Repeated Plasmapheresis of Blood Donors As a Source of Platelets

Transcription

From www.bloodjournal.org by guest on October 28, 2014. For personal use only.
1961 18: 303-309
Repeated Plasmapheresis of Blood Donors As a Source of Platelets
ALLAN KLIMAN, LAWRENCE A. GAYDOS, LESLIE R. SCHROEDER and EMIL J. FREIREICH
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Copyright 2011 by The American Society of Hematology; all rights reserved.
Repeated
By
ALLAN
Plasmapheresis
As a Source
KLIMAN,
LAWRENCE
EMIL
AND
F
RESH
WHOLE
of platelet
thrombocytopenic
a
volume
mainy
come
Pmitation
are
form
of
been
ing
bleeding
and
The
The
the
donate
very
development
the
red
by
problem
to the
when
pheresis
was
frem
adapted
has
produce
the
normal
Normal
blood
health,
donors
had
were
an
initial
quantities
considered
hemoglobin
the
of plasma
amounts
This
the
procedure
By return-
normal
are
re-
individual
to
of overcoming
required
for
any
platelet
transfusions
in
the
technic
of plasma-
of
report
and
made
platelets
unhappy
donation.3
as a means
of repeated
leukemia,
of find-
the
the
has
allows
transfusion
blood
perparing
of blood
suggested
large
MATERIALS
general
been
of donors.
of platelet
on
form
have
problems
avoiding
equipment
alternate
large
group
as a source
plasmapheresis
donors,
and
the usefulness
patients
with
to
a small
of blood
so
thrombo-
materials
the
a
have
of
platelet-rich
about
use
cut-
represent
treatment
bleeding
plasmapheresis
and
of supply
of
phlebotomy
donor,
repeatedly
In order
to study
thrcmbocytopenic
pheresis
hours
its
a successful
considerations
long-term
revolve
means
effect
on
imposes
restricts
of
concentrates
with
and
and
chances
practical
the
emergency
hut
limited
of whole
blood
platelet
but
for
as an
purpose.
treating
veniently
and
SCHROEDER
as an
therapy
where
associated
of plastic
cells
used
platelet
numbers
four
feasible
plasma
of
Gardner2
large
R.
LESLiE
widely
bleeding
difficulties
within
wastage.
of plasmapheresis
ing
form
exploitation
discussed
for transfusion
sults
of blood
been
replacement
full
patients.
recently
GAYDOS,
FREIREICH
plasma
platelet
their
A.
J.
Donors
does
have
a definite
The red cell ccntent
serious
Platelet-rich
prevented
cytopenic
has
this
to
with
small.
possible
far
BLOOD
transfusion
and
hemorrhage.’
to patients
of Blood
of Platelets
platelet-rich-plasma
describes
details
the
con-
use
the
effects
Gm.
per
of plasma-
of intensive
donor.
AND
METhODS
acceptable
concentration
for
plasmapheresis
of
12.5
if they
were
cent
or
in
good
above,
a
platelet
count
of 150,000
num.34
and a total
protein
concentration
above
6.5 Cm.
per
cent
(biuret
nuethod).
Six such
donors
were
chosen
and agreed
to provide
plasma
for
leukemic
children
as required.
Donors
were
subjected
to plasmaphieresis
as often
as the
recipient
required
platelet
transfusions
but in no case was any donor
used
more
than
twice
in one week. The donors
were studied
by determining
hematocrit,
huenuoglobin,
reticulocyte
count.5
white
blood
cell count,6
platelet
count4
and total protein
(hiuret)
concentration
at
the start of each plasmapheresis,
at the end of each
procedure
and
after
termination
of a
period
of plasmapheresis.
Isohemagglutinin
titers7
were
performed
periodically
on
the
donors’
sera to obtain
a practical
measurenuent
of antibody
activity
during
and after
the
period
of plasmapheresis.
In addition,
the donors
were observed
by a physician
during
the
From
Institutes
the Division
of Biologic-s
Standards’
and the National
of Health, Bethesda, Md.
Submitted
Mar. 24, 1961; accepted
for ;nthlication
May 13,
303
Cancer
1961.
Institute,
National
304
KLIMAN,
CAYDOS,
SCHROEDER
AND
FREIRFICII
NEEDLE
SATELLITE
PLASMA
BAG
SATELLITE
PLASMA
BAG
Fig.
1.-Equipment
for
obtaining
500
ml.
of
plasma
by
plasmapheresis.
procedure
amid were also asked
to report
all subjective
reactions
and any chauuge
itu general
health
or well-being.
Plasnuapheresis
was performed
using the plastic
equipnuent
illustrated
in fig. I. This was
a “Double-Blood-Pack
Double
Plasmapheresis
Set (Fenwal
#Y-2086,
Fenwal
Laboratories,
Inc., Morton
Grove,
Ill.) which
was connected
to a standard
blood
recipient
set. The
donor
was
bled into
the container
nearest
the phlebotomy
needle
and this first unit was
then
detached
for centrifugation
fusion
of
blood
was
iuuinutes.
-
per
to
was
cent
the
separation
at
expressing
donor.
collected
As
red
22
returned
isotonic
on
the
saline
the
cell
in
the
as retransfusion
Each
donor
platelet-rich-plasmas
to
was
for
determine
of
with
a slow
at
1100
red
500
process
of
With
this
sequence,
10
blood
while
mg.
the
the
the
of
white
thue effect
bag,
transfusion
a total
and
open
a second
and
received
Platelet
Centrifuge
plasma
repeated.
collected
kept
platelet-rich-plasnua,
completed,
container,
retransfusion
was
obtain
satellite
was
blood
procedure.
To
International
into
be
needle
saline.
a PR-2
plasma
could
the
phlebotonuy
isotonic
thue second
to the donor.
during
C.
soon
i,ul. of plateletrichLplasnua
were
in
the
using
and
while
lueparin
centrifuged
After
turned
imnit
ma
.02
ml.
for
re-
whole
the
counts
a
packed
and
15
were
blood
centrifsmgation,
of heparin
cell
r.p.m.
cells
in-
whole
plas-
total
of
red
500
500
cells
nul.
were
performed
after
sluowed
centrifugation.
RESULTS
The
studied
immediate
in all
effects
six
do,uors.
of
removing
Coiuuparison
500
of
ml.
heinogram
of
before
and
were
of
PLASMAPHERESIS
OF
change
no
beyond
components
able
the
were
to collect
serum
5.7
of repeated
six
liters
donors.
of plasma
abrupt
cessation
determinations
of
these
components.
and
In
four
one
donors
one
Although
tensive
titers
before)
of protein
was
a trend
of
this
variation
significant
change
No
and
the
is
the
titers
to
12.5
obtained
by
not
considered
in isoagglutinin
hema-
at
any
time
Gm.
per
ceiut.
after
on
abruptly
blood
those
of
cell
donors.
plasmapheresis
protein
concentration.
tube
significant
titer
was
as
of
in
and
one
Serial
well
depletion
intervals
rise
two
minimal.
as
observed
with
in
to
effect.
obtained
to compare
ef-
tolerated
variation
below
values
after
activity
was
significant
were
per
the
up
well
determinations
initial
during
of
reticulocytes
was
ml.
dilution
during
for
the
seen
even
method
with
in-
plasmapheresis.
Table
3 gives
information
Table
1.-Immediate
Hemoglobin
Gm.
on
the
Effects
%
per
range
median
13.8
13.1
4700
Postplasma-
13.9
Table
E.:
The
med
ians
n
above
plasmapheresis
coent
per
protein
%
Gm.
range
median
range
42
40
185
152
6.7
Cl
268
39
183
at
least
6.1
5.7
230
s even
Plasmapheresis
7.0
138
44
sep
occasions
arate
on Normal
Platelet
%
Total
mm.’
median
42
represent
Hematocrit
of Plasma
range
4200
of Repeated
x 10’
thrombocyto-
median
5600
give
ml.
the
44
Duration
of
#{231}
Hematocrit
5600
5000
2.-Effects
Plasma
produced
500
to
Platelet
range
14.3
T.
of Donating
6500
13.3
pheresis
transfused
cells
mm.’
15.0
pheresis
material
blood
White
median
Preplasma-
Donor
the
1000
recognizable
ever
protein
in
to
was
individual
was
of
of changes
concentration
days
no
some
never
2 describes
removal
and
determinations
as
index
there
plasmapheresis,
employed.
same
no
cells
response
serum
ml.
protein
95
hut
effects
concentration
as
revealed
reticulocyte
follow-up
the
Isoagglutinin
provided
protein
was
250
Table
and
Total
taken.
with
blood
there
plasmapheresis,
averaged
days.
long
determination
where
terminating
counts
no
hemoglobin
were
from
95
as
protein
While
hemoglobin,
only
of plasma
were
levels.
cent
paucity
produced
total
per
the
shows
in serum
white
Gm.
and
hemogram
a period
protein
immediate
plasmapheresis
over
and
0.6
varying
blood
we
the
to
of plasmapheresis
platelets
and
10
on
hemoglobin,
luematocrit,
t()crit
rates
of
as cellular
plasmapheresis
illustrates
ml.
at
change
repeated
1
frcm
intensive
10 days,
in
average
500
so far
of
of serum
donors
when
ranging
Despite
blood
six
plasmapheresis
Plasinapheresis
and
an
Table
performed
periods
variation
occasions
determinations
of the
was
for
19
fell
observed
Plasmapheresis
the
after
305
SOURCE
individual
cent.
one
components
fects
of
On
ier
on
and
limits
and
Gm.
plasmapheresis
week
PLATELET
concentrations
below
blood
AS
concerned.
before
protein
fell
DONORS
x 10,
count
per
Blood
6.4
of
plasmapheresis.
Donors
Total
mm.’
--
protein
Gm.
%
Donor
(ml.)
(in_days)
median
range
median
range
median
range
L. T.
2000
10
41
40-41
210
158-255
6.8
6.5-7.3
E. S.
2000
13
43
41-45
273
228-305
6.4
6.2-7.0
C. B.
2500
20
41
39-42
288
220-.38()
6.7
6.5-7.0
E. K.
9500
95
42
38-44
263
168-313
6.7
6.1-7.5
T.E.
7000
52
39-45
185
105-268
6.7
6.2-7.1
F. K.
3500
40
41
49
48-49
220
188-248
7.1
6.6-7.5
306
KLIMAN,
Table
3.-Median
Platelet
Donors
and
Donor
Donor
No. of
counts
ES.
5
C. B.
L. T.
GAYDOS,
Counts
on the
on Platelet-Rich
SCHROEDER
Peripheral
Plasmas
AND
Blood
of Plasmapheresis
Produced
Platelet-rich
blood
Median
count
platelet
x 10’
plasma
Median
count
No. of
plasmas
Range
FREIBEICH
platelet
x l0
Range
273
305-228
8
448
6
288
380-220
7
528
778-463
4
243
255-158
8
403
530-323
E. K.
21
263
313-168
25
440
1293-290
F. K.
7
228
248-193
12
518
12.50-353
penic
recipients.
The
centrifugation
method
used
produced
ml. of plasma
in every
case although
the red cells were
platelet
counts
on the plasma
were
always
higher
250
The
donor’s
whole
relatively
plasma.
unmoved
Despite
the
no
blood,
significant
after
often
by
fact
by
the
that
change
in
a factor
of
centrifugation
a platelet-rich
platelet
count
533-358
approximately
only loosely
than
those
2. Presumably,
the
and
remained
product
was
in the
consistently
was
noted
in
any
packed.
on the
platelets
were
supernatant
obtained,
donor
during
or
plasmapheresis.
DiscussioN
The
procedure
of
at a time
from
vide
a uniform
became
but
the
apparent
ing
This
the
plasma
is in
less
could
contrast
to
processing
the
and
With
proficiency,
the
plasma
by plasmapheresis
be
recipient
plasma
that
could
Since
veins
only
was
ture
one
of suitable
The
The
donor
The
technic
no
veins.
No
described
Blood
equipment
and
venipuncture
we
does
not
described
used
to
the
donor
without
the trans-
since
the
not
blood
processrepeated.
units
a transfusion
which
is prepared.
of obtaining
500 ml. of
frequently
only one hour
favorably
It had
with
the time
the advantage
donor,
the
a time
and
discontinued
reactions
is simple
produces
at
be
differ
to see
were
from
such
fresh
to
for
platelet-rich
of
in
a large
twice
design,
completely
in
much
when
in
investment
per
series
donation
series.
compared
use
disposable
biomechanical
plasma
blood
larger
by
of
expendi-
in this
whole
in any
advantages
care
of
encountered
plasmapheresis
as
scruplous
because
ordinary
reactions
certain
technic
require
of the
necessary
have
may
by
and
whole
time
contrasted
blood
units.
had
vasovagal
Fractionator
to proIt soon
as prepared.
was
donor
tolerated
donor
multiple
study
procedure
antigenicity.
work,
each
for the procedure
two hours
and
as soon
procedure
does
not
we would
expect
method
Cohn
initial
well
source
of platelets
whole
blood.
For
for
each
This
whole
of
laboratory
with
required
was under
ml.
only
once
situation
the
maintained,
but since
the
in this potential,
the
after
be transfused
not
routine
crossmatching
time
500
as a research
of platelet
a reliable
fresh
done
and thirty
minutes
were
needed.
produce
plasma
from
multiple
the
was
providing
in procuring
required
crossmatching
require
of
obtain
developed
for studies
procedure
in terms
encountered
the
and
to
donor
was
of platelets
that
economical
difficulties
fusionist,
plasmapheresis
a single
supply
to
others.8’9
for
each
apparatus.
phlebotomy
as
PLASMAPHERESIS
OF
does
the
any
amount
Cohn
the
any
tion
Blood
rates
for
was
ability
level
and
plasmapheresis
for
was
is
that
even
blood
donors
affected
was
the
were
serum
to increase
cells
might
the
most
states’12
production
present
that
normal
have
this
is related
physiologic
series,
six
have
required
means
been
followed.
that
guided
limited
The
fact
for
donors
they
required
them
liter of plasma
the
might
that
production.
prove
deple-
the
limits
plasma
limiting
the
of
protein
factor
of
many
American
weeks.
Red
Cross
data
given
produced
that
Whipple1#{176} long
ago
noted
could
not
render
used
as well.
the
experience
fact
were
not
safely
infusions
can
concentration
survival
time
in the
be
plasma,
more
donation
blood
500
ml.
every
increasing
plasmapheresis
the
of plasma
out
the
of plasma
than
that
presently
eight
nations
weeks,13
production
we
actually
of one
if con-
is limited
the
potential
critical
in examining
and preservatives
convenient
on
the effect
platelet
of time,
response
by
technic
supply
study
deserve
separate
discussion
However,
it should
be apparent
may
affect
platelet
a given
recipient,
we
capabilities
that production
depletion
even
is especially
thrombocytopenic
than
which
conventional
expansion
plasma
Since
than
not
equipment
amount
had
pointed
limits
indicates
significant
whole
Until
had
of
an
enormous
The data
obtained
is not attended
by
to less
plasma
donors
donors
to the
donated
that
efficiency
it should
he
patient
rather
pushed
hypo-
in human
per week.
From
the data
limitation
to plasma
dona-
of
the
but
the
clogs
production.
blood
separate
emphasizes
per
in
them
in clogs
and
liters
of 106
plasma
Studies
protein
human
the
various
factors
which
can
be kept
constant
for
platelet
immunity,
cell
of plasma
practical
26.5
phlebotomy
is capable
of
a factor
of 32.
here
of
normal
The platelet
response
aspects
of this
have been
reported
in detail
elsewhere.14
and
controlling
Since
the donor
liter
is red
500 ml.
that
the
to plasma-
limitation
of one
to donor
motivation
effects
of plasmapheresis.
have
to produce.
per week
of plasmapheresis
plasma
by at least
the
clear
physiologic
was
than
plasmapheresis
affords,
by the requirements
of
donor.
in
This
pro(lt1ctin
to confirm
less
donors
the
only
the
diet
plasmapheresis
would
tinued
intensive
significant
not passed.
The only parameter
protein
level.
Considering
the
the
deficient
tended
is far
study
currently
to any
and
produce
more
no
it seems
plasmapheresis
a protein
been
attempted
at rates
beyond
presented,
it may
be surmised
of the
to
were
donors,
cellular
eventually
capabilities.
intensive
unless
diseases
seems
indicate
within
protein
were
adapted
here
blood
and
studies
well
proteinemic
supplies
readily
described
normal
observed
production
other
week
In
be
plasmapheresis.
protein
preresis,
tion
rather
can
individual.
normal
distinctly
\Vhile
the
of
307
SOURCE
a single
of the bone
marrow
rather
than
the blood
to routine
PLATELET
reported
components
plasmapheresis
that
from
previously
of blood
AS
Fractionator
of plasma
Although
than
l)ONORS
for
of
and
from
studying
transfusion.
evaluation
of
temperature,
and platelet
recipient.
SUMMARY
Repeated
six normal
plasmapheresis
donors
for the
with
purpose
simple
plastic
of obtaining
equipment
was
platelet-rich-plasma.
performed
on
Plasma-
KLIMAN,
.)
pheresis
was
periods
up
performed
at
to three
platelet-rich-plasma,
blood
an
donations
had
No significant
the
in
tensive
of
up
The
six
donors
amount
and
means
protein
plasmapheresis
abruptly
terminated.
for producing
large
Repeated
amounts
means
donor
factors
Repetite
in
plasmaphereses,
effectuate
con
in sex
plachettas.
normal
haherea
lste
(Jilantitate
(los
conventional
requirite
Ni ii Jo significative
osseva
observate
luliluimo.
Nulle
incontrate,
Repetite
mesmo
quando
plasmaphereses
reactiones
pn
methodo
practic
de
tin
were
observed
to
inwas
method
a practical
studies.
simple
equipamento
plastic,
de ohtener
rendimento
es-
plasma
nc
(Ic usque
perioclos
cle usque
a tres menses.
litros
(le l)las1n1
nc in plachettas.
separate
do
e
a ille
(lonatmnes
do sanguine
si nietluo-
hemoglobina,
depletion
plachettas,
del proteint
Jo
intense
programma
o lot icocvtos
seral
esseva
plasmaphreso
do
esseva
le procedimento
esseva
terminate
abruptemente.
ab donatores
particular
es tin convenihile
methoclo
grande
quantitates
rn Ic controlo
(Ic transfusion
of
separate
empleate.
alterationes
Ic donatores.
in
for
liters
reactioius
procedure
is a convenient
and
affords
transfusion
durante
cle 26,5
106
essite
habeva
cells
when
Ic objectivo
effectuate
con tin
esseva
week
106
No
the
con
septimana
un total
per
of 26.5
INTERLINGUA
Ic uso
donatores
Plasrnapherese
a 10(X) ml cle plasnia
per
Le sex donatores
prodticeva
or white
minimal.
even
IN
FREIREICH
used.
was
in platelet
plasma
requried
donor
plasmaplueresis
SUMMAR!O
seva
been
AND
a total
have
platelets
encountered
of
of
produced
depletion
were
SCHROEDER
ml.
1000
would
in hemoglobin,
serum
of controlling
to
which
conventional
changes
donors
rates
months.
GAYDOS,
de
do
plasma
factoros
nc
in
plachettas
e
con Jo donator
connectite
provide
on
in studios
(10 plachettas.
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Repeated Plasmapheresis of Blood Donors As a Source of Platelets

Transcription

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