|Year : 2018 | Volume
| Issue : 1 | Page : 52-55
A retrospective analysis of donor deferral characteristics for plateletpheresis in a tertiary care hospital, South India
Sudhir Kumar Vujhini, Kandukuri Mahesh Kumar, Murali Krishna Bogi, B Shanthi
Department of Transfusion Medicine and Immunohematology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
|Date of Web Publication||5-Apr-2018|
Dr. Kandukuri Mahesh Kumar
Department of Transfusion Medicine and Immunohematology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana
Source of Support: None, Conflict of Interest: None
Background: There is an increasing demand for platelets in the recent years due to increase in cancer cases, dengue fever, and other platelet-related diseases. Blood bank plays a vital role in supplying platelet units which have better yield and fewer complications. Single donor platelet (SDP) unit is a useful platelet product in many diseases for raising the platelet count. For better yield, a healthy and young donor is required which is a great challenge for the blood bank staff. Materials and Methods: This retrospective study was carried out for a period of 4 years from January 2014 to December 2017. Data were collected from the records maintained by the Department of Transfusion Medicine and Immunohematology in a Tertiary Care Hospital, Hyderabad, India. Results: Out of 860, a total of 705 Plateletpheresis donors were selected for SDP donation, and the remaining 155 (18.02%) donors were deferred for various reasons. The predominant age range of the deferred donors was 25–34 years (50.32%). Among the deferred donors, males were 90.32% and females were 9.68%. Temporarily deferred donors account for 98.07% and permanently deferred donors were 1.93%. The most common causes for deferral were low platelet count (31.61%), low hemoglobin (27.09%), and poor venous access (20.64%) and the least common cause was dermatitis at the venipuncture site (1.29%). The most common reason for permanent deferral was seropositivity for HBsAg. Conclusion: Selection of plateletpheresis donor with utmost stringency will give good yield of platelets. Temporary deferred donor should be counseled properly so as to encourage them for the future donations when they become eligible, and this bridges the gap between the demand and supply of apheresis platelets.
Keywords: Apheresis, donor deferral, hemoglobin, platelet count, lateletpheresis, single donor platelets, transfusion transmissible infections
|How to cite this article:|
Vujhini SK, Kumar KM, Bogi MK, Shanthi B. A retrospective analysis of donor deferral characteristics for plateletpheresis in a tertiary care hospital, South India. Glob J Transfus Med 2018;3:52-5
|How to cite this URL:|
Vujhini SK, Kumar KM, Bogi MK, Shanthi B. A retrospective analysis of donor deferral characteristics for plateletpheresis in a tertiary care hospital, South India. Glob J Transfus Med [serial online] 2018 [cited 2018 Aug 17];3:52-5. Available from: http://www.gjtmonline.com/text.asp?2018/3/1/52/229330
| Introduction|| |
Blood bank plays an important role in the healthcare system. The main aim of it is to provide adequate and safe blood and its components. Hence, proper donor selection is a must by formulating selection criteria which ensure the safety of donors and recipients. Recruitment of plateletpheresis donors is further challenging as the donor selection criteria not only includes all those that are followed for routine blood donation but also have to consider various other parameters. In addition, there is an increased demand for single donor platelet units (SDP/apheresis platelet unit) nowadays owing to low risk of alloimmunization and very low risk of transfusion-associated infections. Some donors are generally deferred temporarily or permanently for some of the reasons, and this may create a negative impact on voluntary blood/component donation. Hence, motivation, education, and treatment of these temporarily deferred people are very important to retain them in donor pool and can be recruited later on for repeated donations. Hence, this study was done to know the deferral reasons and rate so that proper measures can be adopted to increase the donor rate so that it benefits the needy patients.
| Materials and Methods|| |
This retrospective study was carried out for a period of 4 years from January 2014 to December 2017. Data were collected from the records maintained by the Department of Transfusion Medicine and Immunohematology in a Tertiary Care Hospital, Hyderabad, India. Donors were selected as per the set criteria for SDP preparation in accordance to our hospital protocols which is according to the drugs and cosmetic act and rules, and are listed below:
- Weight 60 kg or more
- Age between 18 and 60 years
- Hemoglobin % ≥12.5 g/dl
- Platelet count >2.0 lakh/dl
- Adequate venous access on both the hands
- Donors who have taken aspirin containing medication 3 days or 72 h before the procedure are deferred temporarily
- Interval between procedures should be at least 48 h. A donor shall not undergo the procedure more than two times in a week or 24 times in a year
- Absence of any illness
- Negative screening test for human immunodeficiency virus, hepatitis B virus, hepatitis C virus, syphilis, and malaria.
| Results|| |
Out of 860, a total of 705 SDP donors were selected for SDP donation, and the remaining 155 (18.02%) donors were deferred for various reasons. The predominant age range of the deferred donors was 25–34 years (50.32%) [Table 1]. Among the deferred donors, males were 90.32% and females were 9.68% [Table 2]. Temporarily deferred donors account for 98.07% and permanently deferred donors were 1.93%. Most common causes for deferral were low platelet count (31.61%), low hemoglobin (27.09%), and poor venous access (20.64%), and the least common cause was dermatitis at the venipuncture site (1.29%). The most common reason for permanent deferral was seropositivity for HBsAg [Table 3].
| Discussion|| |
Platelet transfusions are traditionally given to those undergoing chemotherapy for leukemia and multiple myeloma; those with aplastic anemia, acquired immunodeficiency syndrome, hypersplenism, idiopathic thrombocytopenic purpura, sepsis, and septic shock; those undergoing bone marrow transplantation; patients on radiotherapy; planned organ transplant cases; or those undergoing surgeries such as cardiopulmonary bypass. Platelet transfusions should be avoided in those with thrombotic thrombocytopenic purpura as the condition can worsen and lead to neurological symptoms, acute renal complications, and failure, and this is presumably due to creation of new thrombi as the platelets are consumed. It should also be avoided in those with heparin-induced thrombocytopenia or disseminated intravascular coagulation. In adults, platelet transfusions are recommended in those who have levels <10,000/ul, <20,000/ul if a central venous catheter is being placed, or <50,000/ul if a lumbar puncture or major surgery is required.,,,
Platelet transfusion is an important therapeutic procedure to prevent morbidity and mortality in patients with severe thrombocytopenia who are at very high risk of spontaneous bleeding. In these patients, platelet count can be restored by transfusing platelets which has a better yield and less alloimmunization. SDP is the best component in such cases as they have better yield as it is a controlled process where the equipment extracts platelets according to the donor height, weight, hematocrit, platelet count, and blood volume. SDP also allows prolongation of intervals between transfusions; however, the most significant problem for increasing the use of apheresis platelets is poor availability of SDP donors, and it is due to increased procedure time, causing noncooperation by donors and partly due to lack of safety awareness. Besides these, ineligibility of donors due to low platelet count, low hemoglobin, or low weight further aggravates the problem. Side effects of the plateletpheresis generally fall into three categories: blood pressure changes, problems with vein access, and effects of the anticoagulant on the donor's calcium level. Changes in blood pressure can sometimes cause nausea, fatigue, and dizziness. Venous access problems can cause bruising and sometimes hematoma. While donating, a supply of calcium antacid tablets is usually kept close by to replenish the calcium lost. Because the anticoagulant works by binding to the calcium in the blood, a donor's levels of calcium – and especially of active calcium ions – drop during the donation process. The lips may begin to tingle or there may be a metallic taste; since calcium enables the function of the nervous system, nerve-ending-dense areas (such as the lips) are susceptible, at least during the donation process. Unusually low calcium can cause more serious problems such as fainting, nerve irritation, and short-duration tetany. Such acute hypocalcemia is usually due to low calcium levels before donation, aggravated by the anticoagulant. Hypocalcemia can be curtailed by modestly increasing dietary calcium intake in the days before donation. Serious problems are extremely rare; however, apheresis donors are typically not allowed to sleep during the long donation process so that they can be monitored.
The risk of these conditions happening can be reduced or prevented by predonation education of the donors and change of apheresis machine configuration.
Repeated platelet donations at short intervals will cause the venipuncture site to scar. While cosmetically it is virtually invisible, the scarring also occurs on the vein itself, making it harder to insert a needle on future occasions.
In this study, the donor deferral rate was 18.02%. Arora et al., Tondon et al., and Pujani et al. have reported 28.03%, 27.5%, and 25.4% of donor deferral rate, respectively, which was much higher than our study. Pandey et al. have reported just 10.6% – a very low deferral rate. A very high donor deferral rate of 44.2% was found in a study by Syal et al. Like in any other studies, the donors deferred were young under 35 years of age (81.93%). This is because the majority of donors who come for donation also fall in this age range only. In a study by Arora et al., 82.9% of the deferred donors were <35 years. Similar findings were also observed in the study conducted by Pujani et al. and Syal et al.,,
In the present study, all the females (15 in number) were deferred either for low hemoglobin or for underweight. This could be because of the iron deficiency anemia which is common in females. The studies in literature also show a very less number of females as plateletpheresis donors. Temporary deferral accounts for 98.07% and 1.93% were permanently deferred in our study. The most common reasons for deferral in our study were low platelet count (31.61%), low hemoglobin (27.09%), and poor venous access (20.64%). Similar findings were observed by Seema et al., Pujani et al., and Dogu and Hacioglu.
Donors with low platelet count can be asked to come again later for retesting the platelet count so that they can donate in the next attempts. Donors with low hemoglobin levels should be counseled, treated, and educated on how to increase the hemoglobin levels. In our study, out of 42 donors deferred for low hemoglobin, 36 (85.71%) were having hemoglobin in the range of 11.5%–12.4% g. Kusumgar et al. observed no effect on platelet yield or adverse donor reactions while performing plateletpheresis on 49 donors with 11.5%–12.4% g hemoglobin levels and stated that one-fifth of the donors can be reconsidered if criteria for hemoglobin can be relaxed. Fraser et al. observed no deleterious effects when the cutoff for hemoglobin was 11.5% g among the donors. In the present study, 22.05% of donors could reenter the donor pool if the cutoff for hemoglobin was 11.5% g which is highest compared to the studies in literature [Table 4].
| Conclusion|| |
The demand for platelets taken from apheresis procedure is increasing day by day in the routine medical and surgical practice. Selection of plateletpheresis donor with utmost stringency will give good yield of platelets. In this study, temporary donor deferral was more, and these donors were counseled and encouraged for future donations with proper information regarding the procedure, so proper counseling of the deferral donors bridges the gap between demand and supply of SDPs. Most of the temporary deferred donors turned up for plateletpheresis after few weeks and months. Lower adverse reaction associated with the plateletpheresis makes it a better and safe procedure.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, et al.
Platelet transfusion: A clinical practice guideline from the AABB. Ann Intern Med 2015;162:205-13.
Bishop JF, Schiffer CA, Aisner J, Matthews JP, Wiernik PH. Surgery in acute leukemia: A review of 167 operations in thrombocytopenic patients. Am J Hematol 1987;26:147-55.
British Committee for Standards in Haematology, Blood Transfusion Task Force. Guidelines for the use of platelet transfusions. Br J Haematol 2003;122:10-23.
Wall MH, Prielipp RC. Transfusion in the operating room and the Intensive Care Unit: Current practice and future directions. Int Anesthesiol Clin 2000;38:149-69.
Wandt H, Frank M, Ehninger G, Schneider C, Brack N, Daoud A, et al.
Safety and cost effectiveness of a 10 × 10(9)/L trigger for prophylactic platelet transfusions compared with the traditional 20 × 10(9)/L trigger: A prospective comparative trial in 105 patients with acute myeloid leukemia. Blood 1998;91:3601-6.
Arun R, Yashovardhan A, Deepthi K, Suresh B, Sreedhar Babu KV, Jothibai DS. Donor demographic and laboratory predictors of single donor platelet yield. J Clin Sci Res 2013;2:211-5.
Khajuria K, Sawhney V, Sharma R, Gupta S. Adverse donor reaction during and after plateletpheresis in a tertiary care centre. Int J Res Med Sci 2017;5:1221-3.
Patidar GK, Sharma RR, Marwaha N. Frequency of adverse events in plateletpheresis donors in regional transfusion centre in North India. Transfus Apher Sci 2013;49:244-8.
Arora D, Garg K, Kaushik A, Sharma R, Rawat DS, Mandal AK, et al.
Aretrospective analysis of apheresis donor deferral and adverse reactions at a tertiary care centre in India. J Clin Diagn Res 2016;10:EC22-4.
Tondon R, Pandey P, Chaudhry R. A 3-year analysis of plateletpheresis donor deferral pattern in a tertiary health care institute: Assessing the current donor selection criteria in Indian scenario. J Clin Apher 2008;23:123-8.
Pujani M, Jyotsna PL, Bahadur S, Pahuja S, Pathak C, Jain M, et al.
Donor deferral characteristics for plateletpheresis at a tertiary care center in India – A retrospective analysis. J Clin Diagn Res 2014;8:FC01-3.
Pandey P, Tiwari AK, Sharma J, Singh MB, Dixit S, Raina V, et al.
Aprospective quality evaluation of single donor platelets (SDP) – An experience of a tertiary healthcare center in India. Transfus Apher Sci 2012;46:163-7.
Syal N, Kukar N, Maharishi RN, Handa A, Aggarwal D. Donor deferral pattern for plateletpheresis at a tertiary care teaching hospital. Sch J Appl Med Sci 2017;5:3145-9.
Seema D, Manocha H, Agarwal D, Sharma S. An analysis of deferral pattern in plateletpheresis donors. J Cont Med A Dent 2015;3:24-7.
Dogu MH, Hacioglu S. Analysis of plateletpheresis donor deferral rate, characteristics, and its preventability. J Appl Hematol 2017;8:12-5. [Full text]
Kusumgar R, Mehta S, Shah M, Rajvanshi R. A two years study of deferral among platelet pheresis donors in a cancer care Institute. Pathol Lab Med 2014;6:37-9.
Fraser JL, Whatmough A, Uhl L, Kruskall MS. Lowering the hemoglobin cutoff for female plateletpheresis donors. Transfusion 1998;38:855-9.
[Table 1], [Table 2], [Table 3], [Table 4]