HOW DO I ...?
How do I provide leukapheresis products? Blood center experience and evidence for process improvement
Article first published online: 31 OCT 2012
© 2012 American Association of Blood Banks
Volume 53, Issue 10, pages 2123–2129, October 2013
How to Cite
Ginzburg, Y., Kessler, D., Narici, M., Caltabiano, M., Rebosa, M., Strauss, D. and Shaz, B. (2013), How do I provide leukapheresis products? Blood center experience and evidence for process improvement. Transfusion, 53: 2123–2129. doi: 10.1111/j.1537-2995.2012.03938.x
- Issue published online: 4 OCT 2013
- Article first published online: 31 OCT 2012
- Manuscript Accepted: 12 SEP 2012
- Manuscript Revised: 11 SEP 2012
- Manuscript Received: 11 JUL 2012
The past few decades have seen a resurgence of interest in leukapheresis products to improve the survival of infected patients with neutropenia. These products have a short shelf life and require donor stimulation with dexamethasone before collection. Additionally, a system with good communications and logistical support is essential. A recent survey of blood centers in North America revealed that the majority of centers collecting leukapheresis products use steroid-stimulated donors. The survey results suggested that an analysis of the process and potential process improvement would be of interest to the transfusion medicine community.
Study Design and Methods
Data from 2008 to 2011 regarding donor selection, donor dexamethasone stimulation, leukapheresis collection, and correlations between potentially pertinent variables for process improvement were analyzed. Results from an analysis of cost are also included.
We evaluate 432 leukapheresis donations and demonstrate correlations between 1) pre- and poststimulation white blood cell (WBC) count (p < 0.0001), 2) interval (donor stimulation to collection) and poststimulation WBC count (p < 0.0001), and 3) poststimulation WBC count and leukapheresis product granulocyte yield (p < 0.0001).
Significant improvement in granulocyte quality and yield can be accomplished in dexamethasone-stimulated donors, by selecting eligible donors with relatively high normal prestimulation WBC counts and/or previously good responses to dexamethasone, increasing the duration between dexamethasone stimulation and granulocyte collection, and maintaining optimal hematocrit (5%-10%) in granulocyte collections. Because the majority of surveyed blood centers collecting stimulated granulocytes use steroids alone, modifications presented here may prove useful. Further assessment of correlation between granulocyte yield and clinical outcome will await results of additional studies.