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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 5  |  Issue : 1  |  Page : 73-77

Analysis of changes in pre- and post-donation hematological parameters among plateletpheresis donors at SKIMS blood bank: A hospital-based study


1 Department of Blood Transfusion and Immunohaematology, SKIMS, Srinagar, Jammu and Kashmir, India
2 Departemnt of Blood Transfusion and Immunohaematology, GMC and AH, Rajouri, Jammu and Kashmir, India

Date of Submission16-Jan-2020
Date of Decision25-Feb-2020
Date of Acceptance04-Apr-2020
Date of Web Publication17-Apr-2020

Correspondence Address:
Irm Yasmeen
Departemnt of Blood Transfusion and Immunohaematology, GMC and AH, Rajouri, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/GJTM.GJTM_3_20

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  Abstract 


Background: Platelet transfusions are routinely needed as an essential part of treatment for patients undergoing cancer therapy, as well as for those with bleeding disorders, and for patients undergoing open heart surgeries or organ transplantation. Our aim was to compare the pre- and post-plateletpheresis parameters of complete blood counts in healthy voluntary donors and to determine the consequences of plateletpheresis on donor's health. Materials and Methods: This study was conducted in the Department of Blood Transfusion and Immunohaematology, SKIMS, over 1 year with effect from June 2018 to June 2019 after getting clearance from the institutional ethical committee. The study was conducted on 100 randomly selected plateletpheresis donors. After donor has been considered eligible for the procedure as per the national guidelines and departmental standard operating procedure, the details of plateletpheresis were explained to each donor before the procedure, and after filling the donor questionnaire form, informed consent was taken from donor for the procedure. Plateletpheresis was done using Trima Accel Automated Cell Separator. Hematological parameters such as hemoglobin (Hb), hematocrit (Hct), platelet counts, mean platelet volume (MPV), and white blood cell (WBC) counts were analyzed both before and after plateletpheresis procedure. Results: A total of 100 donors were subjected for apheresis, all of which were males. 83% of the donors were between the age group of 18 and 40 years while 17% were between the age group of 41 and 58 years. Majority (66%) had a body mass index (BMI) in the range of 18.5–24.9 kg/m2, 32% had 25–29.9, and 2% had 30 or higher, with an overall mean BMI of 23.95 kg/m2. The mean platelet count before apheresis was 227 × 103/μl with the range of 161–330 × 103/μl and the mean platelet count after apheresis was 169 × 103/μl with a range of 113–278 × 103/μl; the mean value of platelet count dropped significantly in postdonation. Similarly, the mean Hb level before apheresis was 15.3 g/dl with the range of 12.3–18.2 g/dl and the mean Hb value after apheresis was 14.7 g/dl with the range of 11.2–16.7 g/dl; the mean value of Hb dropped marginally in postdonation. The mean value of Hct concentration before apheresis was 45% with the range of 36.1%–55.1% and the mean value of Hct concentration after apheresis was 42.3% with the range of 37.3%–52.4%; the mean value of Hct dropped slightly in postdonation. There were also slight changes in the WBC counts and MPV value which were not so significant. Conclusion: A donor with significant decrements should be reviewed and screened for future donations to avoid iatrogenic anemia and thrombocytopenia. Donor safety must be ensured throughout the procedures to prevent any unfavorable events, and for the benefit of donors and patients, training modules for the technical personnel, supervision of transfusion specialists, close monitoring, and follow-up of these donors are required.

Keywords: Anemia, blood donors, hemoglobin, plasmapheresis


How to cite this article:
Khurshid I, Yasmeen I, Jan A. Analysis of changes in pre- and post-donation hematological parameters among plateletpheresis donors at SKIMS blood bank: A hospital-based study. Glob J Transfus Med 2020;5:73-7

How to cite this URL:
Khurshid I, Yasmeen I, Jan A. Analysis of changes in pre- and post-donation hematological parameters among plateletpheresis donors at SKIMS blood bank: A hospital-based study. Glob J Transfus Med [serial online] 2020 [cited 2020 Aug 9];5:73-7. Available from: http://www.gjtmonline.com/text.asp?2020/5/1/73/282736




  Introduction Top


Apheresis is an ancient Greek word that means to “take away” or “separate” or “remove” or “withdraw.” It is a procedure in which whole blood is removed from the body and passed through an apparatus that separates out one or more particular blood constituents. It then returns the remainder of the constituents in the individual circulation. Through the use of sophisticated automation, an apheresis procedure can be performed on either a blood donor to collect a specific blood component (donor apheresis) or a patient to remove a particular blood component for therapeutic purposes (therapeutic apheresis). The process of removing plasma is termed as plasmapheresis. In a simple manner, platelets (plateletpheresis), red blood cells (erythrocytapheresis), or leukocytes (leukapheresis) can be removed or collected using apheresis technology.[1] Single donor platelet (SDP) products are preferred over random donor platelet (RDP) products due to several advantages, such as support for patients with special needs, supplementation of platelet inventory, limited donor exposure, and reduced transmission of infections.[2],[3],[4] To improve the productivity and quality of automated platelet collection, the industry has introduced new instruments. While improvements in apheresis technology are ongoing, some problems do remain, for example, the duration of the procedure and donor discomfort owing to the citrate used for anticoagulation. Therefore, some studies focusing on the comparison of different cell separators have been conducted.[5],[6],[7],[8]

Citrate has been used as the anticoagulant of choice in plateletpheresis procedures for more than two decades. Citrate transiently binds ionized calcium, and if sufficient ionized calcium is bound, there is minimal activation of platelets; however, centrifugation and exposure to plastics also activate platelets and monocytes. This could lead to some activation of coagulation and fibrinolytic system; thus, it was thought that changes in tests could be related to anticoagulant solution acid citrate dextrose (ACD)-A used during the procedure.[9]

The postdonation platelet count, hemoglobin (Hb), hematocrit (Hct), and total leukocyte count have shown significant changes. Some studies have reported an increase in postdonation Hb, Hct, and white blood cell count (WBC),[2] while others have described a fall in these parameters after donation. The changes in the postdonation hematological parameters should be evaluated so that the effect on the donor health can be assessed.

Although many undergo plateletpheresis, the data on consequences of plateletpheresis for donor's health are limited. As the data are conflicting, we planned to study the changes in these parameters in our set-up.

Aims and objectives

  1. To compare the pre- and post-plateletpheresis values of complete blood counts in healthy voluntary donors
  2. To determine the consequences of plateletpheresis on donor's health.



  Materials and Methods Top


The present study was conducted in the Department of Blood Transfusion and Immunohaematology, SKIMS, Soura, Srinagar, which is a 500-bedded tertiary care center catering to the needs of people of Jammu, Kashmir, and Ladakh over 1 year with effect from June 2018 to June 2019. The study was conducted on 100 randomly selected plateletpheresis donors. Plateletpheresis was done on Trima Accel Automated Collection System and Trima Accel Plateletpheresis Kit by Terumobct. ACD-A was used as an anticoagulant. Details of plateletpheresis were explained to each donor before the procedure. Plateletpheresis is perfomed after donor has been considered eligible for the procedure as per the national guidelines and departmental standard operating procedure, i.e., age between 18 and 60 years, body weight >55 kg, platelet count >1.5 lakhs, and Hb >12.5 g/dl by automatic cell counter. After filling the Donor Questionnaire form, informed consent was taken from donor.

Ethics

Ethical clearance was taken from the institutional ethical committee.


  Results Top


During the study period, a total of 100 healthy donors underwent plateletpheresis procedures. All donors were males, and their demographic data are elaborated in [Table 1].
Table 1: Demographic data of donors

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Hematological parameters such as Hb, Hct, platelet count, and mean platelet volume (MPV) were analyzed both before and after plateletpheresis procedure. [Table 2] depicts the changes in hematological parameters before and after plateletpheresis donation which are highly significant in Hb, Hct, platelet count, and MPV (P < 0.05). The changes in WBC counts were found insignificant (P > 0.05) [Table 2].
Table 2: Comparison of pre- and post-donation hematological values of plateletpheresis donors

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Complete blood count parameters were decreased in most of the donors. The average decrement in Hb was 1.1 in 68% of donors, the average decrement in Hct was 2.63% in 66% donors, while platelet count was decreased in all cases and the average decrement was 56 [Table 3].
Table 3: Changes in hematological values after plateletpheresis

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Donors were divided into four groups according to the predonation platelet counts. In Group I of 31 donors (150–200 × 103/μl platelets) with the yield ranging from 2 × 1011 to 5 × 1011/unit, maximum donors (51.61%) provided a yield of 3 × 1011/unit. Similarly, in Group II of 37 donors(201–250 × 103/μl platelets) with the yield ranging from 3 × 1011 to 5 × 1011/unit, maximum donors (56.7%) provided a yield of 3 × 1011/unit. In Group III of 21 donors (251–300 × 103/μl platelets) with the yield ranging from 3 × 1011 to 5 × 1011/unit, maximum donors (47.46%) provided a yield of 4 and 5 × 1011/unit. In Group IV of 11 donors (>301 × 103/μl), maximum donors (54.54%) provided a yield of 4 × 1011/unit [Table 4].
Table 4: Correlation of platelet yield with predonation platelet count

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Donors were divided into three categories based on the body mass index (BMI) scale. There were 66 donors in the BMI range of 18–24.9 kg/m2 of which the maximum yield was 3 × 1011/unit in 59.09% of the donors. Similarly, there were 32 donors in the BMI range of 25–29.9 kg/m2 of which the maximum yield was 4 × 1011/unit in 81.25% of donors. In the BMI range of ≥30 kg/m2, there was a maximum yield of 5 × 1011/unit in 100% of donors [Table 5].
Table 5: Correlation of donor's body mass index with platelet yield

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  Discussion Top


Platelets are essential for the formation of primary hemostatic plug and maintenance of hemostasis. The main function of platelets in maintaining hemostasis is by the formation of primary hemostatic plug, which it does by getting adhered to the exposed endothelium with the subsequent formation of platelet aggregates at the site of vessel injury and the aggregates are strengthen by facilitating thrombin and fibrin formation. Platelet transfusions are needed either prophylactic or therapeutic. A single unit of SDAP (single donor apheresis platelets) equals to that of 4–6 units of RDPs. In our study, postdonation parameters, i.e., Hb, Hct, platelet count, and WBC counts, decreased while MPV increased slightly, which are comparable with the studies conducted by Altuntas et al.,[10] Tendulkar and Rajaddhyaksha,[11] Das et al.,[12] Suresh et al.,[13] and Garg et al.[14]

According to the American Association of Blood Banks (AABB),[15] 75% of the SDP must contain >3 × 1011 per unit, while the European guidelines recommend a platelet yield >2 × 1011 per unit.[16] Our blood bank follows the guidelines laid down by the Drug Controller of India which are largely based on the AABB standards in this respect.[17]

Of 100 healthy plateletpheresis donors, 93% of our SDPs met the AABB criteria. Only 7% of SDPs had platelet yield <3 × 1011/unit. All of these donors had predonation platelet count between 150 and 200 × 103/μl.

Our study results are comparable with the study conducted by Garg et al.[14] [Table 6].
Table 6: Mean comparison of pre- and post-donation hematological parameters of plateletpheresis donors with other studies

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  Conclusion Top


Donor safety was ensured throughout the procedures but to prevent any unfavorable events, and for the benefit of donors and patients, training modules for the technical personnel, supervision of transfusion specialists, close monitoring, and follow-up of these donors are required.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Harmening DH. Modern Blood Banking and Transfusion Practices. 6th ed. F. A. Davis Company, Australia; 2012. p. 331-3.  Back to cited text no. 1
    
2.
Rock G, Sutton DM. Apheresis: Man versus machine. Transfusion 1997;37:993-5.  Back to cited text no. 2
    
3.
Robinson EA. Donor and therapeutic apheresis. Autotransfusion: Therapeutic Principles and Trends. Detroit: Georgy Appleton; 1997. p. 12-23.  Back to cited text no. 3
    
4.
Pomper GJ, Chai LI, Synder EL. Platelet transfusion and alternatives. In: Simon TL, Dzik WH, Synder EL, Stowell CP, Strauss RG, editors. Rossi's Principles of Transfusion Medicine. 3rd ed. Philadelphia, USA: Lippincott Williams and Wilkins; 2002. p. 232-47.  Back to cited text no. 4
    
5.
Burgstaler EA. Blood component collection by apheresis. J Clin Apher 2006;21:142-51.  Back to cited text no. 5
    
6.
Ranganathan S. Comparison of plateletpheresis on the Fresenius AS.TEC 204 and Haemonetics MCS 3p. J Clin Apher 2007;22:1-4.  Back to cited text no. 6
    
7.
Keklik M, Keklik E, Korkmaz S, Aygun B, Arik F, Kilic O, et al. Effectiveness of the haemonetics MCS cell separator in the collection of apheresis platelets. Transfus Apher Sci 2015;53:396-8.  Back to cited text no. 7
    
8.
Strasser EF, Schuster M, Egler K, Bauer J, Weisbach V, Ringwald J, et al. Frequently used plateletpheresis techniques result in variable target yields and platelet recruitment of donors. Transfusion 2005;45:788-97.  Back to cited text no. 8
    
9.
Beyan C, Cetin T, Kaptan K, Nevruz O. Effect of plateletpheresis on complete blood count values using three different cell separator systems in healthy donors. Transfus Apher Sci 2003;29:45-7.  Back to cited text no. 9
    
10.
Altuntas F, Kocyigit I, Ozturk A, Hacioglu S, Kaynar L, Sari I, et al. Comparison of plateletpheresis on the Fenwal, Amicus and Fresenius Com. Tec cell separators for autologous peripheral blood progenitor cell collection. Transfus Apher Sci 2007;36:159-67.  Back to cited text no. 10
    
11.
Tendulkar A, Rajaddhyaksha SB. Comparison of plateletpheresis on three continous flow cell separators. Asian J Transfus Sci 2009;3:73-7.  Back to cited text no. 11
[PUBMED]  [Full text]  
12.
Das SS, Chaudhary R, Verma SK, Ojha S, Khetan D. Pre- and post- donation haematological values in healthy donors undergoing plateletpheresis with five different systems. Blood Transfus 2009;7:188-92.  Back to cited text no. 12
    
13.
Suresh B, Arun R, Yashovardhan A, Deepthi K, Sreedhar Babu KV, Jothibai DS. Changes in pre-and post-donation haematological parameters in plateletpheresis donors. J Clin Sci Res 2014;3:85-9.  Back to cited text no. 13
  [Full text]  
14.
Garg P, Bassi R, Bhardwaj K, Bodal VK. Pre and post donation haematological parameters in plateletpheresis donors; a tertiary care hospital of North India. Int J Sci Res 2018;7:2277-8179.  Back to cited text no. 14
    
15.
Taylor VV, Brecher M, Pisciotto P, editors. Technical Manual. 13th ed. Bethesda, Maryland: American Association of Blood Banks; 1999. p. 23.  Back to cited text no. 15
    
16.
Drugs and Cosmetics Act 1940. 13th ed. Lucknow, India: Eastern Book Company; 2001. p. 361-2.  Back to cited text no. 16
    
17.
Saran RK. Apheresis. In: Transfusion Medicine Technical Manual. 2nd ed. New Delhi: DGHS, Ministry of Health and Family Welfare, Government of India; 2003. p. 229-44.  Back to cited text no. 17
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]



 

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