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Background and Objectives: In Japan, apheresis donation of plasma is allowed to a maximum of 24 times a year, and plateletpheresis are counted as two plasmapheresis donations. Diversion of the initial blood flow is conducted for all donations, and additionally, blood remaining in apheresis machine circuit is lost. Here, we aimed to investigate on the health impact of frequent apheresis donations, as measured by the serum ferritin (sFer). Materials and Methods: A total of 538 male apheresis donors and 538 age‐matched whole blood (WB) donors, who gave informed consent to join the study, were enrolled. sFer were compared, according to age. Another group of 19 apheresis donors were followed during four consecutive donations. Results: About half (48%) of repeat male apheresis donors had iron deficiency (sFer < 26 ng/mL), compared with lower rates (13.9%) among male WB donors. It was evident in all age groups, except for teenagers, possibly because of the lower number of donations. Follow‐up of the 19 donors for 4 months revealed a progressive decrease in sFer. Conclusion: Blood remaining in the apheresis machine circuit and diversion of the initial blood flow have been implicated in iron deficiency for many years. Taking the present results, the manufacturer of apheresis equipment was requested to improve it to allow rinseback of the remaining blood, which was achieved only for plateletpheresis. Until further improvement, plasmapheresis frequency was reduced to 12 times a year. Additional measures, such as oral supplementation of iron, need to be considered. [ABSTRACT FROM AUTHOR]

BACKGROUND: Although plateletpheresis donation is commonly accepted as a safe procedure, its influence on platelet function, coagulation system and fibrinolysis is not completely elucidated. OBJECTIVES: In this study, we tried to assess the effects of plateletpheresis on donor's hemostasis system by measuring platelet activation, development of platelet-leukocyte aggregates, and coagulation activation. STUDY DESIGN: Prospective observational study. METHODS: We used flow cytometry to determine the levels of platelet-monocyte complexes (PMC) and platelet-neutrophil complexes (PNC). sP-selectin and prothrombin fragment (PF) 1 + 2 values were determined by ELISA. RESULTS: The PMC levels increased significantly seven days after apheresis in comparison with just after apheresis and 24 h after apheresis (p < 0.05). The PNC levels increased significantly seven days after apheresis compared to immediately after apheresis (p < 0.05). sP-selectin values decreased significantly immediately after apheresis (p < 0.05). While sP-selectin values increased seven days after apheresis in comparison with immediately after apheresis and 24 h after apheresis, but there were not statistically significant differences for sP-selectin levels (p > 0.05). PF1 + 2 levels decreased significantly immediately after apheresis compared to pre-apheresis (p < 0.05) and increased 24 h after apheresis and seven days after apheresis, but these differences were not statistically significant. CONCLUSION: We concluded that plateletpheresis affects platelet activation but does not cause any change in coagulation activation. [ABSTRACT FROM AUTHOR]

Background and Objectives: The phenomenon of aggregates in apheresis‐derived platelet concentrates (APCs) has not yet been fully elucidated. Initially, visible aggregates (IVA) usually dissolve within 24 h after collection, but some persist till the end of the shelf life (persistent aggregates, PA). A study conducted at the Croatian Institute of Transfusion Medicine aimed to identify factors that influence the aggregate occurrence in APCs. Materials and Methods: We conducted a cross‐sectional study for the 2018–2022 period and collected data on APCs with IVA. We analysed APCs discarded due to PA separately for two apheresis technologies and compared them to the control group. Results: Significantly more donations were discarded in the IVA group compared with the control group and total number of discarded APCs. A total of 205 APCs were discarded due to PA (14.7% of IVA APCs and 1.27% of all APCs collected). Amicus APCs with PA had a significantly lower platelet count and mean platelet volume. They were obtained by procedures with less anticoagulant used. In contrast to Amicus APCs, Haemonetics APCs with PA had a significantly higher platelet count. None of the donor‐related factors examined was predictive of PA. Conclusion: APCs with IVA are more often discarded, not only due to aggregates, but also for impairment of other quality control parameters. Type of apheresis technology, being one of the most common risk factors for IVA, was not confirmed as the main risk factor for PA. There seem to be some donor‐related causal factors. [ABSTRACT FROM AUTHOR]

Background and Objectives Plateletpheresis is the collection of platelets from a donor using an apheresis device. There are different types of apheresis devices used for plateletpheresis, and each device can have an impact on the quality of platelet concentrates produced. This review article aims to investigate the effect of plateletpheresis devices on the quality parameters of produced platelet units. Materials and Methods This article reviewed the effects of different apheresis devices on the quality of platelet units by searching keywords in PubMed, Google Scholar, Science Direct, and Scopus databases and used 83 related articles. Results To evaluate the quality of the plateletpheresis concentrates, various parameters such as platelet count and yield, WBC and RBC count, platelet aggregation, metabolic activity, platelet activity, and the number of platelets microparticles are evaluated. The platelet counts in platelet concentrates obtained from apheresis devices follow AABB and European standards. In examining the metabolic activity of apheresis platelets in most studies, the level of glucose and pO2 decreased, lactate and pCO2 increased, and pH was within acceptable limits. When comparing platelet aggregation with different agonists, the platelet unit from the Amicus device showed the lowest response, while Trima Accel showed the highest response. Moreover, Amicus reported a higher level of platelet activation and microparticle production, whereas the lowest level of both belonged to Trima Accel. Conclusions The quality of the plateletpheresis concentrate can be affected by the apheresis device. Although most available devices can provide platelet concentrates in accordance with the existing standards. According to the studies, the Trima Accel device provides a higher quality platelet concentrate than other devices (Haemonetics MCS+, Amicus, Cobe Spectra, Fresenius). [ABSTRACT FROM AUTHOR]

This article reports a case of Brucella abortus RB51 contamination in a platelet product donated by a healthy large-animal veterinarian. Brucella spp. are bacteria that cause brucellosis, a zoonotic infection. The donor had a history of working with dairy cattle and administering the RB51 brucellosis vaccine. The contaminated platelet product was detected and recalled before transfusion. The donor was treated with antibiotics and will be deferred from further donations. The article discusses the risk of transfusion transmission and potential interventions to prevent such occurrences. [Extracted from the article]

Background and Objectives: Repeated blood donation is a well‐known cause of iron deficiency among donors. However, present scientific literature lacks comprehensive evidence regarding the impact of regular plateletpheresis procedures on body iron reserves. In this study, we aimed to detect and correlate iron deficiency (using iron indices) with the frequency of platelet donations. Additionally, we also analysed the correlation between other iron and haematological indices with serum ferritin to determine cost‐effective parameters that may serve as an initial screening approach to determine which donors should be subjected to serum ferritin testing. Materials and Methods: A total of 180 male participants from our platelet donor registry were enrolled in this observational cross‐sectional study. Enrolment questionnaires were administered to eligible donors, and biological samples were collected during plateletpheresis donation. Biological tests such as complete blood count, reticulocyte indices, iron indices, vitamin B12 and folate were performed. Results: Donors with ≥12 donations per year showed the highest prevalence of low ferritin (serum ferritin: 15–30 ng/mL) and absent iron stores (serum ferritin <15 ng/mL) (41.3% and 26.7%, respectively). Ferritin showed a significant negative correlation with recent (r = −0.346) and lifetime donations (r = −0.196). The efficacy of other indices for identifying iron depletion was much better using a serum ferritin value <15 ng/mL. Conclusion: Regular plateletpheresis donations can lead to varying severities of non‐anaemic iron deficiency. Blood centres must regularly monitor frequent plateletpheresis donors (especially donors with more than 11 donations in a calendar year) and ideally maintain their serum ferritin above 30 ng/mL. [ABSTRACT FROM AUTHOR]

Background: Essential Thrombocytosis is a clonal hematopoietic stem cell disorder that causes increased platelet production. Patients are at risk of microvascular thrombosis and hemorrhage. Essential Thrombocytosis is a diagnosis of exclusion. We reported a case of Essential Thrombocytosis in 42 years female, where initial platelet count of 17 lakhs was reduced to post procedure count of 7.6 lakhs. Treatment consists of aspirin, platelet-lowering drugs (e.g., hydroxyurea, interferon, anagrelide), plateletpheresis, cytotoxic agents & rarely stem cell transplantation. The most important first step in the management of ET is to confirm the accuracy of the diagnosis and make sure that other myeloid neoplasms, which might mimic Essential Thrombocytosis in their presentation are excluded. [ABSTRACT FROM AUTHOR]

Background and Objectives There are different ways to prepare platelets. Every one of these methods can have advantages and limitations for blood transfusion centers, donors, and patients. Knowledge of them is necessary for choosing the proper technique in blood transfusion centers. This article reviewed the methods of preparing platelets and compared them. Materials and Methods Studies related to the preparation of platelet components, the texts of articles, and review references were extracted. PubMed, Web of Science, Scopus, Magiran, SID, Google, and Google Scholar search engines were used for keywords such as blood component, platelet-rich plasma, platelet concentrate, buffy-coat method, platelet storage, buffy-coat pooled platelet, plateletpheresis, pathogen inactivation, Overnight storage, preparation concentrate, Leukofiltered platelets from May to June 2022. Results Studies comparing platelet preparation methods have had different results. One of the advantages of Buffy–coat method may be less activation, as platelets are centrifuged against a cushion of RBCs rather than the plastic container during PRP-PC production. Some recent findings have shown that the quality and clinical effectiveness of the buffy-Coat technique is better than Platelets Rich plasma (PRP) and is equivalent to the apheresis method. However, sufficient evidence is not yet available. The limitations of platelet preparation by the apheresis method, including the cost, declining apheresis donor base, and the time-consuming process, have led to the tendency towards other techniques. However, in cases such as platelet refractoriness, it is necessary to prepare matched platelets using the apheresis method. Conclusions To improve the quality of platelets and optimize the treatment of thrombocytopenic patients, it seems that the preparation of leuko-reduced pooled platelets is a suitable option considering the challenges of the apheresis method. With the advancement of techniques such as pathogen reduction and platelete additive solutions it is attempted for longer life span and safety. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: The long-term effect of regular plateletpheresis on donors has not been characterized. Hence, we planned to study the long-term alterations in hematological, biochemical, and immunological parameters in regular repeat platelet apheresis donors. MATERIALS AND METHODS: Thirty-three healthy voluntary regular repeat apheresis donors presenting for platelet donation, fulfilling the requisite donor selection criteria, underwent sequential analysis of the hematological, biochemical, and immunological parameters over 1 year. RESULTS: A total of 33 regular repeat donors were enrolled in the study; out of these, 22 could be followed up to 3 months, 12 up to 6 months, and 10 donors up to 12 months for their hematological, biochemical, and immunological parameters. Overall, there was no significant change in hematological profile except a rise in platelet count at 3 months (P = 0.023) with no significant difference at 6 and 12 months from the baseline. In addition, serum thrombopoietin levels at 3 months (P = 0.010) and serum erythropoietin at 6 months (P = 0.01) were significantly higher than baseline. Mean platelet volume was significantly higher from baseline at 12 months (P = 0.00). Serum protein, lymphocyte subpopulation, and serum ferritin did not show any significant change from baseline over 12 months of follow-up. However, there was a significant decline (P = 0.00) in serum calcium and an increase in serum magnesium from baseline (P = 0.03) at 12 months. INTERPRETATIONS AND CONCLUSIONS: To conclude, apheresis platelet donation is a safe procedure. However, a complete hematological, biochemical, immunological profile and bone marrow density at regular intervals (3-6 months) are recommended to ensure the safety of regular repeat plateletpheresis donors. [ABSTRACT FROM AUTHOR]

BACKGROUND: Minor ABO-incompatible apheresis platelet transfusion poses a risk of hemolytic transfusion reactions in non-Group O recipients when donor's plasma possesses unusual high titers for anti-A and anti-B. The aim was to determine whether the hemolysin test can be used as a screening tool to predict high-titer Group O platelet apheresis donors. METHODS: A prospective study, with Group O platelet donor's samples, was tested for hemolysin test and antibody titration test in parallel. Antibody titration was also performed on products suspended in platelet additive solution (PAS). Hemolysin test was assessed for diagnostic accuracy against antibody titration. Chi-square test and Mann-Whitney Latest were used to determine the relationship between the hemolysin test and antibody titration. RESULTS: Among 107 Group O platelet donations, median anti-A and anti-B titers in donors were 32 (8-128) and 32 (4-256), respectively. High titer (≥128) for ABO antibodies was seen in 18% of donations, whereas hemolysin test was positive in 69% of donations. Hemolysin test results differ significantly with antibody titration results (P = 0.03). Hemolysin test had higher sensitivity (89%) with a strong negative predictive value (94%). None of the products suspended in PAS had high-titer antibodies. CONCLUSION: Adopting hemolysin test as a screening tool may label a large number of units (69%) unsuitable for ABO-incompatible platelet transfusion. Alternatively identifying donors with high antibody titer or positive hemolysin test and selectively suspending their product in PAS may be a cost-effective approach and certainly prevent high-titer antibodies in the product. [ABSTRACT FROM AUTHOR]

BACKGROUND: The new cell separators make it simple to collect single donor platelets (SDP), although the platelet yield may vary depending on the cell separator used and donor-related clinical and laboratory variables. AIMS: This study aims to study the factors affecting SDP yield and corrected count increment (CCI). MATERIALS AND METHODS: This retrospective study was carried out at a tertiary care facility in northern India, over 4 years (May 2017-April 2020), data were retrieved and analyzed. STATISTICAL ANALYSIS: Categorical variables were presented as proportions, while continuous variables were presented as mean with standard deviation, P < 0.05 was considered significant. RESULTS: We found a positive correlation between predonation platelet count and yield (r = 0.243, P = 0.000). No such significant correlation was found with Hb concentration (r = 0.025, P = 0.720), age (r = 0.016, P = 0.820), sex (r = -0.038, P = 0.584), and weight (r = -0.025, P = 0.714). Maximum platelet yield and minimum time were seen with Trima. Only 39.3% (33/84) meet the 24 h CCI. The majority of patients did not meet the desired CCI could be due to the patients' clinical condition. On logistic regression, we found a significant association of 24 h CCI with product yield (odds ratio [OR] = 0.168, P = 0.015) and posttransfusion platelet count (OR = 0.454, P < 0.05). CONCLUSION: The only donor-related factor that influences yield is predonation platelet count, whereas 24 h CCI may depend on the clinical status of the patient and yield. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to evaluate the effects of Pan Genera Detection (PGD) testing on reducing platelet product wastage and transfusion service costs. Methods We conducted a retrospective cross-sectional study comparing the number of platelet apheresis units wasted before (March 2017 to February 2019) and after (March 2019 to February 2021) PGD implementation. The PGD testing was performed before transfusion on days 6 and 7. Cost analysis considered the costs of platelet units wasted ($500.00/unit) and PGD test supplies and performance (estimated $26.50 per test). Paired samples t -test was used to compare platelet wastage pre- and post-PGD implementation. Results The number of wasted platelet units decreased from pre-PGD (419) to post-PGD (195), representing a significant decrease in platelet wastage from 17.5% to 9.2% (P  < .0001). During the post-PGD period, 366 and 133 units were tested on days 6 and 7, with 28 and 36 units discarded each day, allowing transfusion of an additional 302 platelet units. Costs from platelet wastage decreased from $209,500.00 pre-PGD to $97,500.00 post-PGD. Conclusion Our results showed that PGD testing effectively reduced platelet wastage, extended platelet availability, and reduced transfusion service costs. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: High-yield plateletpheresis donations can reduce donor exposure and be economically beneficial as well. However, obtaining a high-yield plateletpheresis from a maximum number of donors with low basal platelet count and its effect on postdonation platelet count of donors undergoing high-yield plateletpheresis has been a matter of concern. This study aimed to assess the feasibility of making high-yield platelet donation as a routine practice. METHODS: It was a retrospective observational study to determine the effect of high-yield plateletpheresis on donor reactions, efficacy, and quality parameters. It was conducted from January 1, 2019 to June 30, 2021, at the Department of Transfusion Medicine in a tertiary care hospital of South India. RESULTS: Out of the 669 procedures, 564 (84.3%) of the collection had a platelet yield of ≥5 × 1011, 468 (70%) of the collection had a platelet yield of 5.5 × 1011, whereas 284 (42.5%) met the target of 6 × 1011 by coulter. The mean drops in platelet count were 95 ± 16 × 103/μl (77,600–113,000/μl), mean platelet recruitment was 1.31 ± 0.51. The mean collection efficiency of the procedure for the 669 cases was shown to be 80.21 ± 15.34, and the mean collection rate was 0.07 × 1011 ± 0.02 per minute. Only forty donors (5.5%) experienced adverse donor reactions. CONCLUSIONS: High-yield plateletpheresis can be done in routine practice with no added adverse donor reaction with effective quality products. [ABSTRACT FROM AUTHOR]

Background: There is increased concern towards subjects who are frequent donors of plateletpheresis. The present study was conducted to assess the effect of frequent plateletpheresis on the hematologic parameters in the frequent donors. Methods: The present study included frequent donors of plateletpheresis who were the donor for 2nd time in a month. The inclusion criteria were also donors undergoing plateletpheresis for the 3rd or 4th time. The hematologic parameters were assessed and compared on recalls following plateletpheresis. Results: For all the parameters there was a non-significant difference pre 1st duration and pre 2nd duration in the two groups of the study subjects except haemoglobin with an intergroup p- value of pre1st and pre 2nd was 0.227 and 0.882 for PDW, 0.886 and 0.368 for MOV, 0.459 and 0.084 for PCT, 0.279 and 0.004 for TPC where for TCP significant difference was seen in two groups pre 2nd donation, 0.376 and 0.438 for TLC, 0.487 and 0.333 for RDW, 0.236 and 0.434 for MCHC, 0.209 and 0.047 for MCH, 0.077 and 0.100 for MCV, 0.416 and 0.867 for HCT, 0.025 and 0.029 for RBC, and 0.285 and 0.604 for haemoglobin respective. All the parameters showed the non-significant intragroup difference Conclusion: The present study concludes that plateletpheresis can be repeatedly done with no harmful effects on the hematologic parameters among these donors. Same follow-up results post-donation were seen concerning hematologic parameters in the donors. [ABSTRACT FROM AUTHOR]

Background: In previous studies with peripheral blood cells, platelet factors were found to be associated with severe allergic phenotypes. A reliable method yielding highly concentrated and pure platelet samples is usually not available for immunological studies. Plateletpheresis is widely used in the clinics for donation purposes. In this study, we designed a protocol based on plateletpheresis to obtain Platelet‐Rich Plasma (PRP), Platelet‐Poor Plasma (PPP) as well as CD3+ and CD14+ cells matched samples from a waste plateletpheresis product for immunological studies. Methods: Twenty‐seven subjects were voluntarily subjected to plateletpheresis. PRP, PPP and blood cell concentrate contained in a leukocyte reduction system chamber (LRSC) were obtained in this process. CD3+ and CD14+ cells were isolated from the LRSC by density‐gradient centrifugation and positive magnetic bead isolation. RNA was isolated from PRP, CD3+ and CD14+ cell samples and used for transcriptomic studies by Affymetrix. PRP and PPP samples were used for platelet protein quantification by multiplex assays. Results: A reliable high yield method to obtain matched samples of PRP, PPP, CD3+ and CD14+ from a single donor for RNA and protein analyses has been designed. The RNA quality indicators (RQI) routinely used for other cell types were not suitable for platelet RNA characterization. Despite this, the platelet RNA was valid for transcriptomic studies by Affymetrix, as platelet transcripts obtained in our previous studies were confirmed in PRP samples. Platelet samples were enriched in platelet factors as determined in protein multiplex analysis. Conclusions: We have developed a method that yields not only high content and pure platelet samples from a single donor but also CD3+ and CD14+ matched samples that can be used for RNA and protein analyses in immunological studies. [ABSTRACT FROM AUTHOR]

Background: Plateletpheresis involves platelet separation and collection from whole blood while other blood cells are returned to the donor. Because platelets are replaced faster than red blood cells, as many as 24 donations can be done annually. However, some frequent apheresis platelet donors (>20 donations annually) display severe plateletpheresis-associated lymphopenia; in particular, CD4+ T but not B cell numbers are decreased. COVID-19 vaccination thereby provides a model to assess whether lymphopenic platelet donors present compromised humoral immune responses.Study Design and Methods: We assessed vaccine responses following 2 doses of COVID-19 vaccination in a cohort of 43 plateletpheresis donors with a range of pre-vaccination CD4+ T cell counts (76-1537 cells/μl). In addition to baseline T cell measurements, antibody binding assays to full-length Spike and the Receptor Binding Domain (RBD) were performed pre- and post-vaccination. Furthermore, pseudo-particle neutralization and antibody-dependent cellular cytotoxicity assays were conducted to measure antibody functionality.Results: Participants were stratified into two groups: <400 CD4/μl (n = 27) and ≥ 400 CD4/μl (n = 16). Following the first dose, 79% seroconverted within the <400 CD4/μl group compared to 87% in the ≥400 CD4/μl group; all donors were seropositive post-second dose with significant increases in antibody levels. Importantly differences in CD4+ T cell levels minimally impacted neutralization, Spike recognition, and IgG Fc-mediated effector functions.Discussion: Overall, our results indicate that lymphopenic plateletpheresis donors do not exhibit significant immune dysfunction; they have retained the T and B cell functionality necessary for potent antibody responses after vaccination. [ABSTRACT FROM AUTHOR]

Background/Aim. Plateletpheresis (PLTP) is a medical procedure used for collecting donor platelets with multiple benefits for patients who will receive apheresis platelets. The procedure takes one hour and is well tolerated by donors. Nevertheless, adverse events (AEs) may occur during and after the PLTP procedure. The aim of the study was to determine the incidence and type of AEs associated with PLTP in donors. Methods. A retrospective analysis of AEs associated with donor PLTP was conducted at the Blood Transfusion Institute of Vojvodina from January 1, 2010, to December 31, 2019. Results. Out of 2,073 platelet donors, 94.84% were multiple blood donors, predominantly male (98.55%). AEs were identified during 180 (8.68%) platelet donations with no statistical significance in occurrence in the first time donors (10.28%) and repeat donors (8.59%). Mild local reactions related to venous access (42.22%) were the most common AEs. Generalized symptoms were exhibited in 16.67% of donors, 26.11% exhibited symptoms related to apheresis (citrate reactions), and 15% exhibited those related to other complications. It was found that 95.55% of AEs occurred during PLTP and only 4.45% after it. Conclusion. Donor PLTP is a generally safe procedure, well tolerated by donors. Understanding risk factors for a possible occurrence of AEs provides support for adopting measures to prevent them. [ABSTRACT FROM AUTHOR]

Background: Amotosalen/UVA pathogen-reduced platelet components (PRPCs) with storage up to 7 days are standard of care in France, Switzerland, and Austria. PRPCs provide effective hemostasis with reduced risk of transfusion-transmitted infections and transfusion-associated graft versus host disease, reduced wastage and improved availability compared with 5-day-stored PCs. This study evaluated the potency of 7-day PRPCs by in vitro characterization and in vivo pharmacokinetic analysis of autologous PCs.Study Design and Methods: The in vitro characteristics of 7-day-stored apheresis PRPCs suspended in 100% plasma or 65% platelet additive solution (PAS-3)/35% plasma, thrombin generation, and in vivo radiolabeled post-transfusion recovery and survival of 7-day-stored PRPCs suspended in 100% plasma were compared with either 7-day-stored or fresh autologous conventional platelets.Results: PRPCs after 7 days of storage maintained pH, platelet dose, in vitro physiologic characteristics, and thrombin generation when compared to conventional 7-day PCs. In vivo, the mean post-transfusion survival was 151.4 ± 20.1 h for 7-day PRPCs in 100% plasma (Test) versus 209.6 ± 13.9 h for the fresh autologous platelets (Control), (T-ΔC: 72.3 ± 8.8%: 95% confidence interval [CI]: 68.5, 76.1) and mean 24-h post-transfusion recovery 37.6 ± 8.4% for Test versus 56.8 ± 9.2% for Control (T-ΔC: 66.2 ± 11.2%; 95% CI: 61.3, 71.1).Discussion: PRPCs collected in both 100% plasma as well as 65% PAS-3/35% plasma and stored for 7 days retained in vitro physiologic characteristics. PRPCs stored in 100% plasma for 7 days retained in vivo survival. Lower in vivo post-radiolabeled autologous platelet recovery is consistent with reported reduced count increments for allogenic transfusion. [ABSTRACT FROM AUTHOR]

The Bombay Rh D negative is the rarest of the rare in blood groups. A 65-year-old male patient with coronary artery disease was admitted for CABG. During grouping, forward showed no agglutination in A, B, D, and H, and reverse showed agglutination in A, B, and O cell. The blood group was confirmed as Bombay Rh D negative. Four units of PRBC was requested for the surgery as it was cardiothoracic surgery. We checked our inventory and rare donor list for Bombay-negative blood. Acute normovolemic hemodilution was done for 2 units preoperatively with saline replacement. Autologous platelet apheresis was done for this patient. During routine cross-match, one unit was incompatible. The patient had naturally occurring anti-S, which was reactive at 37°C and clinically significant. A total of 4 PRBC (Packed Red Blood Cell), 1 Single Donor Platelet (SDP), 12 Fresh Frozen Plasma (FFP), and 9 cryoprecipitate were transfused throughout the hospital stay. The patient was Bombay Rh negative with anti-S with major surgery, which was re-explored twice; the patient was managed successfully in spite of all these difficulties with cooperation from different blood banks from all over India. [ABSTRACT FROM AUTHOR]

BACKGROUND: In clinical practice, laboratory results are of great importance for the diagnosis and treatment. Reference intervals of different parameters aid health-care professionals in the interpretation of results. There are very few studies on reference intervals from India. This prospective study was conducted to determine the reference intervals for platelet count (PLT) and PLT indices; mean PLT volume (MPV), PLT distribution width (PDW), and PLT large cell ratio (P-LCR). These values can be obtained as a part of a routine complete blood count (CBC) and have diagnostic and prognostic significance in certain diseases. PLT count is an important criterion for the selection of donors for repeat plateletpheresis donation. MATERIALS AND METHODS: Sixteen hundred and thirty-four first-time healthy volunteer plateletpheresis donors were enrolled for the study. CBC was done, values of PLT, MPV, PDW, and P-LCR were noted, and the results were analyzed. The 95% of the reference distribution was estimated using the 2.5th and 97.5th percentiles following Clinical and Laboratory Standards Institute guidelines. Adverse donor reactions, if any and quality parameters of single donor PLTs (SDP) were also studied. RESULTS: Reference range values of PLT, MPV, PDW, and P-LCR were 137,825–355,175/μl, 8.1–13.9/fl, 9.1–22.5/fl, and 11.7%–52.9%, respectively, and compared well with other published studies from India. It was observed that reference values of PLT count obtained in the study were lower than reference values that are currently used in most laboratories (150,000–450,000/μl) in India. CONCLUSION: Based on our results, we are of the opinion that the PLT count cutoffs for repeat plateletpheresis donation may need to be revised downwards for our country which would also mitigate the scarcity of apheresis donors. [ABSTRACT FROM AUTHOR]

BACKGROUND: Increasing demand of single donor platelet requires blood banks to expand the donor pool. A reassessment of donor deferral criteria for plateletpheresis is required to ensure that this increasing demand is met without compromising on product quality and donor safety. AIMS: (1) To list the various causes of SDP donor deferral. (2) To discuss various approaches to minimize it. MATERIALS AND METHODS: Data of plateletpheresis donor deferral were collected from records retrospectively over a period of 4 years from January 2017 to December 2020. STATISTICAL ANALYSIS: All statistical tests were performed using IBM SPSS software for Windows version 20. Categorical variables were presented as proportions, while continuous variables were presented as mean with standard deviation, mean calculated P < 0.05 was considered statistically significant. RESULTS: Out of the 7478 donors screened for plateletpheresis procedure, 3232 (43.2%) were deferred among which 3089 (42.5%) were male and 142 (63.1%) were female donors. Majority (96.5%) of deferral were temporary. These included low platelet count (47.4%) followed by poor venous access (22.4%) and low hemoglobin (Hb) (7.2%). Among the donors deferred for low Hb, 24.7% (58 out of 234) had Hb between 12 and 12.4 g%. Similarly, among donor deferred for low platelet count, 12% (184 out of 1532) had platelet count between 140 and 149 × 103/μl. CONCLUSION: There is potential for increasing the number of eligible plateletpheresis donors if the present donor selection criteria were relaxed to a minimum Hb of 12 g/dl and minimum platelet count of 140 × 103/μl. [ABSTRACT FROM AUTHOR]

The purpose of this study is to obtain the iron parameters level of blood donors and the population who need to pay attention to iron parameters level in this area. A total of 993 plateletpheresis donors were included in this study, including 798 males and 195 females. The results of erythrocyte and iron parameters of blood donors were compared and analyzed in different groups according to the gender, age and number of blood donations. The proportion of men and women with low serum ferritin (SF) levels was 10.8 % and 27.7 %, respectively. The mean levels of serum iron (SI), SF, transferrin saturation (Tfs), hemoglobin (Hb) and hematocrit (HCT) of male blood donors decreased with the increase of age groups, but there was no significant statistical difference between the results of female blood donors. The level of SI, SF, Tfs, Hb and HCT of male donors decreased with the increase of blood donations in the past year, while TRF and TIBC increased. The level of Hb, HCT and SF of female donors showed no significant downward trend, while the levels of TRF increased with increasing donations in the past year, excluding first-time donors. The SI of female donors trended down, and TIBC trended up with increasing donations. Blood collection institutions need to focus on iron parameters levels in older and frequent male donors, and young fertile female donors. [ABSTRACT FROM AUTHOR]

Objective: To determine the plateletpheresis procedure adverse reactions as described by donors in a regional blood transfusion centre. Study Design: Cross-sectional study. Place and Duration of Study: Armed Forces Institute of Transfusion (AFIT), Rawalpindi Pakistan, from Oct to Dec 2018. Methodology: The data of 300 plateletpheresis donors, who underwent the procedure, was collected from the donor record of AFIT. All these donors were contacted through cell phone for interviews. The donors willing to participate were interviewed as per the structured questions. Results: Out of the 300 plateletpheresis donors contacted, only one was female (0.3%). The 166 (55%) male donors responded and showed willingness for inclusion in the study. The overall experience was described as very good by 89 (54%), good by 52 (31%), satisfactory by 23 (14%) and unpleasant by 2 (1%) donors. No adverse effects were observed in 144 (87%) donors, while 22 (13%) had mild adverse reactions. The 152 (91%) blood donors were willing to donate blood again in future. Conclusion: Plateletpheresis was considered, by donors, a very safe and pleasant procedure if appropriately performed, taking all necessary precautions. However, chances of adverse reactions exist as in all procedures related to blood donation. Our study shows that the minor common adverse reactions do not limit the donors from future blood donations. [ABSTRACT FROM AUTHOR]

Background: Single donor platelet products are preferred over random donor platelet products due to several advantages. However, safety issues with regard to post procedure hematological decrements and serum calcium and magnesium levels in donors undergoing plateletpheresis have been explored minimally. Aims: This prospective study was done to analyze the effects of plateletpheresis on donor's hematological parameters and serum calcium and magnesium levels. Settings and Design: It is a prospective, cross-sectional study conducted in the department of immunohematology and blood transfusion. Material and Methods: This study was undertaken on 150 healthy plateletpheresis donors over a period of 1 year. Blood samples were collected from each donor before and after the procedure, one in ethylenediaminetetraacetic acid (EDTA) vial for estimation of hematological parameters and another in plain vial for serum calcium and magnesium levels. Statistical Analysis Used: Paired t-test was used to analyze the data. Results: This study included donors in the age group of 18 to 60 years who underwent plateletpheresis on Haemonetics model of a machine (MCS) + intermittent flow cell separator. A statistically significant increase was observed in mean post procedural Hb (0.95%), Hct (0.7%), and red blood cell (RBC) count (1.3%). There was a decrease in mean post procedural platelet count (27.5%), white blood cell (WBC) count (4.02%), mean serum calcium (1.5%), and serum magnesium (5.1%), which was statistically highly significant (P < 0.001). No significant change was observed in post procedural mean platelet volume (MPV) and platelet distribution width (PDW). Conclusion: Amid the need of increased demand for plateletpheresis, donor safety must be ensured. Failing to do so can be detrimental to blood supply chain, hence stringent programs for post donation screening of plateletpheresis donors need to be established. [ABSTRACT FROM AUTHOR]

Background & Objectives: Hyperthrombocytosis may cause acquired thrombosis-related symptoms and fatal vascular complications. Currently, therapeutic platelet reduction (TPR) with medical therapy remains the mainstay of hyperthrombocytosis management. We encounter patients with high platelet counts with requests for TPR. Here, we share our experience of TPR procedures in patients with symptomatic hyperthrombocytosis due to various underlying etiologies. Methods: The study from January 2013 to October 2020 included 36 patients of hyperthrombocytosis who underwent 82 TPR procedures by apheresis technology. Patient details were obtained from the treatment file and all procedures were performed following recommended instructions and protocol. Statistical analysis was done using the SPSS statistical package. Results: The median age of patients was 53 years with mean hemoglobin, platelet count, plateletcrit, and platelet distribution width of 9.9 g/dL, 1711.3 × 106/mL, 0.57%, and 43.4%, respectively. A total of 26 patients had primary thrombocytosis. The mean TPR procedure time, whole blood volume processed, and anticoagulant used were 162 min, 5070 mL, and 430.3 mL, respectively. The mean reduction of platelets in patients who underwent two and three procedures was 72.4% and 82.7%, respectively (P = 0.003). Conclusion: We conclude that TPR is a useful method in reducing platelet count rapidly in hyperthrombocytosis. It relieves patients of acute symptoms and prevents thrombotic events. The decision to perform TPR should be individualized and based on the clinical scenario, degree of thrombocytosis, and risk factors associated with TPR procedures. [ABSTRACT FROM AUTHOR]

Aim: The aim of this study was to investigate the demographic characteristics of platelet apheresis donors during the coronavirus disease 2019 (COVID-19) pandemic, to examine the association of platelet counts with blood groups and body mass index (BMI), and to characterize the effects of BMI on platelet apheresis donation. Material and Methods: In this retrospective study, the demographic characteristics of platelet apheresis donors admitted to our center between January 2020 and January 2021 were examined, and hemogram parameters, previous platelet donation frequencies, and blood groups information were recorded. The relationship between donors' platelet counts, blood groups, and BMI were analyzed. Results: There was no statistically significant relationship between the platelet counts and blood groups. Although platelet counts were higher in Rh positive donors, no statistically significant relationship was found between platelet counts and the Rh group (p=0.675). Even though the platelet counts were lower in low-weight donors, there was no statistically significant relationship between platelet count and BMI groups (p=0.134). The lower collected platelet counts of the normal group, compared to the obese group, was found to be statistically significant (p=0.001). The number of donations for the overweight group being higher than the normal and obese groups was found to be statistically significant (p=0.002). Conclusion: Even though the platelet count increases with obesity, it does not have any statistical significance in healthy platelet donors. In conclusion, obesity does not have an inverse relationship with platelet apheresis donation and high BMI should not be considered as a prognostic factor for donation. [ABSTRACT FROM AUTHOR]

Background: Plateletpheresis using a leukocyte reduction system (LRS) traps donor WBCs in the LRS chamber, which may lead to lymphopenia, especially in frequent plateletpheresis donors. It seems plausible that this might cause adverse effects. However, current knowledge about potential confounders and donor health impacts is incomplete. Donors and methods: Recent platelet donors and donations collected at University Hospital Regensburg from 2016 to 2019 using the Terumo BCT Trima Accel LRS system were retrospectively analyzed and compared with historical platelet donors and donations collected mainly with Fresenius Kabi Amicus non‐LRS system from 2010 to 2013. Additionally, recent donors were prospectively surveyed using a health‐related topics questionnaire. Results: Analysis of 819 recent donors with 11,254 blood counts and 1464 questionnaires and 1011 historical donors with 12,848 blood counts revealed that increased annual platelet donation frequencies were associated with decreased lymphocyte counts in both groups. Median lymphocyte counts in recent donors with no versus ≥24 previous annual donations declined from 2.0 to 1.2 × 103/μL (p < 2.2 × 10−16), and those in historical donors with no versus ≥24 previous annual donations decreased from 2.0 to 1.5 × 103/μL (p = 6 × 10−4), respectively. The questionnaire results showed that donation frequency and lymphopenia were not associated with upper respiratory tract infection (URTI) incidence or duration, but platelet donors who concomitantly donated granulocytes had significantly shorter URTI durations than those who did not (p =.008). Conclusion: This study confirmed that plateletpheresis‐associated lymphopenia occurs in LRS and to a lesser degree in non‐LRS platelet donors, but revealed no evidence of a negative impact on donor health. [ABSTRACT FROM AUTHOR]

Background and Objectives Apheresis is an efficient method for collecting blood products such as plasma, platelets, red and white blood cells. Considering the importance of donor health and due to the limited number of apheresis donors' health related articles, we decided to investigate the effect of apheresis on platelet count, hemoglobin, hematocrit levels, and total leukocyte counts of donors. Materials and Methods A descriptive cross-sectional study was performed on 25 donors who were eligible for inclusion criteria in the study from May 2016 to January 2017. Samples were taken from donors before and after platelet apheresis and also 7 days after platelet apheresis to be tested on blood cells. CBC samples were analyzed with calibrated Mindray BC 300 cell counter device and then results were recorded in the prepared checklist and analyzed by SPSS 23 software. Results Twenty five male donors had a mean age of 32.4 ± 9.97 years, minimum age 19 and maximum 59 and average weight 85.84 ± 17.2 kg, and mean height 178.2 ± 6.69. There was no significant change in WBC, RBC, HCT, and Hb before and after apheresis and 7 days later in Haemonetics MCS+. Platelet counts decreased immediately after donation from 235.720 ± 52.109 to 176.400 ± 44.240 (103/μL) and it reached to the level of before donation after 7 days (243.400 ± 67.399)(103 /μL). Conclusions There was no significant change in WBC, RBC, HCT, and Hb before and 7 days after donation. [ABSTRACT FROM AUTHOR]

During plateletpheresis, citrate induces hypocalcemia and hypomagnesemia, which are usually transient and self-limiting, but they can lead to significant donor discomfort. The aim of study was to determine the effect of citrate infusion on a multitude of biochemical parameters during plateletpheresis in healthy donors and to correlate changes with adverse donor reactions. The study was conducted on 60 healthy plateletpheresis donors. Blood samples were drawn on three occasions, a baseline pre-donation sample, 30 min at start of procedure and 30 min post procedure. Heparinized samples were taken to measure ionized calcium and plain samples to measure serum calcium, serum magnesium, parathyroid hormone, total protein and serum albumin. There was statistically significant decline in mean total calcium (9.27 ± 0.66 mg/dl to 8.72 ± 0.87 mg/dl) and ionized calcium (3.8 ± 0.51 mg/dl to 2.9 ± 0.67 mg/dl) from baseline until 30 min after the start of procedure respectively. A significant fall in serum magnesium, total protein and serum albumin was observed. The mean parathyroid hormone showed significant increase from baseline levels till at the completion of procedure (19.94 ± 12.1 pg/ml to 92.08 ± 36.78 pg/ml). If the yield was set constant, there was negative correlation between ACD used and pre-donation platelet count. Majority of adverse donor reactions were hypocalcemic reactions, which were more with Amicus double yield plateletpheresis and were managed with calcium supplementation. Plateletpheresis induces marked reduction in serum calcium and magnesium levels. Moreover, increase in parathyroid hormone levels was significant. In addition, decline in total protein and serum albumin may be a concern in donors also participating in plasmapheresis. [ABSTRACT FROM AUTHOR]

Background: Refrigeration, or cold-storage, of platelets may be beneficial to extend the limited shelf-life of conventionally stored platelets and support transfusion protocols in rural and military areas. The aim of this study was to compare the morphologic, metabolic, and functional aspects of apheresis platelets stored at room-temperature (RT) or cold conditions, in either plasma or supplemented with platelet additive solution (PAS).Study Design and Methods: Double-dose apheresis platelets were collected in either 100% plasma or 40% plasma/60% PAS-E using the Trima apheresis platform. One component from each group was either stored at RT (20-24°C) or refrigerated (2-6°C). Platelets were tested over a 21-day period.Results: The platelet concentration decreased by approximately 30% in all groups during 21 days of storage (p > .05). Cold-storage reduced glycolytic metabolism, and the pH was maintained above the minimum specification (>6.4) for 21 days only when platelets were stored in PAS. The surface phenotype and the composition of the supernatant were differentially affected by temperature and storage solution. Functional responses (aggregation, agonist-induced receptor activation, clotting time) were improved during cold-storage, and the influence of residual plasma was assay dependent.Conclusion: In vitro platelet quality is differentially affected by storage time, temperature, and solution. Cold-storage, particularly in PAS, better maintains key metabolic, phenotypic, and functional parameters during prolonged storage. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to investigate the allele and genotype frequencies of 8 human platelet antigen (HPA) systems among blood donors from the Blood Transfusion Institute of Serbia and to compare them with published studies. These data would be useful to establish the basis for a platelet apheresis donor registry. Material and Methods: Seventy-two unrelated male platelet apheresis/blood donors from Serbia were typed for 8 HPA systems (HPA-1 to HPA-6, HPA-9, and HPA-15) via the FluoGene method, based on polymerase chain reaction-sequence-specific amplification (PCR-SSP; PCR using sequence-specific primers) with fluorometric signal detection. Allele and genotype frequencies were estimated by direct counting and compared to the expected genotype frequencies according to the Hardy-Weinberg principle. The transfusion mismatch probability was calculated for every HPA specificity. Results: The allele frequencies were: HPA-1a, 0.868; HPA-1b, 0.132; HPA-2a, 0.917; HPA-2b, 0.083; HPA-3a, 0.611; HPA-3b, 0.389; HPA-5a, 0.903; HPA-5b, 0.097; HPA-9a, 0.993; HPA-9b, 0.007; HPA-15a, 0.472; and HPA-15b, 0.528. For HPA-4 and HPA-6 only allele a was detected. Discussion: The HPA allele frequencies of European populations showed no significant differences in comparison with our results. Statistically significant differences were revealed in comparison with some populations of non-European origin. In the tested donors no HPA-2 bb genotype was detected, but we found 1 donor with the rare HPA-9b allele. The biggest transfusion mismatch probability in the Serbian population is for systems HPA-15 (37.4%) and HPA-3 (36.2%), which means that more than a third of random transfusions could cause mismatch in these systems. This study was enabled by the introduction of molecular HPA typing, and it provides initial results of the HPA allele and genotype frequencies in the population of blood donors in Serbia. They will be used to provide a compatible blood supply on demand for treating patients with alloimmune thrombocytopenic disorders. The successful implementation of PCR-SSP with fluorometric signal detection could be further complemented in the future by the introduction of high-throughput methods, which will largely depend on the available financial resources. [ABSTRACT FROM AUTHOR]

Background and Objectives: Although blood donation by apheresis is very safe, it is essential to identify the adverse reactions that happen and address the factors related to it so as to improve the donation experience both to the donors and the center accepting donations. This study was designed to assess the frequency of adverse reaction in donors undergoing apheresis for platelet donation and delineate the factors associated with the occurrence of such adverse donor reactions, if any. Methodology: This was an analytical retrospective study on the available data of all the donors who donated single-donor apheretic platelets in our blood center from January 2014 to October 2018. Results: The overall donor reaction rate was 8.3%, with the majority (4.7%) being a local reaction in the form of a hematoma. The other 3.6% were systemic reactions, among which 2.1% were citrate reactions and 1.5% vasovagal reactions (VVRs). The variables associated with a VVR were body weight <75 kg and diastolic blood pressure of <70 mmHg, whereas for citrate-related toxicities, it was the duration of the procedure and the amount of anticoagulant used. 4.7% of them were localized reactions in the form of the hematoma, which were more common in first-time donors. Conclusion: Adverse donor reactions to plateletpheresis are notable (8.3%) but generally mild. Auditing them to look for factors associated helps us review the policies and improve competencies among the staff to improve the safety of donors. [ABSTRACT FROM AUTHOR]

Background: A nationwide ban on family/replacement donation (FRD) went into effect on April 1, 2018 in China. To date, no reports relevant to the trend of plateletpheresis donations before and after a nationwide ban on FRD were found.Methods: We used two independent full samples, consisting of 135,851 and 82,129 plateletpheresis donors from Guangzhou and Chengdu between October 2012 and September 2019, respectively. A pseudo-panel data approach was applied by grouping three time-invariant covariates - gender, blood donation history, and birth year across 14 cross-sections (a 6-month interval each) to form a total of 24 cohort groups (14 × 24 = 336 cohorts, i.e., cells) with each having common covariates. The outcome was average apheresis platelet units per donor in each cell. We performed a two-piecewise linear mixed model with the cross-section (i.e., time) just right before the ban as a time breakpoint (i.e., 11th cross-section) to examine the trend of outcome with the adjustment of three time-invariant covariates. We removed the FRDs in each of the first 11 cross-sections to detect its possible influence on the trend.Results: The final model for the samples from Guangzhou presented a two-piecewise linear trend of the outcome over time with a horizontal line to the left of the breakpoint (βtimeBefore11 = 0.0111, p = 0.0976) and a significantly positive linear trend to the right (βtimeAfter11 = 0.0404, p < 0.0001). The male donors and the donors with plateletpheresis donation history had an increased baseline outcome and a significant outcome change over time after the ban. Such a two-piecewise linear trend pattern can be replicated using the samples from Chengdu with some minor variations. Removing the FRD before the ban can change the pattern.Conclusion: The significant increase of the average apheresis platelet units per donor over time after the FRD ban may be related to the implement of the FRD ban and the improved donation behavior of male donors and/or donors with platelet donation history after the ban. Our findings may potentially motivate the policymakers in other countries where the FRD for plateletpheresis donation is still legitimate to phase out their FRD strategy and ultimately achieve 100% voluntary plateletpheresis donation. [ABSTRACT FROM AUTHOR]

After a plateletpheresis donor was incidentally discovered to have a CD4 T-cell count below 200/ l, Gansner et al.2 performed a study of 60 donors, 20 from each of three cohorts: infrequent donors (1-2 donations in the last year), intermediate-frequency donors (3-19), and frequent donors (20-24). I "If it's not one thing, it's another" - Rosanne Rosannadanna i The recent manuscript by Zhao and colleagues1 follows on the observation that very frequent and prolonged platelet donation on the Trima platform may result in CD4 lymphopenia in some donors. Because apheresis platelet collections in Sweden are largely on the Trima platform, the investigators compared infection rates among frequent plateletpheresis donors with frequent plasmapheresis donors whose collections do not have an LRS chamber. [Extracted from the article]

Background: Recently, plateletpheresis donations using a widely used leukoreduction system (LRS) chamber have been associated with T-cell lymphopenia. However, clinical health consequences of plateletpheresis-associated lymphopenia are still unknown.Study Design and Methods: A nationwide cohort study using the SCANDAT3-S database was conducted with all platelet- and plasmapheresis donors in Sweden between 1996 and 2017. A Cox proportional hazards model, using donations as time-dependent exposures, was used to assess the risk of infections associated with plateletpheresis donations using an LRS chamber.Results: A total of 74 408 apheresis donors were included. Among donors with the same donation frequency, plateletpheresis donors using an LRS chamber were at an increased risk of immunosuppression-related infections and common bacterial infections in a dose-dependent manner. While very frequent donors and infections were rare in absolute terms resulting in wide confidence intervals (CIs), the increased risk was significant starting at one-third or less of the allowed donation frequency in a 10-year exposure window, with hazard ratios reaching 10 or more. No plateletpheresis donors that used an LRS chamber experienced a Pneumocystis jirovecii, aspergillus, disseminated mycobacterial, or cryptococcal infection. In a subcohort (n = 42), donations with LRS were associated with low CD4+ T-cell counts (Pearson's R = -0.41; 95% CI, - 0.63 to -0.12).Conclusion: Frequent plateletpheresis donation using an LRS chamber was associated with CD4+ T-cell lymphopenia and an increased risk of infections. These findings suggest a need to monitor T-lymphocyte counts in frequent platelet donors and to conduct future investigations of long-term donor health and for regulators to consider steps to mitigate lymphodepletion in donors. [ABSTRACT FROM AUTHOR]

Background: Plateletpheresis is generally safe but may have adverse reactions. Adverse reactions can negatively influence donor recruitment and retention. Valsalva is a proven method of attenuating pain caused by venipuncture. Aims: The aim was to evaluate the efficacy of the Valsalva maneuver on the attenuation of needle pain and donor anxiety. Settings and Design: This prospective randomized controlled trial was conducted between November 2015 and April 2016 at the Department of Transfusion Medicine. Subjects and Methods: One-hundred and sixty consecutive donors were grouped into control group (C) and Valsalva group (V) each of sample size 80. The Valsalva group performed a Valsalva maneuver and control did nothing before the venipuncture. Anxiety and pain were scored using a 10 cm visual analog scale (VAS). Severity was graded as VAS = 0 defines no pain and anxiety, VAS = 1–3 as mild pain and anxiety, VAS = 4–6 as moderate pain and anxiety, VAS = 7–9 as severe pain and anxiety, whereas VAS = 10 denotes extreme pain and anxiety. Statistical Analysis: Statistical Package for Social Sciences, version 23 was used for analysis. Independent samples t-test/Mann–Whitney U-test was used to compare between treatment and control group, whereas the Wilcoxon signed-rank test was used to test the difference between pre- and postobservations. Results: In the Valsalva group, post-Valsalva anxiety levels were significantly reduced to (1 [0–2]) from their pre-Valsalva values of (2 [0–3]); (P < 0.001). Pain was significantly lower (2[1-2]) in Valsalva group compared to control (4[2–5]); (P < 0.001). Conclusions: Valsalva reduced both severity of venipuncture pain and anxiety. Valsalva can be performed by donors as it is an easy, painless, and nonpharmacological method of pain and anxiety attenuation. [ABSTRACT FROM AUTHOR]

Objective A 77 year old female was admitted with a subdural hematoma requiring 1 unit of apheresis platelets. She was a study subject in the 1960s and was found to be Rhnull, along with another individual who previously served as a directed donor for her. Methods Serologic testing performed by the immunohematology reference laboratory (IRL) confirmed that the patient was Rhnull and expressed anti-Rh29 antibodies. While searching for red blood cells (RBCs) for possible transfusion, it was discovered that the individual from the original study had recently donated an autologous unit. Results The IRL discovered that the donor's antigen typing was r'r'. Testing had been performed using a molecular human erythrocyte antigen BeadChip (HBC). Due to the discrepancy between current and historical testing results, a donor segment was thawed and by tube testing confirmed to be Rhnull. A limitation of HBC is that many null phenotypes will be missed. Conclusion This case demonstrated that Rhnull evaluation of the donor required both serological and molecular methods. [ABSTRACT FROM AUTHOR]

Background: Strategies to reduce platelet (PLT) bacterial contamination include donor screening, skin disinfection, sample diversion, bacterial culture, pathogen reduction (PR), and day-of-transfusion tests. We report bacterial sepsis following a pathogen-reduced PLT transfusion.Case Report: An adult male with relapsed acute lymphoblastic leukemia was successfully treated for central catheter-associated Staphylococcus aureus bacteremia. A peripherally inserted central catheter (PICC) was placed. Chills, rigors, and flushing developed immediately after PICC-infused pathogen-reduced PLTs, progressing to septic shock requiring intensive care management.Methods: PICC and peripheral blood (PB), transfused bag saline flushes (TBFs), environmental samples, and the pathogen-reduced untransfused co-component (CC) were cultured. Plasma metagenomic and bacterial isolate whole-genome sequencing; PLT mitochondrial DNA (mtDNA) testing of untransfused CC and TBF; CC testing for amotosalen (S-59)/S-59 photoproducts; isolate PR studies (INTERCEPT); and TBF polymerase chain reaction for recipient Y-chromosome DNA were performed.Results: PB and PICC cultures grew Acinetobacter calcoaceticus/baumannii complex (ACBC). TBF was gram-positive; mass spectrometry identified ACBC and Staphylococcus saprophyticus (SS). CC Gram stain and cultures were negative. Environmental cultures, some done after decontamination, were ACBC/SS negative. Posttransfusion patient plasma and TBF ACBC sequences were genetically identical. No Y-chromosome signal was detected in TBF. S-59 photoproducts and evidence of mtDNA amplification inhibition were found in the CC. Spiking PR studies showed >5.9-log inactivation for both isolates. Donor skin cultures for Acinetobacter were negative.Conclusion: CC sterility, PR studies, residual S-59 photoproducts, and mtDNA amplification inhibition suggest successful PR. Unidentified environmental sources and inherent or acquired bag defects may have contributed to postmanufacturing pathogen-reduced PLT contamination. [ABSTRACT FROM AUTHOR]

Background: The microparticle content (MP%) of apheresis platelets-a marker of platelet activation-is influenced by donor factors and by external stressors during collection and storage. This study assessed the impact of apheresis technology and other factors on the activation status (MP%) of single-donor apheresis platelets.Study Design and Methods: Data from six US hospitals that screened platelets by measuring MP% through dynamic light scattering (ThromboLUX) were retrospectively analyzed. Relative risks (RRs) were derived from univariate and multivariable regression models, with activation rate (MP% ≥15% for plasma-stored platelets; ≥10% for platelet additive solution [PAS]-stored platelets) and MP% as outcomes. Apheresis platform (Trima Accel vs Amicus), storage medium (plasma vs PAS), pathogen reduction, storage time, and testing location were used as predictors.Results: Data were obtained from 7511 platelet units collected using Trima (from 16 suppliers, all stored in plasma, 20.0% were pathogen-reduced) and 2456 collected using Amicus (from four different collection facilities of one supplier, 65.0% plasma-stored, 35.0% PAS-stored, none pathogen-reduced). Overall, 30.0% of Trima platelets were activated compared to 45.6% of Amicus platelets (P < .0001). Multivariable analysis identified apheresis platform as significantly associated with platelet activation, with a lower activation rate for Trima than Amicus (RR: 0.641, 95% confidence interval [CI]: 0.578; 0.711, P < .0001) and a 6.901% (95% CI: 5.926; 7.876, P < .0001) absolute reduction in MP%, when adjusting for the other variables.Conclusion: Trima-collected platelets were significantly less likely to be activated than Amicus-collected platelets, irrespective of the storage medium, the use of pathogen reduction, storage time, and testing site. [ABSTRACT FROM AUTHOR]

Objective: Currently, there are discrepancies in the reports on the extent of the reduction in platelet count after platelet donation by apheresis, and its impact on mean platelet volume (MPV). This study was conducted to meta‐analyze the effect of plateletpheresis on platelet count and on mean platelet volume, based on studies published between 1980 and 2018. Methods: Medline‐Pubmed, Scielo, ScienceDirect, and Scopus databases were searched from inception to December 31 2019. The PRISMA guidelines, reproducibility, and evaluation of the methodological quality were guaranteed. Heterogeneity was evaluated with DerSimonian‐Laird's, publication bias with a Begg's test. Sensitivity analysis and cumulative meta‐analysis were also conducted, as well as a forest plot. Results: Twenty‐five studies with 3769 donors were systematized to analyze platelet count, and seven studies with 1176 donors to observe MPV. Most studies were published in India and the United States. There was a postprocedure reduction in both variables. The reduction in platelet count was 14.3 × 103/μL (95% CI 11.4 to 17.1 × 103⁄μL). The reduction in MPV was 1.43 fL (95% CI 0.3 to 2.5 fL). The analysis of subgroups showed that, in the case of platelet count, the reduction is not statistically significant two weeks after donation. Conclusion: Platelet donation by apheresis reduces platelet count and MPV in donors, which is detrimental to the purposes of the procedure; although the decrease is not clinically significant for the donor or the recipient. This demonstrates the need for subsequent studies to evaluate variables, such as donation frequency and donation intervals, should be considered to evaluate if the reported decrease is easily compensated, without adverse consequences for donors, or if modifications in donor selection criteria are required. [ABSTRACT FROM AUTHOR]

Background: UVC illumination of agitated platelet concentrates (PCs) inactivates pathogens and white blood cells by modifications of their nucleic acids. Related effects on mitochondrial DNA (mtDNA) in platelets serve as a basis for an efficient monitoring suited for routine quality control (QC) of this purely physical pathogen reduction technology.Study Design and Methods: Samples from PCs (n = 530) were tested with an established LightCycler PCR (LC PCR) for QC of the UVC procedure. RNR2 and TRNK/ATP8 genes were sequenced in the PCs (n = 21) with out-of-specification results in the LC PCR. A digital droplet PCR (ddPCR) was developed to minimize the outliers and cross-validated by testing the 530 PCs. The ddPCR was further evaluated in a subgroup of 300 PCs without mtDNA extraction and in samples from systematic variations of UVC dose and agitation speed.Results: Apheresis PCs (n = 380) resulted in 5.3% outliers in LC PCR versus only 0.7% in buffy coat pool PCs (n = 150). Sequencing of these outliers revealed single-nucleotide polymorphisms in the primer- and probe-binding sites of LC PCR. The development of a ddPCR assay with modified probe sequences reduced the outliers to 0.4%. The ddPCR analysis of PCs both with and without mtDNA extraction demonstrated low intra- and interassay variabilities and congruent results also compared to LC PCR. Experiments varying the UVC dose and the agitation speed demonstrated that the ddPCR results closely reflect functional effects of the UVC treatment.Conclusion: The ddPCR assay offers a valid and reliable tool for QC of routine production of the UVC-treated PCs as well as for monitoring treatment conditions during optimization of the UVC procedure. [ABSTRACT FROM AUTHOR]

Background: Hospital-based blood centers in India adopt pre-donation testing for transfusion-transmitted infections (TTI) before plateletpheresis donations. However, the WHO emphasizes on TTI tests be performed on samples collected during the donation process. The study objective was to determine whether cost implications by adopting product testing along with predonation testing or only product testing strategy in platelet donation in Indian blood centers. Materials and Methods: Cross-sectional study on registered plateletpheresis donors, strategy-1 with predonation testing using rapid tests and product testing using chemiluminescence (CLIA) were compared with alternate models: Strategy-2 (predonation test using CLIA and product testing with rapid test) and strategy-3 (product testing). For strategy-1 and 2, donors wait for predonation test to complete or visit blood center twice, while strategy-3 donors donate plateletpheresis immediately. The cost implications of these strategies were compared among registered plateletpheresis donors. Results: Out of 560 donors registered with strategy-1, three donors were reactive in predonation tests and six platelet units were discarded at product testing. After modeling, for strategy-2, nine donors would be identified as sero-reactive at pre-donation test only, while in strategy-3, nine units would be discarded in product testing. Only 506 donations were completed in strategy 1 after donor attrition. Recoverable costs was greater for strategy-3 (INR 5,146,500) than strategy-2 (INR 5,120,000) and strategy-1 (INR 5,069,000). Conclusion: Strategy-3 appears cost-effective but requires regulatory changes in the Indian setting. Testing apheresis procedures using Strategy 2 had greater cost recovery, and also prevents infectious donations and thereby enhances blood safety with the present guidelines. [ABSTRACT FROM AUTHOR]

Background: Point-of-issue tests, such as the Verax Pan Genera Detection (PGD) test, can be used to mitigate the occurrence of septic reactions. Little is known about how widespread the adoption of the PGD test is across US hospitals.Study Design/methods: The Red Cross hemovigilance database was used to determine the numbers of PGD-positive test results between 2013 and 2018. An examination of the impact of a reactive PGD test on product availability was performed for 2018.Results: The number of reported cases doubled, rising from approximately 50 to 100 per year between 2013 and 2018. A total of 475 initially reactive PGD tests during the entire study period were reported, and 7 (1.5%) of these were determined to be true positives. Hospitals surveyed reported testing platelet units once, with no repeat testing if the unit was PGD reactive. Evaluation of the reported PGD reactive cases for apheresis platelets for 2018 (n = 93) resulted in an estimated cost to the blood center of $87,000, which included the labor and material costs of working up the cases and the estimated value of the lost 64 units and co-components. In addition, there was a loss of the opportunity to collect over 85 apheresis platelets during the time the implicated donor was temporarily deferred.Conclusions: The number of hospital reports of reactive PGD tests has shown modest growth in the past 5 years. The number of initially reactive PGD tests that were confirmed was minimal. Blood centers can incur cost and platelet inventory loss from initially false-positive test results. [ABSTRACT FROM AUTHOR]

Background: Traditionally, white blood cells (WBCs) are collected from buffy coats or freshly drawn blood. However, the increasing demand for peripheral blood mononuclear cells (PBMCs) in the research phases of immunological therapy development makes it necessary to identify alternative sources of these cells.Study Design and Methods: Leukapheresis products are cost intensive and not offered by all blood banks. Therefore, thrombocyte apheresis cassettes (TACs), plateletpheresis waste products, were investigated as a possible low-cost and easily accessible blood source for research laboratories. The recovery rate, phenotype, and functionality of WBC subsets from TAC are unknown and were investigated in comparison to frequently used blood resources via flow cytometry.Results: On average, TACs provide 30.3 × 106 /mL PBMCs, situating themselves between peripheral whole blood (WB; 5.35 × 106 /mL) and leukoreduction system chamber (LRSC; 163.9 × 106 /mL) yields. Frequencies of CD14, CD3, CD4, CD8, CD56, CD19, and CD11c positive cells in TACs correlate with normal proportions of WBC populations. Stimulation of TAC-derived PBMCs by lipopolysaccharide (LPS) and resiquimod (R848) showed no significant differences in expression levels of human leukocyte antigen (HLA)-DR, DQ, DP, and CD86 or cytokine secretion compared to other blood source derived PBMC. Following stimulation with LPS or R848, comparable levels of tumor necrosis factor-α, interleukin-10, and interleukin-1β could be measured between TAC, LRSC, and WB. Additionally, TAC-derived T cells retained their proliferation capability and were able to produce interferon-γ following T-cell receptor stimulation.Conclusion: TACs provide a cost-effective source of viable and functional human blood cells that can readily be used for clinical and laboratory investigations after plateletpheresis preparation. [ABSTRACT FROM AUTHOR]

Essential thrombocythemia (ET) is one of the myeloproliferative neoplasms, characterized by persistent thrombocytosis, platelets >450,000/μL, and evident clonal abnormalities like JAK2 V617F, MPL, CALR mutation and not fulfilling WHO criteria for MDS, CML, PV, and IDA. Here we report a 24-year-old female who presented with headache and was found to have thrombocytosis with a platelet count of 2,141 × 103/μL, diagnosed as ET as per WHO criteria 2008; she required ICU admission and thrombocytapheresis with a favorable outcome. [ABSTRACT FROM AUTHOR]

Background: Most single-donor platelet (SDP) donors transition to plateletpheresis after prior red blood cell (RBC) donation. Recruitment may follow identification of a high platelet count, a marker associated with iron depletion (ID). SDP donors may have underrecognized risk for iron depletion.Study Design and Methods: To assess the prevalence of ID, we performed ferritin testing on male plateletpheresis donors with hemoglobin levels less than 13.5 g/dL. Multivariable logistic regression identified risk factors for low ferritin (LF; ferritin ≤26 ng/mL) and absent iron stores (AIS; ferritin <12 ng/mL). To assess the impact of notifying donors of LF results, we compared donation behavior of "Test" subjects before and after sending an LF notification letter to that of "Control" subjects before and after increasing the minimum hemoglobin for male donors. An electronic survey to Test donors inquired about iron supplementation practices.Results: Prevalence of LF was 50% and AIS was 23%, with increase in risk associated with more frequent SDP donation, both controlling for RBC donation and in donors with no recent RBC donations. Donation frequency after intervention declined less in 1272 Test donors (19%, from 13.9 to 11.2 annualized donations) than in 878 Control donors (49%, from 12.3 to 6.3 donations). Only 20% of Test donors reported taking supplemental iron when they received the LF letter; 64% of those not taking iron initiated iron supplementation following the letter.Conclusions: Donors were responsive to notification of LF and attendant messaging on iron supplementation. Ferritin testing potentially benefits donor health and a stable platelet supply. [ABSTRACT FROM AUTHOR]

Background: The reemergence of yellow fever virus (YFV) in Africa and Brazil, and massive vaccine campaigns triggered to contain the outbreaks, have raised concerns over blood transfusion safety and availability with increased risk of YFV transfusion-transmitted infections (TTIs) by native and vaccine-acquired YFV. Blood donor deferral for 2 to 4 weeks following live attenuated YFV vaccination, and deferral for travel to endemic/epidemic areas, may result in blood donor loss and impact platelet component (PC) stocks. This study investigated the efficacy of INTERCEPT Blood System pathogen reduction (PR) with use of amotosalen and ultraviolet A (UVA) light to inactivate high levels of YFV in PCs.Materials: Four units of apheresis platelets prepared in 35% plasma/65% platelet additive solution (PC-PAS) and 4 units of PC in 100% human plasma (PC-Plasma) were spiked with high infectious titers of YFV (YFV-17D vaccine strain). YFV-17D infectious titers were measured by plaque assay and expressed as plaque-forming units (PFU) before and after amotosalen/UVA treatment to determine log reduction.Results: The mean YFV-17D infectious titers in PC before inactivation were 5.5 ± 0.1 log PFU/mL in PC-PAS and 5.3 ± 0.1 log PFU/mL in PC-Plasma. No infectivity was detected immediately after amotosalen/UVA treatment.Conclusion: The amotosalen/UVA PR system inactivated high titers of infectious YFV-17D in PC. This PR technology could reduce the risk of YFV TTI and help secure PC supplies in areas experiencing YFV outbreaks where massive vaccination campaigns are required. [ABSTRACT FROM AUTHOR]

Background: Cold (4°C)-stored platelets are currently under investigation for transfusion in bleeding patients. It is currently unknown how long cold-stored platelets can be stored for clinical applications.Study Design and Methods: Twenty three subjects were recruited. Twenty-one subjects were available for in vivo assessment and received indium-111 radiolabeled, cold-stored platelets. We investigated 5- (n = 5), 10- (n = 6), 15- (n = 5), and 20-day-stored (n = 5) platelets and obtained samples for in vitro testing at baseline and after the designated storage time. Twenty three units were available for in vitro testing. Five- and 7-day (n = 5 each), room temperature (RT)-stored platelets served as the current clinical standard control.Results: In vivo, we found a continuous decline in platelet recovery from 5 to 20 days. Platelet survival reached a low nadir after 10 days of storage. Ex vivo, we observed the maximum platelet αIIbβ3 integrin response to collagen at 5 days of cold storage, and we saw a continuous decline thereafter. However, platelet integrin activation and mitochondrial membrane integrity were better preserved after 20 days at 4°C, compared to 5 days at RT. Platelet metabolic parameters suggest comparable results between 20-day cold-stored platelets and 5- or 7-day RT-stored platelets.Conclusion: In summary, we performed the first studies with extended, cold-stored, apheresis platelets in plasma for up to 20 days with a fresh comparator. Storing cold-stored platelets up to 20 days yields better results in vitro, but further studies in actively bleeding patients are needed to determine the best compromise between hemostatic efficacy and storage prolongation. [ABSTRACT FROM AUTHOR]

Background: The level of residual red blood cells (RBCs) in platelet concentrates (PCs) is of interest because of clinical concerns related to alloimmunization to RBC antigens in transfused patients. This work aims at characterizing and quantifying the levels of intact and fragmented RBCs in apheresis (AP-PCs) and buffy coat PCs (BC-PCs) to assess their potential risk for RhD antigen alloimmunization. Methods: After staining with anti-CD41 (platelets) and anti-CD235a (RBCs) antibodies, the size and density of RhD antigen on intact and fragmented RBCs were analyzed by flow cytometry. Results: Residual RBC counts were 29 ± 22 × 106/unit in AP-PCs and 121 ± 54 × 106/unit in BC-PCs, which correspond to about 3 and 11 µL of RBCs by product, respectively. RhD expression was about 4 times higher on RBC particles in AP-PCs, and these particles contribute to 66 and 75% of the total antigenic load in BC-PCs and AP-PCs, respectively. Conclusions: Processing methods influence the quantity and nature of contaminating residual RBCs and RBC-derived particles in PCs. The estimation of residual RBCs in these blood products is generally based on measurements of intact RBCs, which might underestimate the risk for alloim-munization in transfused patients. The question of whether these RBC-derived particles can produce an immune response and, thus, should then be taken into consideration for Rh immune prophylactic treatments, remains to be clarified. [ABSTRACT FROM AUTHOR]

Background: Despite West Nile virus (WNV) blood donation screening using nucleic acid testing (NAT), donors with low viral loads not detected by mini-pool-NAT have led to transfusion transmitted (TT)-WNV infection. We describe a probable case of fatal TT-WNV infection from an individual donor (ID)-NAT non-reactive apheresis platelet donation.Study Design and Methods: An apheresis platelet donation was WNV ID-NAT reactive and prior donations from the same donor were investigated. A WNV ID-NAT non-reactive apheresis platelet unit collected 26 days earlier was transfused during heart transplantation to a patient who subsequently developed WNV neuroinvasive disease and expired. The source of the recipient's WNV infection was investigated.Results: Twenty-six days after collection of the suspect platelet unit, a donation from the same donor was WNV ID-NAT reactive and WNV IgM and IgG positive. In addition to the suspect platelet unit, the heart transplant recipient who developed WNV infection received 17 blood components from 24 donors. Serologic testing performed on 11 of the remaining 24 donors (46%) was WNV IgM negative. Pre-transplant recipient and heart donor samples tested WNV RNA and IgM negative.Conclusion: A probable case of fatal neuroinvasive TT-WNV was linked to an infectious apheresis platelet unit undetected by WNV ID-NAT. It is hypothesized that the suspect unit was collected early in the viremic period when viral RNA was below the limit-of-detection of the ID-NAT assay. Implementation of ID-NAT screening of blood donors has not entirely eliminated the risk of TT-WNV infections, which may best be addressed by pathogen inactivation technologies. [ABSTRACT FROM AUTHOR]