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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 8  |  Issue : 1  |  Page : 12-15

Analysis of plateletpheresis donor deferral rate, characteristics, and its preventability


1 Clinic of Hematology, Istanbul Training and Research Hospital, İstanbul, Turkey
2 Department of Hematology, Pamukkale University Faculty of Medicine, Denizli, Turkey

Date of Web Publication12-Apr-2017

Correspondence Address:
Mehmet H Dogu
Istanbul Training and Research Hospital, Clinic of Hematology, 34098 İstanbul
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_6_17

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  Abstract 


Introduction: Plateletpheresis is a procedure included in donor apheresis in which the donor blood is passed through an extraction machine, the platelets are extracted, and the remainder is returned into the circulation. Donor selection is important because donors are the only source for meeting blood product needs. In our study we aimed to evaluate deferral reasons in applications for plateletpheresis donation and reveal determine the preventable ones among them.
Materials And Methods: The persons who were admitted to our Blood Center to be plateletpheresis donors during the period of six month, after a demand/request for platelet suspension was issued by the clinics. Their eligibility for being plateletapeheresis donors was decided.
Results: A total of 1098 persons have applied to be plateletpheresis donors; 1045 were male and 53 female. A total of 787 persons were found to be eligible for being plateletpheresis donors; 772 were male and 15 female. 891 units of apheresis platelets were obtained from apheresis donors, including double units collected from 104 of them. Applications of 311 persons were deferred due to various reasons. The most common reason for donor deferral was inappropriate vascular access in 80 persons (25.7%, 69 males, 11 females). This is followed by abnormal laboratory values in 57 persons (18.3%) and drug use (most commonly analgesics) in 46 persons (14.7%).
Discussion: During the assessment of blood product donors, proper selection of the candidates should be considered very carefully in order to not to harm the donor but to supply the demand of the recipient properly. When the deferral reasons were evaluated, improvement of in-hospital technical reasons and education sessions for people in order to increase the social awareness may substantially decrease the deferral rates.

Keywords: Donor, plateletpheresis, transfusion


How to cite this article:
Dogu MH, Hacioglu S. Analysis of plateletpheresis donor deferral rate, characteristics, and its preventability. J Appl Hematol 2017;8:12-5

How to cite this URL:
Dogu MH, Hacioglu S. Analysis of plateletpheresis donor deferral rate, characteristics, and its preventability. J Appl Hematol [serial online] 2017 [cited 2017 Sep 20];8:12-5. Available from: http://www.jahjournal.org/text.asp?2017/8/1/12/204428




  Introduction Top


Blood and its components may be life saving when used with appropriate, accurate indications. Donor selection is important because donors are the only source for meeting the blood product needs.[1] Apheresis is the process by which the blood of the donor or the patient is passed through an apparatus; various blood components are extracted to meet the tailored need of a patient, and the remainder is returned to the circulation. There are three types of apheresis: donor apheresis, therapeutic apheresis, and peripheral stem cell apheresis. Plateletpheresis is a procedure of donor apheresis in which the platelets in the donor blood are separated from the blood by being passed through an apparatus and returning the remainder donor blood into the circulation.[2]

Platelet transfusion is indicated in patients with thrombocytopenia or platelet dysfunction. In both cases, platelet transfusion is given prophylactically to prevent bleeding and to stop active bleeding. If possible, platelets with the same blood group should be used for transfusion. The concentrates of platelets are obtained either from the whole blood (random donor platelets) or by using cytapheresis (plateletpheresis) technique. By using apheresis, the amount of platelets equivalent to the platelets derived from 3 to 13 units of the whole blood may be obtained.[3]

The main objective in the selection of the blood donors is to detect healthy donors without harming the donor or worsening the condition of the recipient. Therefore, donor questionnaire forms are prepared to enable donor screening. Donors first complete the questionnaire forms; later, the serological tests of the eligible donors are performed. The vascular access of the donor appropriate for the blood product is also sought. After all these stages, the donor will be accepted or deferred.[4]

On the basis of this information, in our study, we aimed to evaluate the deferral reasons in applications for plateletpheresis donation and determine the preventable causes among them.


  Materials and Methods Top


The participants were admitted to our Blood Center as plateletpheresis donor during a period of 6 months after there arose a demand for platelet suspension from the clinics of our hospital. All donors were assessed according to the eligibility criteria of the blood donors in The National Blood and Blood Products Guideline published by the Turkish Republic Ministry of Health. All donors of 18–65 years of age and weighing >50 kg with a platelet count of >150,000/mm3 were accepted. All donors completed the blood donor questionnaire and information forms. Eligibility was decided by the doctor responsible for assessing the donor’s blood at the Blood Center in the light of these forms and laboratory tests. Thus, a thorough history was obtained, and the blood samples were collected for a complete blood count as well as for testing transfusion-transmitted infections. The samples were tested for anti-Human Immunodeficiency Virus (HIV), Surface antigen of the hepatitis B virus (HBsAg), anti-Hepatitis C Virus (HCV), and Venereal Disease Research Laboratory test (VDRL). Cardiac and respiratory examinations were also performed on all donors. Plateletpheresis was performed using Amicus (Fenwal Inc., Lake Zurich, IL) with continuous flow. Vascular access in both the arms of the participant was required for the system to function.


  Results Top


A total of 1098 participants applied to be plateletpheresis donors. Among them, 1045 of the participants were male and 53 were female. A total of 787 individuals were found to be eligible for plateletpheresis donation, with 772 being male and 15 being female. A total of 891 units of apheresis platelets were obtained from these apheresis donors, including double units collected from 104 of them. The applications of 311 participants were deferred due to various reasons. The most common reason for donor deferral was inappropriate vascular access, as noticed in 80 participants (25.7%; 69 males and 11 females). This was followed by abnormal laboratory values in 57 participants (18.3%) and drug use (most commonly analgesics) in 46 participants (14.7%). The details regarding the reasons for deferral are presented in [Table 1].
Table 1: Deferral reasons for the apheresis donor

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  Discussion Top


Transfusion of the blood products is a vital issue. In spite of the recent developments in the medical field, the whole blood transfusions are indicated only in a limited number of conditions. Rather, the most suitable replacement method is preparing the required blood component and delivering only this blood component to the patient. Platelet transfusion is critical both in bleeding prophylaxis and bleeding treatment.[5] Thus, platelet transfusion may be required in a variety of conditions, including treatment-related reasons, lack of production, and increase in destruction. Bearing in mind that platelet suspensions have a shorter storage time than erythrocyte suspensions or fresh frozen plasma, recruiting donors is crucial. There are two possible techniques for obtaining platelet suspensions: producing larger volumes of platelet suspension with direct apheresis procedure or producing random platelet suspension from the whole blood as per the required procedures. However, by apheresis, platelets can be derived from the plateletpheresis donor in more frequent intervals and in higher amounts than random platelet concentrates derived from the whole blood donor.[6]

In addition to the prerequisites for being a blood product donor, there are certain other conditions required for being a plateletpheresis donor. On the basis of this information, the individuals who applied to our hospital blood bank to be a plateletpheresis donor over a period of 6 months were assessed. The deferral reasons of voluntary plateletpheresis donors were evaluated.

To use continuous flow systems for plateletpheresis, suitable vascular access should be available in both the arms.[7] Because only continuous flow system is available in our hospital to obtain plateletpheresis suspensions, appropriate vascular access in both the arms of the patients is sought. Thus, the most common deferral reason in our study was inappropriate vascular access in 25.7% of the donors. As is known, availability of only one vascular site may be adequate in the intermittent flow systems. However, with this technique, the procedure time is prolonged, and a larger quantity of blood is taken out of the blood vessels; thus, the symptoms resulting from the procedure may increase.

One of the most common problems for voluntary donors is the preprocedure laboratory tests.[8],[9] The second common deferral reason of voluntary donors in our study is abnormal laboratory values, as in 18.3% of the eligible donor candidates. Leukocytosis is the most common abnormal laboratory parameter (36%), and it is followed by low hemoglobin level (35%). Leukocytosis may not be predicted at the time of the application of the donor, but low hemoglobin level may be suspected during a detailed personal history inquiry.

The third most frequent deferral reason in voluntary donor inquiry is recent drug use (14.7%). The most commonly used drugs are nonsteroid, anti-inflammatory drugs. Educating voluntary donors about blood donation may be one among the possible measures. Even though it does not seem to be prominent, body weight is among the most common reasons for donor deferral (8.6%). Withdrawal of the donor due to fear/duration of the procedure after being determined eligible for donation comes after inappropriate body weight (8.0%). In this case, the questions of the donor may be answered in detail and the donor may be given enough time to make a decision. If he/she has time constraints, a more convenient time for the procedure may be decided mutually. Hyper/hypotension before the procedure was another deferral reason (4.8%). These donors may have a rest for a while and be reassessed by retaking the blood pressure. If still not eligible, the donor may be invited back another day. The number of voluntary female donors is too low, and there was no specific reason for this small number. Therefore, population-based education was planned. More rare deferral reasons among the applicants to our center were recent surgery (3.5%), blood group difference (2.2%), risky sexual behavior (1.9%), recent alcohol consumption (1.6%), tattoo/piercing (1.2%), and other reasons combined making a total of 9% of the deferrals. These rare reasons can be evaluated, and increasing the awareness of donors with education might be a solution to eliminate these reasons.[10],[11],[12],[13],[14]

In conclusion, as is well known, the blood products have vital importance. Thus, during the assessment of the blood product donors, accurate selection of the candidates should be performed very carefully so as not to harm the donor and supply the demand of the recipient appropriately. Plateletpheresis suspension, which is a blood product, is of importance because of its preparation method and short shelf-life. Thus, in this study conducted in our blood bank, we aimed to show the reasons for donor deferral and detect the possibly preventable reasons. On the basis of this information, the availability of an intermittent flow system as well as a continuous flow system may overcome the problem of inappropriate vascular access and increase the collection rate. Finally, in addition to improving the technical capacity within the hospital, organizing educational meetings to increase social awareness may decrease the deferral rates.

Acknowledgements

We thank our apheresis team for their technical assistance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Bilgen H. The blood donor ’of donors’ selection. Transfusion Medicine Symposium Series for Everyone; May 2005. p. 14-42. [in Turkish].  Back to cited text no. 1
    
2.
Szczepiorkowski ZM, Winters JL, Bandarenko N, Kim HC, Linenberger ML, Marques MB et al. Guidelines on the use of therapeutic apheresis in clinical practice − Evidence-based approach from the Apheresis Applications Committee of the American Society for Apheresis. J Clin Apher 2010;25:83-177.  Back to cited text no. 2
    
3.
National Blood and Blood Products Guide; 2012. [in Turkish].  Back to cited text no. 3
    
4.
National Blood Centers and Transfusion Medicine Course VII; 2004. [in Turkish].  Back to cited text no. 4
    
5.
Yin G, Xu J, Shen Z, Wang Y, Zhu F, Lv H. The relationship of platelet yield, donor’s characteristic and apheresis instruments in China. Transfus Apher Sci 2013;49:608-12.  Back to cited text no. 5
    
6.
Collection of Platelets by Automated Methods. Bethesda, MD: Food and Drug Administration (Center for Biologics Evaluation and Research); 2007.  Back to cited text no. 6
    
7.
Norol F, Aubert C, Scotto F, Duedari N. Apheresis experience with a continuous flow cell separator. Transfusion 1988;28:470-3.  Back to cited text no. 7
    
8.
Tondon R, Pandey P, Chaudhry RA. 3-Year analysis of plateletpheresis donor deferral pattern in a tertiary health care institute: Assessing the current donor selection criteria in Indian scenario. J Clin Apher 2008;23:123-8.  Back to cited text no. 8
    
9.
Fraser JL, Whatmough A, Uhl L, Kruskall MS. Lowering the hemoglobin cutoff for female plateletpheresis donors. Transfusion 1998;38:855-9.  Back to cited text no. 9
    
10.
Newman B. Blood donor suitability and allogeneic whole blood donation. Trans Med Rev 2001;15:234-44.  Back to cited text no. 10
    
11.
Arslan O. Whole blood donor deferral rate and characteristics of the Turkish population. Transfus Med 2007;17:379-83.  Back to cited text no. 11
    
12.
Zou S, Musavi F, Notari EP, Rios JA., Trouern-Trend J, Fang CT. Donor deferral and resulting donors loss at the American Red Cross Blood Services 2001 through 2006. Transfusion 2008;48:2531-9.  Back to cited text no. 12
    
13.
Agnihotri N. Whole blood donor deferral analysis at a center in Western India. Asian J Transfus Sci 2010;4:116-22.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Shaz BH, James AB, Hillyer KL, Schreiber GB, Hillyer CD. Demographic variations in blood donor deferrals in a major metropolitan area. Transfusion 2010;50:881-7.  Back to cited text no. 14
    



 
 
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