Commentary on <scp>Zhao</scp> et al., “<scp>Frequent</scp> platelet donations is associated with lymphopenia, and risk of infections: A nationwide cohort study”

Gorlin, Jed B.

doi:10.1111/trf.16373

Cited by 6 publications

(6 citation statements)

References 14 publications

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“…This wide variation can be explained by differences in anticoagulant ratios, device settings, draw and return management, processed blood volumes, and annual donation frequencies between studies 11, 30 . One study reports that the LRS chamber caught 15%–20% of mononuclear cells passing through the apheresis device 32 . Accordingly, a rate of 26 donations per year would result in is a loss of at least 16 × 10 9 lymphocytes due to the content of lymphocytes trapped in the LRS chambers.…”

Section: Discussionmentioning

confidence: 99%

Total platelet donation count and donation frequency are determinants of plateletpheresis‐associated lymphopenia

et al. 2021

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Background Plateletpheresis using a leukocyte reduction system (LRS) traps donor WBCs in the LRS chamber, which may lead to lymphopenia, especially in frequent plateletpheresis donors. It seems plausible that this might cause adverse effects. However, current knowledge about potential confounders and donor health impacts is incomplete. Donors and methods Recent platelet donors and donations collected at University Hospital Regensburg from 2016 to 2019 using the Terumo BCT Trima Accel LRS system were retrospectively analyzed and compared with historical platelet donors and donations collected mainly with Fresenius Kabi Amicus non‐LRS system from 2010 to 2013. Additionally, recent donors were prospectively surveyed using a health‐related topics questionnaire. Results Analysis of 819 recent donors with 11,254 blood counts and 1464 questionnaires and 1011 historical donors with 12,848 blood counts revealed that increased annual platelet donation frequencies were associated with decreased lymphocyte counts in both groups. Median lymphocyte counts in recent donors with no versus ≥24 previous annual donations declined from 2.0 to 1.2 × 103/μL (p < 2.2 × 10−16), and those in historical donors with no versus ≥24 previous annual donations decreased from 2.0 to 1.5 × 103/μL (p = 6 × 10−4), respectively. The questionnaire results showed that donation frequency and lymphopenia were not associated with upper respiratory tract infection (URTI) incidence or duration, but platelet donors who concomitantly donated granulocytes had significantly shorter URTI durations than those who did not (p = .008). Conclusion This study confirmed that plateletpheresis‐associated lymphopenia occurs in LRS and to a lesser degree in non‐LRS platelet donors, but revealed no evidence of a negative impact on donor health.

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Section: Discussionmentioning

confidence: 99%

Total platelet donation count and donation frequency are determinants of plateletpheresis‐associated lymphopenia

et al. 2021

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“…One challenge is that platelet donors must be healthy enough to donate. This creates an inherent selection bias in many studies of blood or platelet donors, referred to as the “healthy donor” effect 12 . Zhao et al 13 used the Swedish Scandinavian donations and transfusions (SCANDAT3‐S) database to conduct a nationwide study of adverse clinical events among frequent platelet donors.…”

Section: Discussionmentioning

confidence: 99%

“…This creates an inherent selection bias in many studies of blood or platelet donors, referred to as the "healthy donor" effect. 12 Zhao et al 13 used the Swedish Scandinavian donations and transfusions (SCANDAT3-S) database to conduct a nationwide study of adverse clinical events among frequent platelet donors. SCANDAT3-S integrates data from national registers on blood products, donors, and recipients.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for T‐cell lymphopenia in frequent platelet donors: The BEST collaborative study

Kaufman,

Marks,

Flamand

et al. 2023

Transfusion

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BackgroundSevere T‐cell lymphopenia of uncertain clinical significance has been observed in frequent apheresis platelet donors. Two commonly used plateletpheresis instruments are the Trima Accel, which uses a leukoreduction system (LRS) chamber to trap leukocytes and the Fenwal Amicus, which does not use an LRS chamber.Study Design and MethodsWe performed an international, multicenter, observational study comparing T‐cell populations in frequent platelet donors collected exclusively using the Trima instrument (n = 131) or the Amicus instrument (n = 77). Age‐ and sex‐matched whole blood donors (n = 126) served as controls.ResultsCD4+ T‐cell counts <200 cells/μL were found in 9.9% of frequent Trima (LRS+) platelet donors, 4.4% of frequent Amicus (LRS−) platelet donors, and 0 whole blood donors (p < .0001). CD4+ T‐cell counts <200 cells/μL were only seen in platelet donors with ≥200 lifetime donations. In multivariable analysis, age, lifetime donations, and instrument (Trima vs. Amicus) were independent risk factors for lymphopenia. In 40 Trima platelet donors, a plasma rinseback procedure was routinely performed following platelet collections. No Trima platelet donors receiving plasma rinseback had a CD4+ T‐cell count <200 cells/μL versus 13/91 Trima platelet donors not receiving plasma rinseback (p = .01).DiscussionRecurrent bulk lymphocyte removal appears to contribute to the development of T‐cell lymphopenia in frequent, long‐term platelet donors. Lymphopenia is more common when an LRS chamber is used during platelet collection but can occur without an LRS chamber. Blood centers using LRS chambers can mitigate donor lymphopenia by performing plasma rinseback.

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“…Given that there is little evidence for lymphopenia-related morbidity, Gorlin doubted that there were also depletions in the lymphocyte populations elsewhere. 6 However, the plateletpheresis donor population is an older group facing age-related decline in immune function independently of their donation history. Emblematic of this decline is a reduction in the circulating counts of CD4+ and CD8+ T-cells as well as B-cells 13 along with lymph node changes that include reduction in their numbers and impairment of germinal centers' function.…”

Section: Duties To Donorsmentioning

confidence: 99%

“…They did not, however, propose a threshold value for unacceptability. In an accompanying editorial to their paper, Gorlin proposed that the apheresis donor consent includes comment about the “uncertain significance of lymphocytopenia.” 6 “Uncertain” was an appropriate choice of adjective. Other investigators were equally uncertain.…”

mentioning

confidence: 99%

Duties to donors

Sayers

2023

Transfusion

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Commentary on Zhao et al., “Frequent platelet donations is associated with lymphopenia, and risk of infections: A nationwide cohort study”

Cited by 6 publications

References 14 publications

Total platelet donation count and donation frequency are determinants of plateletpheresis‐associated lymphopenia

Total platelet donation count and donation frequency are determinants of plateletpheresis‐associated lymphopenia

Risk factors for T‐cell lymphopenia in frequent platelet donors: The BEST collaborative study

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