from one donor by apheresis, thus multicomponent apheresis.Scope of multicomponent combinations: Combinations are possible for nearly every kind of blood components. In one session it is possible -depending on the apheresis device -to collect up to four plasma units alone, one or more plasma units and one or two red blood cell (RBC) units, one or more plasma units and one or more platelet units, one or more plasma units and one or two RBC units and one or more platelet units, one or two RBC units and one or more platelet units, two RBC units alone, one or more platelet units.Also in leucocytapheresis the collection of more than one blood component has become a routine procedure. Performing allogeneic stem cell apheresis can lead to a cell dose for two transplantations or to one unit of PBSCs and concurrently collected and frozen mononuclear cells used for donor lymphocyte infusions therapy. Autologous mononuclear cell products (e.g. PBSCs or monocytes for dendritic cell generation) usually are cryoconserved before use and require additional plasmaproteins for cryoconservation. The latter can be obtained by the concurrent collection of plasma during leucocytapheresis. Thus, the combination of cell and plasma units or of cell units of different dose or for different purpose are further examples for the implementation of multicomponent apheresis in tumor therapy. Conclusions:The understanding of apheresis technologies facilitates the use of multicomponent apheresis in the vast application field for tailoring the kind, quantity, and quality of blood components for patient care.

Comparison of plateletpheresis on the Fenwal Amicus, Fresenius COM.TEC, and Trima Accel Cell separators

“…All volunteer donors met the Council of Europe Guidelines and Recommendations for apheresis and the standard guidelines established by the American Association of Blood Banks [9,10]. Criteria for eligibility for a single unit (3 3 10 11 ) were as follows: (1) age 18-60 years; (2) preapheresis peripheral blood (PB) PLT count 150 3 10 9 /L; (3) hemoglobin (Hb) level 13.5 g/dL; (4) donor body weight 50 kg; (5) negative tests for HIV, hepatitis B surface antigen, hepatitis C, and syphilis; (6) absence of any illness; (7) in good health; (8) at least 3 months since last whole donation; (9) at least 3 days since last plateletpheresis; (10) adequate venous accesses; and (11) no consumption of nonsteroidal anti-inflammatory drugs and acetyl salicylic acid in the last 7 days [11]. Details of plateletpheresis were explained to each donor who gave informed consent before the procedure.…”

Donor safety in triple plateletpheresis: results from the German and Austrian Plateletpheresis Study Group multicenter trial

“…Technical improvements enable modern blood cell separators to rapidly process several liters of donor blood and to collect very large quantities of individual blood cells from each donor during a single apheresis procedure. The latest generation of apheresis machines—the Amicus (introduced by Baxter [Deerfield, IL] in 1995), the Trima (CaridianBCT [Lakewood, CO], 1997), or the COMTEC (Fresenius Hemocare [Bad Homburg, Germany], 1999)—have demonstrated significant progress with respect to collection efficiency, citrate management, and donor comfort (e.g., single‐needle [SN] usage, short processing times) and are specifically designed to harvest at least 2 units of platelet (PLT) components (COMTEC) or even more and different blood products (multicomponent donations: Amicus, Trima, Haemonetics MCSplus [Haemonetics, Braintree, MA]) 1‐6 . Moreover, as nearly all contaminating red blood cells (RBCs) and white blood cells (WBCs) can be returned to the donor, it is common practice to repeat apheresis donations at close intervals.…”

“…In Europe, the plateletpheresis‐associated PLT loss per donor is indirectly restricted by the maximum limit of 26 apheresis procedures per year and a relative low minimum number of at least 2 × 10 11 PLTs/TU 13,14 . Hence, any intensification of the procedure, either by increasing the number of PLTs, for example, to at least 4.0 × 10 11 per TU, 10,15 or by introducing TP with a minimum PLT content of at least 2.5 × 10 11 to 3.5 × 10 11 per TU, 5,9,16‐18 will inevitably lead to higher PLT losses for donors. In an attempt to establish a possible safety margin for a TP program, a single‐center observational pilot trial was performed at Hannover Medical School in 2005 and included 1132 DPs and 442 TPs 18 .…”

Risk-Reduction Strategies for Platelet Transfusion in the United States

“…If that is the case, instead of trying to prevent TRALI by removing as much plasma as possible from the RBC and platelet components, we should strive to prevent TRALI by removing the exposures to the donors themselves [65]. Multicomponent apheresis [66,67] permits the collection of RBCs and platelets (and/or plasma) from the same donation for transfusion to the same recipient. It can thus replace the whole-blood collections of the 20 th century and meet all of a patient's transfusion needs with exposure to fewer donors.…”