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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 2  |  Issue : 1  |  Page : 19-23

Apheresis platelets in additive solution: Is it a good alternative to conventional group-specific apheresis platelets?


Department of Transfusion Medicine, Blood Bank, Fortis Escorts Heart Institute, New Delhi, India

Date of Web Publication22-Mar-2017

Correspondence Address:
Amit Agrawal
Department of Transfusion Medicine, Blood Bank, Fortis Escorts Heart Institute, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GJTM.GJTM_5_17

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  Abstract 

Introduction: India is among the medium developed countries with a population over 1.25 billion with areas of difficult terrains, landslides, and there is requirement of platelets for dengue outbreaks,cancer patients or patients needing intensive care. Use of nongroup-specific platelets is common and the incompatible plasma comes with complications at times. Thus, finding group-specific platelets have always been difficult. Arranging group-specific donor is really a challenge, especially in cases of international patients, outstation patients, and patients that require numerous platelet transfusions, more so in hospital-based blood banks that have limited voluntary apheresis blood donor registry. Materials and Methods: This study was conducted in multispecialty tertiary health-care hospital of Delhi/NCR where the majority of patients are from a different place or different state or a different country. To make do with the available donors who are often replacement donors of a group different from the patient, platelet additive solution (PAS) was used to replace the incompatible plasma. Use of PAS was implemented on all apheresis prepared using storage solution for platelets (SSP+, Macopharma, France) using apheresis platform. PAS was added after collection of hyperconcentrated platelets units. Control group (n = 10) included patients receiving group-specific platelets during the study. Results: A total of 130 apheresis units were prepared on PAS during the study. 126 units were issued to 77 patients. 99.2% of donors under study were male and 47.7% in age group 18–30 years and 31.5% of blood Group O positive. Final platelet volume prepared was 300 ± 20 ml. Mean platelet volume and product pH were within normal range. Conclusion: Use of PAS for apheresis platelets eliminates the need for group-specific platelets converting all single-donor apheresis platelets to universal platelets, thereby helping in better management without compromise in patient safety.

Keywords: Apheresis, platelet additive solution, single donor apheresis platelet


How to cite this article:
Agrawal A. Apheresis platelets in additive solution: Is it a good alternative to conventional group-specific apheresis platelets?. Glob J Transfus Med 2017;2:19-23

How to cite this URL:
Agrawal A. Apheresis platelets in additive solution: Is it a good alternative to conventional group-specific apheresis platelets?. Glob J Transfus Med [serial online] 2017 [cited 2017 Dec 11];2:19-23. Available from: http://www.gjtmonline.com/text.asp?2017/2/1/19/202718


  Introduction Top


Human blood is an essential element of human life and till now yet there are no substitutes for blood.[1] Availability of safe blood and blood products is a critical component in improving health care.[2] The need for blood is growing day-by-day as a result of advancement in clinical medicine.[3]

India is among the medium developed countries with a population over 1.25 billion with areas of difficult terrains, landslides, and there is a requirement of platelets due to seasonal outbreaks of Dengue.[4] In addition, many others such as cancer patient or patients needing intensive care are constantly in need of platelets.

Arranging group-specific donor is really a challenge, especially in cases of international patients, outstation patients, and patients that require numerous platelet transfusions in cases such as dengue and especially in hospital-based blood banks that have limited voluntary apheresis blood donor registry. There is an acute shortage of group-specific platelets, and use of platelets across ABO/Rh groups is quite rampant. Platelet additive solutions (PAS) are a boon that has just entered the Asian market. PAS replaces incompatible plasma and makes Platelet switches across groups more scientific. PAS as a replacement fluid for plasma may be used both for single-donor apheresis platelets (SDPs) as well as pooled platelet concentrate although this study focuses on former and not the latter.

PAS basically contain acetate, citrate and phosphate, sodium, potassium, and magnesium. It has been used in proportion of 70:30 ratio with donor plasma. The pH of the platelets is similar to that of platelets stored in plasma.[5]

Advantages associated with use of PAS are:[6]

  • Greater removal of ABO-incompatible plasma, thus reducing the risk of hemolysis
  • Product can be issued across all group patients
  • Lesser allergic reaction to patients
  • Lesser vasovagal reaction to donors
  • Smooth inventory
  • Wastage prevention.


Objectives

To demonstrate the clinical equivalence of PAS-SDP with group-specific SDP if any.


  Materials and Methods Top


This study was conducted in a multispecialty tertiary care, hospital of Delhi/NCR where major patient clientele are international patients or patients from other state or place in India. Screening for apheresis donor is same as of normal donor, but additionally, weight of donor should be ≥55 kg, Platelet count should be more than 150,000/μL, history of drug ingestion, especially aspirin needs to be ruled out and good veins that do not collapse under the pressure exerted by apheresis machine are basic requirements over and above the whole blood requirements. Additional requirement for group-specific platelets posed a problem.

We, therefore, used PAS approved by the Drug Controller General of India after getting a clearance from the Central Hospital Transfusion Committee. Use of PAS was implemented on all apheresis platelets prepared using storage solution for platelets (SSPs). PAS used was SSP + from Macopharma, France, and using Apheresis platform. PAS is added after the collection of hyperconcentrated platelet units.[7]

Control group (n = 10) included patients receiving group-specific platelets during the study mainly adult patients admitted for cardiac surgery with no underlying associated disease.

Duration of the study was 6 months from August 2016 to January 2017.

All donors participating in this study met the guidelines for the selection of blood donors.[1],[8]

All platelets collected were stored at 22°C under constant agitation, and underwent quality control checks from Day 1 to Day 5 with samples drawn from the from platelet pouch, even after issue of the product.

Study markers

  • Volume of the final product
  • Platelet counts and mean platelet volume (MPV) analysis were performed using a cell counter (Countender 20+, SFRI France)
  • pH
  • Swirling movement by visual inspection
  • Patient platelet count pretransfusion
  • Patient platelet count on next day after transfusion (Day 1) if no fresh transfusion
  • Patient platelet count after transfusion (Day 3) if no fresh transfusion.


Statistics

Data were reported as mean ± standard deviation. The data were compared using Chi-square test to find statistical significance.


  Results Top


Totally, 130 apheresis units were prepared on PAS during the study. 126 units were issued to 77 patients. Four units were discarded being date expired. 99.2% of donors under the study were male [Figure 1] and 47.7% in age group 18–30 years [Figure 2] and 31.5% of blood Group O positive [Figure 3]. Final platelet volume prepared was 300 ± 20 ml. The majority of patients transfused with PAS platelets were diagnosed with cardiac disease [Figure 4]. MPV was within normal range 7.4–10.4 Fl [Figure 5]. Swirling was fully maintained during the study (graded by visual inspection) in all units, indicating that the platelets had kept their discoid shape. Product pH was in the range of 7.1 ± 0.1 [Figure 6], platelet count 1538 ± 17 × 103/μL [Figure 7].
Figure 1: Sex distribution of donors

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Figure 2: Age distribution of donors

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Figure 3: Blood group distribution of donors

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Figure 4: Patient diagnosis

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Figure 5: Mean platelet volume

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Figure 6: Product pH

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Figure 7: Product platelet count

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Patient platelet count was assessed before apheresis transfusion and then 24 h after transfusion and percentage increment was calculated for 25 patients receiving PAS apheresis [Table 1]. Mean percentage increment (MPI) was 232% and range 64.71%–650%. Control group of ten patients receiving group-specific platelet during the same study was also assessed [Table 2]. MPI was 218% and range 140%–500%. No adverse transfusion reactions were noted in any case.
Table 1: Percentage increment after platelet additive solution apheresis transfusion (study group)

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Table 2: Percentage increment after group-specific apheresis transfusion (control group)

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  Discussion Top


In country like India, majority of blood donation is arranged through replacement donation. Although National AIDS Control Organization definition says, relatives are voluntary donors, but they are not true voluntary donors as they are not available for other patients when in need.[9]

There is a trend in Australia toward using SDPs rather than whole blood-derived pooled platelets, which carries the additional risks of exposing the recipient to blood products from multiple donors. The ability to provide a standardized product with a reduced plasma content is therefore of importance.[10]

For numerous reasons, storing platelets in synthetic media are becoming a more popular practice and is currently a standard in several European countries. The possibility to increase the availability of universal platelets and to diminish the risk of transfusion reactions is some arguments among others.[11]

A study conducted by Diedrich et al. at Sweden stated that difficulty in predicting the outcome of platelet transfusion in vivo from the results of laboratory testing is well-known. In this study, swirling movement, pH, and other parameters were taken into account.[12]

In our study, majority of patients requiring platelet transfusions were cardiac patients, but dengue patients underwent more than >1 apheresis platelet transfusions. Percentage increment in patients (study group) receiving PAS is almost equivalent to patients (control group) receiving group-specific apheresis platelets [Table 1] and [Table 2]. Although the right time to check for posttransfusion platelet increments is 1 h posttransfusion, it is ethically incorrect to prick the patient exclusively for the purpose of the study, and hence, platelet counts done within 24 h to determine the need for further transfusion was used an indicator of the effectiveness of transfusion.

Although limited data are available, there may be reason to believe that the shorter survival time found in healthy controls may not be as important in patients because of the rapid consumption of platelets in thrombocytopenic patients due to the fact that platelet viability also depends on the severity of thrombocytopenia, the underlying illness and the presence of human leukocyte antigen and ABO antibodies.[13],[14],[15]

Apheresis donor registry is available at very limited centers as procedure being cumbersome and time-consuming. Searching donor of same blood group is really a pain. This study will open doors for universal apheresis blood donor registry.

To summarize, the use of PAS represents a potential benefit to blood centers and patients by increasing platelet availability, and there is a growing clinical need to accurately assess clinically meaningful platelet quality.


  Conclusion Top


Use of PAS for apheresis platelets eliminates the need for group-specific platelets converting all SDPs to universal platelets, thereby helping in the better management of available groups without compromise in patient safety. PAS–SDP were comparable to normal SDP both in terms of Platelet count in the blood bag and platelet increment obtained in patients, thereby demonstrating clinical equivalence. No adverse reactions were reported with any of the PAS-SDP group indicating safety. papers on this subject, especially in the Indian subcontinent are few and larger studies are needed before PAS-SDPs become the norm. The author (s) feel that universal implementation of PAS-SDP will benefit large number of patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
National AIDS Control Organization. Action Plan for Blood Safety. New Delhi: National AIDS Control Organization, Ministry of Health and Family Welfare, Government of India; 2007.  Back to cited text no. 1
    
2.
Dhingra N, Lloyd SE, Fordham J, Amin NA. Challenges in global blood safety. World Hosp Health Serv 2004;40:45-9, 51, 52.  Back to cited text no. 2
    
3.
Available from: http://www.who.int/bloodsafety/voluntary_donation/en/index.html. [Last accessed on 2009 Jun 12].  Back to cited text no. 3
    
4.
World Health Organization Dengue and Severe Dengue. Media Centre Fact Sheet. WHO, 2013. Available from: http://www.who.int/mediacentre/factsheets/fs117/en/. [Last accessed on 2014 Feb 08].  Back to cited text no. 4
    
5.
Gulliksson H. Platelet storage media. Vox Sang 2014;107:205-12.  Back to cited text no. 5
    
6.
Ringwald J, Zimmermann R, Eckstein R. The new generation of platelet additive solution for storage at 22 degrees C: Development and current experience. Transfus Med Rev 2006;20:158-64.  Back to cited text no. 6
    
7.
Johnson L, Winter KM, Hartkopf-Theis T, Reid S, Kwok M, Marks DC. Evaluation of the automated collection and extended storage of apheresis platelets in additive solution. Transfusion 2012;52:503-9.  Back to cited text no. 7
    
8.
Patel SG, Patel JN, Patel AC, Raja KA, Dobariya GH, Pandya AN. Blood donor notification and counselling of reactive test result in Blood Bank of South Gujarat: A better approach to prevent reactive donors from donating blood again. Glob J Transfus Med 2016;1:57-60.  Back to cited text no. 8
  [Full text]  
9.
Jain R, Gupta G. Family/friend donors are not true voluntary donors. Asian J Transfus Sci 2012;6:29-31.  Back to cited text no. 9
  [Full text]  
10.
Ness PM, Campbell-Lee SA. Single donor versus pooled random donor platelet concentrates. Curr Opin Hematol 2001;8:392-6.  Back to cited text no. 10
    
11.
Heddle NM, Klama L, Singer J, Richards C, Fedak P, Walker I, et al. The role of the plasma from platelet concentrates in transfusion reactions. N Engl J Med 1994;331:625-8.  Back to cited text no. 11
    
12.
Diedrich B, Sandgren P, Jansson B, Gulliksson H, Svensson L, Shanwell A.In vitro and in vivo effects of potassium and magnesium on storage up to 7 days of apheresis platelet concentrates in platelet additive solution. Vox Sang 2008;94:96-102.  Back to cited text no. 12
    
13.
Hanson SR, Slichter SJ. Platelet kinetics in patients with bone marrow hypoplasia: Evidence for a fixed platelet requirement. Blood 1985;66:1105-9.  Back to cited text no. 13
    
14.
Slichter SJ. Post-storage platelet viability in thrombocytopenic patients is reliably measured by radiochromium labeled platelet recovery and survival measurements in normal volunteers. Transfusion 1986;26:8-13.  Back to cited text no. 14
    
15.
Norol F, Kuentz M, Cordonnier C, Beaujean F, Haioun C, Vernant JP, et al. Influence of clinical status on the efficiency of stored platelet transfusion. Br J Haematol 1994;86:125-9.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7]
 
 
    Tables

  [Table 1], [Table 2]



 

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