|Year : 2016 | Volume
| Issue : 4 | Page : 174-179
Hematological and biochemical parameter alteration after plateletpheresis donation
Manal H Farahat MD 1, Mohammad A Sharaf2
1 Department of Clinical Pathology, Faculty of Medicine, Zagazig University Hospitals, Zagazig, Egypt
2 Department of Biochemistry, Zagazig University Hospitals, Zagazig, Egypt
|Date of Submission||07-Sep-2016|
|Date of Acceptance||22-Sep-2016|
|Date of Web Publication||20-Jan-2017|
Manal H Farahat
Department of Clinical Pathology, Faculty of Medicine, Zagazig University Hospital, Zagazig, 11111
Source of Support: None, Conflict of Interest: None
Background The plateletpheresis process is a great improvement in transfusion medicine, and it is thought to be generally safe to the donor. However, donors’ safety issues and the anticoagulant used during these procedures have not been fully explored. This study aimed at analyzing the significance of alteration in some hematological parameters, total calcium and total magnesium levels, in donors after plateletpheresis procedure.
Materials and methods The plateletpheresis procedures were performed on 72 donors. Prehematological and posthematological values were analyzed, such as hemoglobin concentration, hematocrit, platelet, white blood cell, red blood cell, mean platelet volume, and platelet distribution width, as well as measured total serum calcium (tCa2+) and magnesium levels (tMg2+), at different time intervals during and after the procedure in all donors.
Results After plateletpheresis procedures, we observed that the hemoglobin concentration, hematocrit%, and white blood cell count were highly significantly decreased (P<0.000), platelet count was decreased significantly (P<0.001) in the donors, and there was a significant slight increase in mean platelet volume (P=0.036), without significant changes in platelet distribution width and red blood cell. In addition, there were significant decrease (P<0.05) in mean total serum calcium and magnesium levels after 60 min from the procedure onset compared with values of baseline levels, and their levels increase again near baseline levels 30 min after the procedure.
Discussion Plateletpheresis procedures are very safe for donors; however, indicated biochemical and hematological parameters before and after the donation are definitely useful to establish postdonation reference ranges that are needed for carefully monitoring, retaining and following-up the donor, reviewing the repeated donations, and to protect donation safety by looking for the cumulative effects of these changes, as well as transfusion of blood products with higher-quality needs.
Keywords: biochemical, donation, hematological, parameters, plateletpheresis
|How to cite this article:|
Farahat MH, Sharaf MA. Hematological and biochemical parameter alteration after plateletpheresis donation. Egypt J Haematol 2016;41:174-9
|How to cite this URL:|
Farahat MH, Sharaf MA. Hematological and biochemical parameter alteration after plateletpheresis donation. Egypt J Haematol [serial online] 2016 [cited 2018 Oct 21];41:174-9. Available from: http://www.ehj.eg.net/text.asp?2016/41/4/174/198652
| Introduction|| |
Apheresis is a procedure to collect either one or more specific blood components, such as platelets, (plateletpheresis), plasma (plasmapheresis), and stem cells, with the benefit of collection of standardized highly qualified product . Plateletpheresis is a procedure in which whole blood is processed from a donor, platelets are separated alone, and the other blood components are returned to the donor. The repeated plateletpheresis donation might lead to a great amount of cell loss and clinically significant problems in donors, such as transient thrombocytopenia and anemia .
In addition, citrate is used as an anticoagulant in plateletpheresis procedures in the form of acid citrate dextrose (ACD) through reversible chelation of circulating calcium and magnesium , causing alternation of the level of total calcium (tCa2+), which may result in donor hypocalcemia, as well as total magnesium (tMg2+), which is involved in many metabolic processes, and therefore it may affect both calcium metabolism and parathromone response .
The standard citrate infusion rate for plateletpheresis procedures is to prevent its accumulation to toxic levels in the donor ; the half-life of infused citrate is 36±18 min, which is infused at a higher rate than its removal. It is reported that the ratio of 12 : 1 is the ratio of whole blood to citrate anticoagulant. Although donors can generally tolerate up to a 20% decrease in ionized calcium levels , but repeated and longer procedures, might resulted in citrate accumulation and significant donor symptoms, which were found to be more among platelet donors. As according to previous literature about 16–50% plateletpheresis donors develop citrate-related reactions . Magnesium levels decrease up to 30–50% depending on the procedure performed, and the citrate infusion rate may also result from increased urinary excretion of magnesium, which occurred during and after apheresis. Although the drop in magnesium levels is faster and takes longer time to recover when compared with calcium levels, symptoms are very similar to that of hypocalcemia .
The present study was aimed to analyze the significance of alteration in some hematological parameters, total calcium and total magnesium levels at different time intervals in donors after plateletpheresis procedure.
| Materials and methods|| |
All the procedures were performed on 72 healthy plateletpheresis donors in our Blood Transfusion Center of University Hospitals between February and April 2016, who gave their informed consent; all were male donors aged between 21 and 47 years, and the study was approved by our institutional ethical committee. Trima Accel automated blood collection system (Terumo BCT software, version 6.0; Terumo BCT, Lakewood, Colorado, USA), the closed system apheresis kits, and anticoagulant ACD in the proportion of 1 : 10–1 : 12 (blood flow rate 50–80 ml/min) were used for the plateletpheresis procedure.
According to our institutional standard donation criteria, regulation for plateletpheresis donation was restricted to predonation platelet count greater than or equal to 200×103/µl; hemoglobin levels greater than or equal to 12.5 g/dl; donor body weight greater than or equal to 60 kg and with adequate venous access; and time interval of at least 3 months from last whole blood donation and 10 days from last plateletpheresis donation. In addition, avoiding intake of acetylsalicylic acid or nonsteroidal anti-inflammatory drugs for at least 7 days and avoiding the intake of prophylactic calcium or magnesium supplementation before the procedure were the other criteria. All donors were nonreactive to hepatitis C antibody; hepatitis B surface antigen; HIV-1,2 antigen/antibody; and syphilis.
Whole blood was taken from the donor into EDTA tubes just before apheresis (baseline) and within 30 min after procedure. Predonation and postdonation hematological values for hemoglobin concentration (Hb), hematocrit % (Hct%), platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), red blood cell count (RBC), and white blood cell count (WBC) were measured using Sysmex XN-2000 (Sysmex Corporation, Kobe, Japan).
Biochemical measurement of total calcium and magnesium
Whole blood samples were obtained under aseptic precautions in a plain vial from each apheresis donor just before the procedure (baseline), at 60 min (during the procedure), and at 30 min after the end of the procedure. Samples were collected from each time interval, they were centrifuged, and the supernatant was used for in-vitro quantitative determination of tCa2+ and tMg2+ levels, which was performed by Calcium Gen.2 and Magnesium Gen.2 on Roche/Hitachi Cobas c 701/702 systems (Roche Diagnostics GmbH, Mannheim, Germany).
Serum calcium ions (Ca2+) react with 5-nitro-5′-methyl-BAPTA (NM-BAPTA) under alkaline conditions to from a complex. The complex formed reacts in the second step with EDTA. The change in absorbance is directly proportional to the calcium concentration and measured photometrically at a wavelength of (sub/main) 376/340 nm ,.
In addition, complexometric colorimetric end point method was used to determine magnesium in an alkaline solution containing EDTA to mask the calcium in the samples. Magnesium forms a purple complex with xylidyl blue and diazonium salt. Magnesium (Mg2+) concentration is measured photometrically by the decrease in the xylidyl blue absorbance at a wavelength of (sub/main) 505/600 nm .
The statistical analysis was performed using SPSS computer software, version 20 (SPSS Inc., Chicago, Illinois, USA). Data were presented as mean±SD. The mean preplateletpheresis and postplateletpheresis values were compared and tested for statistical significance using paired t-test. Differences were considered to be statistically significant when the P value was less than 0.05.
| Results|| |
The plateletpheresis procedures were performed on 72 healthy donors, with a mean blood volume processed of 4774±624 ml over a mean duration of run of 77.9±10 min by using 413±59.3 ml of ACD during procedures.
After the plateletpheresis procedure (postdonation), the Hb concentration, Hct%, and WBC count were highly significantly decreased (P<0.000), and PLT count was decreased significantly (P<0.001). In addition, there was a slight statistically significant increase in MPV postdonation. However, there were slight nonstatistically significant decreases in postdonation PDW and RBC ([Table 1]). We noticed that two donors (2.8%) had a postplateletphersis Hb level of less than 12 g/dl, but no clinical event occurred either during or after the procedure, which according to the WHO defines anemia in any normal adult; one had a predonation Hb level of 12.6 g/dl and the other had a level of 12.9 g/dl. The other two donors (2.8%) had a postprocedure PLT of less than 100×103/µl; one of them had a preplateletpheresis PLT of 235 and the other had a count of 222×103/µl.
|Table 1 Hematological values alteration before and after plateletpheresis procedure (n=72)|
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[Table 2] and [Figure 1] show a significant drop (P<0.05) in mean total calcium levels of donors at 60 min during the procedure, with a mean difference of 1.35±0.78, representing about 14% decline compared with baseline levels, but the levels increased close to their initiating baseline levels with a mean difference of 0.45±0.50 30 min after the procedure. In addition, [Table 3] and [Figure 2] show a significant decrease (P<0.05) in mean total magnesium concentration of donors at 60 min during the procedure with a mean difference of 1.07±0.25, representing about 47% drop compared with baseline levels, but the levels increased close to their initiating baseline levels with a mean difference of 0.16±0.30 30 min after the procedure.
|Table 2 Alteration in serum total calcium levels at different time intervals after plateletpheresis procedure (n=72)|
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|Figure 1 Comparison of total serum calcium levels at different time intervals during plateletpheresis. 0 min, baseline value; 60 min, 60 min from starting the procedure; post-30, 30 min postprocedure.|
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|Table 3 Alteration in serum total magnesium concentration at different time intervals after plateletpheresis procedure (n=72)|
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|Figure 2 Comparison of total serum magnesium concentration at different time intervals during plateletpheresis. 0 min, baseline value; 60 min, 60 min from starting the procedure; post-30, 30 min postprocedure.|
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| Discussion|| |
More prospective studies are required to establish guidelines for donor safety in parallel to product quality while performing collection of apheresis platelet procedures such as demographic and hematological characteristics of the donor population from own plateletpheresis donor data, donor routine quality programs, and follow-up .
Single plateletpheresis procedure time ranges from 60 to 120 min, and it removes about 25–50% of circulating platelets, but significant thrombocytopenia does not occur because of the release of sequestered platelets in the donor spleen; such a decrease of donor’s PLT usually rebounds after 1–2 weeks. Although such a decrease in hematological values after plateletpharesis was expected, adverse clinical events, such as thrombocytopenia and anemia, should always be prevented for donor safety . However, the short- and long-term effects of this procedure on donor platelet are not clear .
In the present study, we evaluated donor safety issues with regard to donor hematological values after plateletpheresis. We noticed a statistically significant decrease of postdonation Hb concentration (P<0.000), with a mean difference of 0.4±0.3 (2.7%), Hct of 1.1±0.9 (2.5%), and WBC count of 0.7±0.2 (9%) from preprocedure values in the plateletpheresis donors; a significant decrease (P<0.001) in postdonation PLT with a mean difference of 111.2±23.9×103/µl (38.6%) in all of the procedures; a slight but statistically significant increase (P=0.036) in postdonation MPV of −0.1±0.4 (0.95%); and a nonstatistically significant decrease in RBC count of 0.07±0.3 (1.4%) (P=0.060) and PDW 0.2±0.9 (1.6%) (P=0.076).
Previous studies regarding the hematological value changes after plateletpheresis donation are still controversial and provide conflicting data. Some studies showed significant reduction in Hb concentration, Hct, and WBC count after plateletpheresis. In contrast, other authors described its increase.
The study by Suresh et al.  found almost similar results as ours, and it was conducted on 90 donors after the plateletpheresis procedure on Fresenius Kabi AG (Else-Kröner-Straße 1, Bad Homburg, Germany); they observed that Hb (P=0.002), Hct (P=0.045), and PDW (P=0.039) values decreased significantly in the donors, and that there was a slight increase in MPV (P=0.067) and a decrease in MCV and RBC (P>0.5), but the results were not clinically significant. In another study conducted by Das et al.  on 477 donors after plateletpheresis procedures using five different cell separators, the mean difference of Hb (0.8±0.81), Hct (2.4±2.39), PLT (67.6±29.91), and WBC count (1.1±1.55) decreased significantly in the donors (P<0.01), and there was an increase in the mean difference of postdonation MPV (−0.17±0.58) and a decrease in PDW (0.3±1.03), with no significant change after the plateletpheresis procedure (P>0.5).
Another study showed that all the postdonation hematological parameters decreased postdonation, which was conducted by Nomani et al.  on 60 regular plateletpheresis donations by Fenwal CS3000 plus (Baxter, Deerfield, IL, USA) and showed a significant decrease from the predonation values for Hb (7.82%), PLT (31.85%), HCT (9.96) %, and WBC (7.15%) (P<0.001). A study was conducted by Lazarus et al.  with similar results; this study included 939 plateletpheresis donors and documented a transient but significant decrease in blood count values, Hb, Hct, PLT, MPV, and PDW in the donors (P<0.001), although they had very good count before donation.
A study conducted by Sachdeva et al.  demonstrated conflicting results regarding increase in Hb and Hct; it was conducted on 171 donors after plateletpheresis procedure on amicus automated blood collection system, and they observed a statistically significant increase in postdonation Hb (1.7%) (P<0.001), which was explained as being due to the concentrated red cells that were transferred back to the donor and the plasma retained at the end of the procedure, as the sample was taken immediately after the procedure. They found a significant mean decrease of the postdonation PLT (74.0±36.6×103/µl) (30.7%) (P<0.001), and a nonstatistically significant mean decrease in the MPV (0.0752) (0.7%) (P=0.116) and in PDW (0.115) (0.3%) (P>0.500). Another study noticed an increase in WBC count; this study was conducted by Mahmood et al.  on 76 donors using Hemonetics MCS+ and Trima Accel (Gambro BCT, Lakewood, CO, USA) cell separators, and they found a significant reduction (P<0.001) with mean difference between predonation and postdonation values for Hb (0.2±0.5), Hct (0.6±1.3), PLT (70.5±21.9), MPV (0.3±0.3), and PDW (0.6±0.5), but in contrast they found a significant increase in mean difference for WBC (−0.4±0.6) (P<0.001).
As we noticed earlier, the hematological change values differ after the apheresis procedure and might be because of different technologies of the cell separators used, residual blood volume lost in the apheresis kit, the mechanical hemolysis of blood in tubes by machine’s pumps, and the anemia caused by hemodilution because of citrate infusion . There are also many factors that should be taken into consideration when analyzing the effect of plateletpheresis on the donor platelet, such as time interval between donations and number of donated units per single procedure . It may also be because of the methods of taking blood samples, different cell count and reagents used, time period between the end of the procedure and taking the sample, physiologic changes in the donor PLT, wide normal variation in PLTs, a reduced donor platelet reserve, or an altered megakaryopoietic homeostasis in repeated plateletpheresis donors .
In our study, two donors (2/72) (2.8%) had a postplateletphersis Hb level of less than 12 g/dl, but no clinical event occurred either during or after the procedure; one of them had a predonation Hb level of 12.6 g/dl and the other had a level of 12.9 g/dl, which had also been reported in other studies. Lazarus et al.  reported that four donors (4.4%) had a postplateletphersis Hb of less than 12 g/dl but no untoward clinical event occurred: three had a predonation Hb of more than 13 g/dl and one had a value of 12.7 g/dl. Das et al.  reported that after plateletpheresis 8.1% of the donors had a postdonation Hb of less than 12 g/dl.
We also observed that two donors (2/72) (2.8%) had a postprocedure PLT of less than 100×103/µl; although they had preplateletpheresis PLTs of 235 and 222×103/µl, associated clinical manifestations were not evident either during or after the procedure from their venous access. Some authors explained PLT decrease as a clinical thrombocytopenia in donors who have a predonation PLT of less than 200×103/µl. However, in our study, according to our departmental standard operating procedure, only those donors who have a PLT of more than 200×103/µl were taken for donation. It has been reported by other studies that plateletpheresis was associated with statistically, but not clinically, important decrease in PLT with no clinical manifestations. Suresh et al. , Das et al. , and Sachdeva et al.  found almost similar postprocedure decline in PLT of donors to less than 100×103/µl – 2.2, 2, and 2.3%, respectively – and a study by Nomani et al.  reported that postdonation PLT was less than 100×109/l in 16.6% of donors, although they have a predonation value of less than 200×109/l.
Citrate-related complications during the plateletpheresis procedure are reported to occur in donors, such as shivering, nausea, vomiting, abdominal pain, chills, fever, lightheadedness, tremors, and muscle cramps, more severe hypocalcemia, may progress to frank tetany, including life-threatening laryngospasm. However, there is individual variability in the occurrence of citrate-induced hypocalcemia; the predictors of citrate toxicity include older age, female, low body weight, performing apheresis on consecutive days, and longer total time for donation. In addition, the amount of reinfused citrate is influenced by the efficiency of centrifugation separation, the return speed, amount, and type of citrated blood component returned .
In the present study, we evaluated donor safety issues regarding donor biochemical alteration after plateletpheresis. We have measured total calcium tCa2+ and magnesium tMg2+ levels in donors before plateletpheresis procedure, at time periods of 60 min during procedure and 30 min postprocedure. A continuous and significant drop (P<0.05) in mean total calcium levels of donors was observed at 60 min during the procedure with a mean difference of 1.35±0.78, which represented about 14% decline compared with baseline levels, but the calcium levels increased close to their initiating baseline levels, with a mean difference of 0.45±0.50 30 min after procedure. Similarly, a significant reduction (P<0.05) in mean total magnesium concentration of donors at 60 min during the procedure was observed, with a mean difference of 1.07±0.25, which represented about 47% drop compared with baseline levels; however, magnesium concentration increased close to their initiating baseline levels, with a mean difference of 0.16±0.30 30 min after the procedure. This could be explained by the mobilization of their stores and increased kidney absorption; increased calcium levels might also be due to increased parathyroid hormones .
These results were almost close to those of another study that was conducted on 60 plateletpheresis donors by Solanki and Agarwal , who analyzed tCa2+ and magnesium tMg2+ levels at time intervals of 0 (baseline), 30, and 60 min during the procedure and 30 min after the end of the procedure. A continuous, significant drop (P<0.05) in mean tCa2+ levels of the donors was observed at 30 and 60 min during the procedure, with a mean difference of 0.78±0.46 and 1.50±0.84, respectively, versus baseline levels; however, calcium levels increased close to their initiating baseline levels, with a mean difference of 0.41±0.67 30 min after the procedure. Mean tMg2+ concentration of the donors significantly decreased from baseline levels (P<0.05) at 30 and 60 min, with a mean difference of 0.41±0.19 and 0.97±0.24, respectively, versus baseline levels; however, 30 min after the procedure, mean levels increased close to their initiating baseline levels, with a mean difference of 0.11±0.31.
There were certain limitations in our study; the donor sample was taken soon after the procedure. Therefore, hematological value changes that were reported may not be the changes that occurred after a longer time period (1 or 2 days), and none of the female donors could satisfy the minimum donor selection criteria for plateletpheresis in this study, and thus we could not evaluate these changes in female donors.
| Conclusion|| |
Plateletpheresis procedures are very safe for donors; in fact, as reported, severe problems occur in only a very small percentage. However, on the basis of the results of this study and also because of wide range of conflicting data given by previous studies and the number of varied factors affecting this procedure, there is a need that all transfusion centers should have their own demographic and hematological data of their plateletpheresis donors.
Therefore, indicated biochemical and hematological parameters before and after donation are definitely useful to establish postdonation reference ranges that are needed for carefully monitoring, retaining and following-up the donor, reviewing the repeated donations, and to protect donation safety by looking for the cumulative effects and any long-term consequences of these changes, as well as transfusion of blood products with higher-quality needs.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]