Reduced use of allogeneic platelets through high‐yield perioperative autologous plateletpheresis and reinfusion. Issue 5 (28th October 2013)

• Record Type: Journal Article
• Authors: Alberts, Melissa; Bandarenko, Nicholas; Gaca, Jeffrey; Lockhart, Evelyn; Milano, Carmelo; Alexander, Stanlin; Linder, Dean; Lombard, Frederick W.; Welsby, Ian J.
• Is Part Of: Transfusion. Volume 54:Issue 5(2014)
• Page Start: 1348
• Page End: 1357
• Publication Date: 2013-10-28
• Subjects: Hematology -- Periodicals; Blood -- Transfusion -- Periodicals; Blood Group Antigens -- Periodicals; Blood Preservation -- Periodicals; Blood Transfusion -- Periodicals; 615
• DOI: 10.1111/trf.12463
• Languages: English
• ISSNs: 0041-1132

Abstract

<abstract abstract-type="main"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="trf12463-sec-0001" sec-type="section"> <title>Background</title> <p>Intraoperative autologous platelet (PLT) collection as part of a multimodal blood conservation program carries a Class IIa recommendation from the Societies of Thoracic Surgeons and Cardiovascular Anesthesiologists, but achieving a suitable PLT yield limits its application. A novel, autologous, intraoperative, high‐yield plateletpheresis collection program was established and retrospectively analyzed to identify potential improvements over previously reported plateletpheresis protocols.</p> </sec> <sec id="trf12463-sec-0002" sec-type="section"> <title>Study Design and M‐ethods</title> <p>Targeting complex cardiothoracic surgery patients without recent anti‐PLT agents, thrombocytopenia, or severe anemia, the program aimed to achieve a PLT yield of at least one standard apheresis unit (3.0 × 10<sup>11</sup>) within 60 to 90 minutes and using an automated plateletpheresis device (Trima, Terumo BCT). Anesthetized and invasively monitored patients underwent plateletpheresis via a large‐bore, indwelling central line placed for the surgery. Collection‐related data for quality control purposes and subsequent PLT transfusion requirements were analyzed and reported.</p> </sec> <sec id="trf12463-sec-0003" sec-type="section"> <title>Results</title> <p>Forty‐two patients donated autologous PLTs between 2011 and 2012. PLT yield was 4.5 (3.9‐5.0) × 10<sup>11</sup>, which significantly exceeds previously reported yields, and procedure duration was 53.2 (48.4‐57.9) minutes. As anticipated, postcollection PLT count decreased from 268 (242‐293) × 10<sup>9</sup> to 182 (163‐201) × 10<sup>9</sup>/L; hypocalcemia was minimized by infusion of 1 g of CaCl<sub>2</sub>. Autologous PLT yield was inversely correlated with allogeneic PLT use, and avoidance of allogeneic PLT transfusion was increased when the autologous yield was the equivalent of 2 or more apheresis units.</p> </sec> <sec id="trf12463-sec-0004" sec-type="section"> <title>Conclusion</title> <p>High‐yield, intraoperative autologous PLT collection is achievable using an automated plateletpheresis device. Initial experience shows a reduction in reliance on allogeneic PLTs for complex cardiothoracic surgery.</p> </sec> </abstract>