Red cell salvage and reinfusion in pediatric bone marrow donors

Kletzel, Morris; Olszewski, Marie; Danner-Koptik, Karina; Coyne, Kelly; Haut, Paul R.

doi:10.1038/sj.bmt.1701904

Cited by 11 publications

(6 citation statements)

References 4 publications

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“…Previous studies have shown that a recovery of approximately 90% of the harvested BM-RBCs decreased the homologous transfusion requirement of healthy BM donors significantly [7]. When paediatric BM donors were investigated and BM-RBCs were separated by density gradient centrifugation using Ficoll-Hypaque, similar results were obtained [5]. Although the clinical benefit of the transfusion of processed BM-RBCs in reducing homologous transfusion requirements after BM harvest, especially in children, was clearly shown, limited information is available about a standardized procedure and the quality of the processed BM-RBCs [8][9][10].…”

Section: Introductionsupporting

confidence: 68%

“…At the time of retransfusion the results of sterility testing are not available, but since BM collection is performed under aseptical conditions and further cell processing is done in a functional closed system, the risk of bacterial contamination is minimal [5]. A recent publication on bacterial contamination of BM harvests describes an incidence of 7AE4% contaminated products without any major adverse sequela after infusion of grafts [22].…”

Section: Discussionmentioning

confidence: 99%

“…Donors and patients are at risk to develop a severe anaemia because collected BM can contain up to 20% of their red cell mass. To reduce the risk of anaemia after BM donation, at least one unit of autologous blood should be collected prior to the harvest procedure [5]. Alternatively, certain clinicians place the donors on supplemental iron plus rhEPO, transfuse their donors with allogeneic RBC units or tolerate anaemia when not severe [6].…”

Section: Introductionmentioning

confidence: 99%

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Red blood units collected from bone marrow harvests after mononuclear cell selection qualify for autologous use

et al. 2010

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Background After large volume bone marrow (BM) harvest, donors and patients can develop severe anaemia, because collected BM can contain up to 20% of their red cell mass. In a prospective analysis, we investigated the feasibility to recover red blood cells (RBCs) from the harvested BM and investigated whether these RBC units meet the quality requirements of the European Council.Patients and Methods From 19 patients (median age 51 yrs, range 31-77) with acute myocardial infarction, who participated in the MYSTAR study, a median volume of 1299 ml (range, 700-1870 ml) BM was collected. During BM processing, mononuclear cells (MNC) were separated using the Cobe SpectraÔ apheresis system and the residual RBCs were collected in a separate bag. The quality of the collected RBCs was assessed by measuring LDH, free haemoglobin, potassium and lactate. Haemolysis was calculated and the intracellular concentration of ATP, ADP, AMP was determined by HPLC.Results RBC units recovered from BM after MNC separation had a mean volume of 312 ± 95 ml with a haematocrit of 47 ± 8AE9%, a haemoglobin content of 51 ± 15 g per unit, a haemolysis of 0AE15 ± 0AE005%, a pH of 6AE8 ± 0AE007 and an intracellular ATP concentration of 135 pmol ⁄ 10 6 RBC ± 41, which is comparable with freshly collected packed red blood cells (PRBCs).Conclusion RBCs, collected from bone marrow harvests, can be used for autologous blood support to minimize allogeneic blood transfusions in donors and patients after large volume BM donation.Key words: blood sparing measurements, bone marrow harvest, bone marrow processing, salvage of red blood cells. IntroductionLarge volume bone marrow (BM) harvest is an alternative to G-CSF-induced peripheral blood stem cell collection in patients or donors who are poor mobilizers, in the paediatric setting or in the regenerative medicine, when patients with myocardial infarction are intended to receive stem cells intracardially [1][2][3][4]. Donors and patients are at risk to develop a severe anaemia because collected BM can contain up to 20% of their red cell mass. To reduce the risk of anaemia after BM donation, at least one unit of autologous blood should be collected prior to the harvest procedure [5]. Alternatively, certain clinicians place the donors on supplemental iron plus rhEPO, transfuse their donors with allogeneic RBC units or tolerate anaemia when not severe [6]. Previous studies have shown that a recovery of approximately 90% of the harvested BM-RBCs decreased the homologous transfusion requirement of healthy BM donors significantly [7]. When paediatric BM donors were investigated and BM-RBCs were separated by density gradient centrifugation using Ficoll-Hypaque, similar results were In a prospective analysis, we assessed the extent of cell lesions occurring during manipulation by measuring the release of lactate dehydrogenase (LDH), free haemoglobin (fHb), potassium (K+) and lactate at each manipulation step. Special attention was paid to intracellular purine content by measuring ATP, ADP, AMP, as a surrogate mar...

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Section: Introductionsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Red blood units collected from bone marrow harvests after mononuclear cell selection qualify for autologous use

et al. 2010

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“…For children, reinfusion of autologous red blood cells from the collected BM may be especially useful. Kletzel et al 19 evaluated the use of a semiautomated processing technique to salvage red blood cells from 13 pediatric BM donors to minimize the risk of severe anemia following BM harvest and ABO incompatibility in the recipient. The authors concluded that the procedure was safe and it reduced the risk of anemia in pediatric donors following BM harvest.…”

mentioning

confidence: 99%

Feasibility of marrow harvesting from pediatric sibling donors without hematopoietic growth factors and allotransfusion

Yabe

Morimoto

Shimizu

et al. 2014

Bone Marrow Transplant

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We retrospectively studied 108 marrow harvests from 105 pediatric sibling donors. The median age of donors was 8 years (range: 1-15) and the median body weight was 27 kg (range: 10-100). The volumes of aspirated marrow were 5.0-23.8 mL/kg donor body weight, and harvested bone marrow volume exceeded 15 mL/kg in 42% of the donors. A total of 100 autologous blood donations were performed, and eight donors had red cells salvaged from their harvests reinfused. The median Hb levels before and after harvests were 12.3 g/dL (range: 10.0-14.7) and 11.0 g/dL (range: 8.9-13.8), respectively. None of the donors received allogeneic blood transfusions or hematopoietic growth factors such as EPO and G-CSF before or after collection. Transplanted dose was 1.4-10.8 × 10 8 cells/kg recipient body weight without differences due to donor age. Higher concentrations of nucleated and CD34 + cells were obtained from younger donors. All donors tolerated the procedures well, with no serious complications. Thus, children may safely donate marrow for allogeneic transplantation, and the yields of nucleated cells for engraftment are substantial.Bone Marrow Transplantation (2014) 49, 921-926;

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“…Finally, Kletzel et al 26 performed red-cell salvage from the BM during the harvesting procedure. This interesting approach, however, resulted in more than 50% reduction in the TNC dose infused.…”

Section: Discussionmentioning

confidence: 99%

Multiple BM harvests in pediatric donors for thalassemic siblings: safety, efficacy and ethical issues

Biral¹,

Chiesa²,

Cappelli³

et al. 2008

Bone Marrow Transplant

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Allogeneic BMT represents the only chance of cure for b-thalassemia. Occasionally, two affected individuals from the same family share a matched healthy sibling. Moreover, a high incidence of transplant rejection is still observed in Pesaro class III patients, requiring a second BMT procedure. In these settings, one option is to perform a second BM harvest from the same donor. Although BM harvest is a safe procedure in children, ethical issues concerning this invasive practice still arise. Here, we describe our series of seven pediatric, healthy donors, who donated BM more than once in favor of their b-thalassemic HLA-identical siblings between June 2005 and January 2008. Three donors donated BM twice to two affected siblings and four donors donated twice for the same sibling following graft rejection of the first BMT. All donors tolerated the procedures well and no relevant side effects occurred. There was no significant difference between the two harvests concerning cell yield and time to engraftment. Our experience shows that for pediatric donors, a second BM donation is safe and feasible and good cellularity can be obtained. We suggest that a second harvest of a pediatric donor can be performed when a strong indication for BMT exists.

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Red cell salvage and reinfusion in pediatric bone marrow donors

Cited by 11 publications

References 4 publications

Red blood units collected from bone marrow harvests after mononuclear cell selection qualify for autologous use

Red blood units collected from bone marrow harvests after mononuclear cell selection qualify for autologous use

Feasibility of marrow harvesting from pediatric sibling donors without hematopoietic growth factors and allotransfusion

Multiple BM harvests in pediatric donors for thalassemic siblings: safety, efficacy and ethical issues

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