Transfusion and Apheresis Science 34 (2006) 157–161

intl.elsevierhealth.com/journals/tras

EVect of donor variables on yield in singledonor plateletpheresis by continuous Xow cell separator

Rajendra Chaudhary ¤, Sudipta Sekhar Das, Dheeraj Khetan,Pratul Sinha

Department of Transfusion Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, India

Received 15 June 2005; received in revised form 15 August 2005; accepted 30 September 2005

Abstract

The quality of single donor platelets (SDPs) in terms of yield inXuences platelet recovery in the recipient. Variousdonor factors such as pre-donation platelet count and hemoglobin (Hb) concentration aVect the platelet yield. We studiedthe inXuence of pre-donation donor clinical and laboratory factors such as gender, age, weight of the donor, platelet countand Hb on the platelet yield. A total of 94 plateletpheresis procedures performed on continuous Xow cell separator(CS3000, Baxter Healthcare, Round Lake, IL, USA) were evaluated for platelet yield. A relationship between pre-dona-tion donor variables and yield of platelets was studied using the Pearson correlation. The mean platelet yield was2.8§ 0.73£1011. While a direct relationship was observed between pre-donation platelet count and yield (rD 0.50,p < 0.001), no such correlation was noticed with donor Hb concentration (rD¡0.10, p > 0.005). Similarly, no correlationwas observed between gender (rD 0.05), age (rD 0.11) and weight (rD 0.18) of the donor with yield. Optimization of plate-let yield, which is inXuenced by pre-donation platelet count, is an emerging issue in blood transfusion services. IdentiWca-tion of such factors may help in selecting donors to obtain higher platelet yields and consequently better clinical outcome.© 2006 Elsevier Ltd. All rights reserved.

Keywords: Donor platelet count; Single donor platelets; Donor hemoglobin; Plateletpheresis; Cell separator

1. Introduction

The developments in transfusion practice andintroduction of advanced cell separators have deW-

* Corresponding author. Tel.: +91 522 2668700x2500; fax:+91 522 2668017.

E-mail address: rkcchaud@sgpgi.ac.in (R. Chaudhary).

1473-0502/$ - see front matter © 2006 Elsevier Ltd. All rights reservedoi:10.1016/j.transci.2005.09.040

ned platelet therapy in terms of quality and pro-ductivity. Platelet recovery in the patient isinXuenced by the transfused dose of platelets,which in turn is dependent on the quality of theplatelet product in terms of yield [1]. It has beenshown that transfusion of high yield platelet prod-ucts could reduce transfusion requirements of athrombocytopenic patient [2]. Single donor platelet

d.

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(SDP) products, unlike pooled platelet concen-trates, lowers the risk of transfusion transmittedinfections, alloimmunization and febrile non-hemolytic reactions [3,4]. Therefore, there is nowmore focus on the use of SDPs than pooled plateletconcentrates. Automated apheresis techniqueswere Wrst developed in 1975 and since then haveundergone a number of technical modiWcationsand standardization to meet the platelet inventoryneeds of transfusion services which are supportingmore patients with thrombocytopenia. Withincreasing use of SDPs, the need for potentialplateletpheresis donors also increased. Althoughthe collection of quality SDP is made easy with thenew cell separators, donor related factors, bothclinical and laboratory, might inXuence the plateletyield. Therefore, we investigated the inXuence ofdonor variables such as gender, age, weight, pre-donation platelet count and Hb concentration onthe yield of platelets.

2. Materials and methods

The study included 94 (87 males, 7 females; agedfrom 20 to 52 years) plateletpheresis proceduresperformed on continuous Xow cell separator(CS3000, Baxter Healthcare, Round Lake, IL,USA) using closed system apheresis kits (Code No.4R2182) over a period from January to December2004 at the Apheresis Unit, Department of Trans-fusion Medicine, Sanjay Gandhi PostgraduateInstitute of Medical Sciences, Lucknow, India. Allthe donors met the donor eligibility criteria as laiddown by the Drugs Controller of India [5]. Hema-tological parameters such as platelet count andHb% were measured on an automated analyzer(Micros 60, ABX Diagnostics, France).

The plateletpheresis procedures were performedas per the standard operating procedure (SOP)using TNX-6 separation chamber with interfaceoVset (IO) of 6. Blood Xow rate for all collectionswas maintained at 40–50 ml/min with anticoagu-lant (ACD-A) ratio of 12:1. The end point was thetarget yield of 3£ 1011 platelets per unit. After theprocedure, it was ensured that the segment in thecollected bag was kept approximately 15 cm forsampling to calculate the yield. Approximately

1 ml sample from each bag was collected in EDTA(K2 EDTA) after thorough stripping the segmentto ensure representative product of the bag. Thesamples were then mixed thoroughly by means ofmechanized blood mixer (Techno FAB, India) for15 min and then subjected to determination ofplatelet indices (count, MPV, PDW) and cellularcontamination (RBC, WBC) after appropriatedilution (1:50) on automated analyzer to calculatethe yield. InXuence of donor variables such as age,gender, weight, pre-donation platelet count andHb% on the yield of platelets was studied by multi-ple linear regression analysis and calculating “r”value (Pearson correlation) using SPSS softwareversion 9.0 for Windows.

3. Results

A total of 94 healthy donors (mean age 29.3§3.87 years) weighing 62.2§9.4 kg underwent plate-letpheresis on continuous Xow cell separator(CS3000, Baxter Healthcare, Round Lake, IL,USA). The mean blood volume processed was3.8§0.70 L over the mean duration of 82.58§18.1 min using 309§56.4 ml ACD-A. The volumeof the product was consistent with mean of 200.6§14.6 ml. The mean MPV of the unit was 8.7§1.8Xwhile mean PDW was 13.8§ 1.7%. The mean cellu-lar contamination in terms of white cells and redcells was 5.3§ 0.6£108/unit and 1.1§ 0.7 ml/unit,respectively.

Table 1 shows correlation between pre-dona-tion platelet count and the yield of platelets inSDP. The mean platelet yield of all procedures was2.8§0.73£ 1011. Fig. 1 shows a direct correlationbetween pre-donation platelet count and the yield(rD 0.50, p < 0.001). The yield was 73£ 1011 in>80% of procedures when the pre-donation plate-let count was 7300£ 103/mm. Table 2 shows pre-donation Hb concentration and the platelet yield,which was not found to be signiWcantly correlated(rD¡0.10, p > 0.005). The SDPs obtained fromthree donors with Hb 716 g/dl had low plateletyield (mean 1.8£ 1011/unit) compared to thosehaving Hb <16 g/dl (mean yield 2.8£ 1011/unit).Similarly, multiple linear regression analysis dem-onstrated no eVect of donor gender (rD 0.05), age

R. Chaudhary et al. / Transfusion and Apheresis Science 34 (2006) 157–161 159

Dependent variable: yield/bag (£1011).

Table 1Correlation of pre-donation platelet count with yield

Pearson correlation indicates good correlation between pre-donation platelet count and yield for all procedures (r D 0.50, p < 0.001).

Platelet yield £ 1011 150–200£ 103/mm (n D 42) 200–300£ 103/mm (n D 40) 7300 £ 103/mm (n D 12) All (n D 94)

Mean § SD 2.5 § 0.59 2.8§ 0.63 3.65 § 0.80 2.8 § 0.73Median 2.6 2.8 3.5 2.8Range 1.5–3.4 1.6–4 2.8–5.7 1.5–5.7%73£ 1011 32.5 41 80 41.5

Fig. 1. The relationship between pre-donation platelet count and platelet yield (nD 94). Pearson correlation analysis indicated goodcorrelation (r D 0.50, p < 0.001).

1

1.5

2

2.5

3

3.5

4

4.5

5

5.5

6

100 150 200 250 300 350 400 450

Donor PLT count (1000/mm)

PL

T y

ield

x 1

011

Table 2Correlation of pre-donation donor hemoglobin with yield

Pearson correlation indicates signiWcant correlation between pre-donation Hb concentration and platelet yield for all procedures(r D¡0.10, p > 0.005).

Platelet yield £ 1011/unit Donor Hb <14.5 g/dl meanPLT count 221 £ 103/mm (n D 64)

Donor Hb 714.5 g/dl meanPLT count 213 £ 103/mm (n D 30)

Mean § SD 2.86 § 0.74 2.66 § 0.64Median 2.8 2.6Range 1.6–5.7 1.5–3.6%73£ 1011 44 37

Table 3EVect of diVerent donor variables on platelet yield in plateletpheresis

Variable CoeYcient Standardized coeYcient p value

Constant 2.678 0.008Pre Hb (g/dl) ¡0.036 ¡0.05 0.541Pre platelet count 0.000536 0.48 0.000Age ¡0.015 ¡0.159 0.065Gender 0.058 0.018 0.827Weight 0.013 0.217 0.013

160 R. Chaudhary et al. / Transfusion and Apheresis Science 34 (2006) 157–161

(rD0.11) and weight (rD 0.18) on platelet yield(Table 3).

4. Discussion

The last decade has witnessed an increase in theuse of SDPs as opposed to platelets derived fromwhole blood. Such practice not only increased thepurity of the product in terms of decreased cellularcontamination but also increased the platelet col-lection yield. Various studies have demonstratedthat the platelet yield is predominantly dependenton the donor platelet count [1,6,7]. Our results arealso in agreement with these observations. Therewas a direct correlation between the platelet yieldand the pre-donation platelet count (rD0.50,p < 0.001). (Table 1 and Fig. 1). Out of 94 platelet-pheresis procedures, the mean platelet yield was3.65§ 0.80£ 1011 when the pre-donation plateletcount was 7300£ 103/mm, while the mean yieldwas 2.5§0.59£ 1011 when the pre-donation plate-let count was <200£ 103/mm.

According to the American Association of BloodBanks (AABB) [8], 75% of the SDP must contain73£1011 per unit while the European guidelines [9]recommend a platelet count 72£1011 per unit.Only 41.5% of our SDPs met the AABB criteria(73£1011). These levels have been determined toprovide desired hemostatic platelet doses to therecipient. Goodnough et al. [10] studied 708 platelet-pheresis procedures having a mean pre-donationplatelet count of 237§49£103 mm which resultedin a platelet product with mean yield of 4.24§1.1£1011. A direct linear correlation was observedwith all the procedures. In 12% of their proceduresthe mean yield was <3£1011 when the pre-dona-tion count was <200£ 103 mm. Similarly, Hesteret al. [11] could obtain high yield SDP on selecteddonors with a pre-donation platelet count of>200£ 103/mm; however, such a practice consider-ably minimized the donor pool [12]. A large num-ber (44.7%) of our eligible donors would beunsuitable for plateletpheresis if the criteria of apre-donation platelet count >200£ 103/mm is fol-lowed, as 42 of the 94 donors had platelet countsranging from 150 to 200£ 103/mm (Table 1).Another donor factor that may have an inXuence

on the platelet yield is the pre-donation Hb con-centration of the donor. Although we found nosuch correlation in the present study (rD¡0.10),there was a trend that a donor with a Hb >16 g/dlgave a comparatively lower platelet yield. How-ever, no conclusive comment can be made in thisregard as there were only three donors with Hb>16 g/dl in the present study. Ogata et al. [7] alsoobserved no correlation between the pre-donationHb concentration of the donor and the yield.However, Guerrero-Rivera et al. [1] demonstratedan inverse relationship of Hb with the yield(rD¡0.554). SDPs from donors with a pre-dona-tion Hb 716 g/dl had signiWcantly lower yieldscompared to SDPs obtained from donors with aHb <16 g/dl. This may be related to the higherplasma volume processed in donors with low Hbconcentration thereby giving a higher plateletyield.

We also studied the eVect of donor clinical vari-ables such as gender, age and weight on yield.There was no signiWcant correlation observed(p > 0.005). Buchholz et al. [13], studied the qualityof SDP in relation to low weight (90–110 pound)of the donors and demonstrated no eVect of donorweight on platelet yield. With regard to the genderof the donor, previous studies [14,15] have shown adirect correlation of female gender with yield. Thepossible explanation is a higher prevalence of irondeWciency among women with a consequentincrease in platelet count. We found no such corre-lation in the present study. Optimization of plateletyield, which is inXuenced by pre-donation plateletcount, is an emerging issue in blood transfusionservices. Therefore, thrombopoietin is being triedin donors to increase the pre-donation plateletcount [16]. However, this approach needs evalua-tion in terms of donor acceptability, its eYcacy andcost.

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