Quantitative assessment of the anticoagulant in plasma units collected by plasmapheresis

Abstract

BACKGROUND: To date, the quantification of the anticoagulant (ACD-A) in plasma units has been based on theoretical calculations. An accurate quantification could help minimize the risks associated with plasmapheresis, given that the total ACD-A used during the procedure is distributed between the donor and the plasma unit. Our aim was to experimentally quantify the volume of ACD-A in units collected by plasmapheresis. STUDY DESIGN AND METHODS:We used proton nuclear magnetic resonance spectroscopy to measure the ACD-A volume in 295 plasma units collected by the Azienda USL-IRCCS of Reggio Emilia, Italy. We analyzed the determinants of the differences between estimated and measured ACD-A through multivariate regression models. RESULTS:The experimentally measured ACD-A in plasma units was variable, with 45% of the samples showing a discrepancy of more than 15 mL compared to the manufacturer's estimate. ACD-A was underestimated for higher density of the units (p < 0.0005); a weak association was also observed with triglycerides (underestimated for higher levels, p = 0.015) and sex (overestimated in females, p = 0.008), but our model explained only 35% of the individual variability. CONCLUSION:The manufacturer's algorithms do not accurately estimate the ACD-A in units collected by plasmapheresis. Donor-related characteristics may affect ACD-A distribution between donor and plasma unit, thereby explaining the discrepancies between estimate and measurement. Errors in the estimate of the ACD-A actually received by donors could hamper studies on dose-response relationship between anticoagulant and adverse reactions. Our work should stimulate research on tailored procedures aimed at minimizing the anticoagulant received by donors and increasing plasmapheresis safety. From the

Impact of saline infusion and citrate infusion rate during donor plasmapheresis

“…10,11 Vurro et al have argued that mathematically derived CIR may underestimate the risk of citrate at DP and dosing should be individualized because of significant variations in the amount of citrate in the plasma collected. 31 Plasmapheresis was performed with the PCS2 using Anticoagulant Citrate Dextrose A (ACD A) in a flow ratio of 1:12 to blood. [31][32] However, the use of ACD A is restricted to the production of platelet rich plasma.…”

“…31 Plasmapheresis was performed with the PCS2 using Anticoagulant Citrate Dextrose A (ACD A) in a flow ratio of 1:12 to blood. [31][32] However, the use of ACD A is restricted to the production of platelet rich plasma. and no longer meets the international standard of TSC 1:16 to blood for DP.…”

“…33 This is consistent with our experience that if the venipuncture was performed correctly and the TSC:blood flow ratio at 1:16 was correct, no anticoagulation or bleeding problems would occur. 14 Since the authors did not provide information about the CIR or clinical side effects, 31 we approximated the CIR from processed blood volume divided by 12 = TSC used ± 149 mL, TSC in collected plasma ± 90 or ± 92 mL, free citrate ion 2.13 mg%, 32 estimated body weight 70 to 75 kg, and duration of plasmapheresis ± 48.7 min. 31 This resulted in an average CIR between 0.33 and 0.37 mg/kg/min.…”

“…14 Since the authors did not provide information about the CIR or clinical side effects, 31 we approximated the CIR from processed blood volume divided by 12 = TSC used ± 149 mL, TSC in collected plasma ± 90 or ± 92 mL, free citrate ion 2.13 mg%, 32 estimated body weight 70 to 75 kg, and duration of plasmapheresis ± 48.7 min. 31 This resulted in an average CIR between 0.33 and 0.37 mg/kg/min. It follows that the calculated CIR is in agreement with the earlier reports, 10,29 and that an individualized dosing of TSC in plasma donations with a low flow ratio of TSC 1:16 to blood is not required.…”

Dietary Patterns and Blood Biochemical and Metabolic Parameters in an Italian Population: A Cross-Sectional Study

“…We assessed the following metabolic parameters using automated laboratory procedures as previously described [44]: complete blood count, including mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red blood cell distribution width (RDW), reticulocyte count, platelet count (PLT), white blood cell or leukocyte count, hemoglobin (Hb), ferritin, blood glucose, alanine aminotransferase (ALT) and lipid profile (total cholesterol, HDLcholesterol, triglycerides); creatinine; and total protein. In particular, we quantified the total cholesterol, HDL cholesterol, triglyceride and glucose levels using an AEROSET c8000 system (Abbott Diagnostic, IL, USA) [53]. We calculated levels of LDL cholesterol through the Friedewald formula.…”