采前外周血小板计数和红细胞比容对机采血小板的影响

随着血液分离技术的提高和一次性塑料采血袋的使用,成分输血的飞速发展,机采血小板的应用越来越广泛,已成为现代成分输血的重要内容。提高机采血小板制品的产量是保证良好的临床输注效果的前提,而采前外周血小板计数（PLT）是保证机采血小板产量的最主要因素,采前红细胞比容是影响机采血小板收集量的重要因素。笔者通过对198例无偿献血者使用995E耗材和MCS＋系统中的少白细胞的血小板程序单采浓缩血小板,对献血者的全血循环量、抗凝剂用量和产品收集量进行分析,现报告如下。     

血细胞计数仪用于机采浓缩血小板计数

随着成分输血的逐步推广,机采浓缩血小板的应用越来越多.机采浓缩血小板在临床上的止血效果与输注的血小板数量直接相关.而机采浓缩血小板产品的浓度较大,可达4×10 12/L,远远超出血细胞计数仪的检测范围,不能直接用血细胞计数仪进行检测,用人工计数误差又大,如何准确地检测机采浓缩血小板产品中血小板的浓度已成为质量控制中的难点.笔者就如何应用血细胞计数仪对机采浓缩血小板产品进行计数的方法作如下探讨.     

影响机采血小板收集因素分析

血小板输注是临床治疗血小板缺乏或血小板功能障碍性疾病的有效方法。血细胞分离机采集的血小板具有血小板含量高、白细胞污染率低、输血不良反应少、经血传播疾病发生机率低和临床治疗效果好等优点,因此被广泛应用于临床。本站采用MCS-3P采集血小板,结果发现其影响因素较多。现就应用该机实践,探讨影响机采血小板收集的因素。     

Amicus血细胞分离机机采血小板收集量主要影响因素分析

以本站2011年12月～2012年6月期间进行血小板献血者为研究对象,详细的观察220例血小板献血者采集机采血小板之前的血常规计数以及全血终点值对机采血小板收集量的影响。结果献血者在献血之前的血常规计数、全血终点值以及全血的流速等均是影响机采血小板收集量的主要原因。在为献血者进行采血之前,应该详细的分析其各项血常规的监测数据,并仔细的了解献血者的身体状况,对其进行严格的筛选,才能够不断提高输血机采血小板的数量与质量。     

血细胞分离机在机采血小板采集中常见报警故障

<正>Amicus血细胞分离机是最新一代血细胞分离机,可为临床提供去白细胞机采血小板,以满足日益提高的临床治疗需求。2005年3月～2010年4月,我们对本中心使用的Ami-cus机器采集血小板46 733例进行研究,对采集过程中常见报警故障[1]进行分析,并提出处理方法及技巧,现报道如下。1报警故障一1.1报警名称"进血管路阻塞"原因分析:1)献血者精神紧张、晕针、血管过细、针头斜面位置不当或采血过程中针头     

对机采血小板供者口服钙剂观察

目的　了解口服钙剂能否减少机采血小板供者枸橼酸盐引起的低钙症状的发生。方法　机采血小板的全血速度均为 5 0ml/min ,界面探测值 6 ,全血与抗凝剂流速比为 (9.5～ 10 ) :1,机采前口服钙剂 (10 %葡萄糖酸钙10ml)者 12 1人 ,均为 1次采 2个治疗单位 ;未口服钙剂者有 339人为 1次采 1个治疗单位 ;88人为 1次采 2个治疗单位。结果　口服钙剂的 12 1人中有 1人出现一过性轻微的口周发麻感觉 ,未服用钙剂者未观察到低钙症状。结论　机采一个或两个治疗单位血小板可以不预防性口服葡萄糖酸钙     

机采血小板供者采前血小板计数与全血处理量的关系

目的　探讨优化机采血小板的操作 ,观察全血处理量与采前血小板计数之间的关系。方法　直接使用机器系统操作默认设置的参数处理全血量及循环次数 ;在机采前将供者血小板计数输入血细胞分离机的程序中 ,机器自动提示所需处理全血量及循环次数。结果　采前输入供者血小板计数可以明显地提高最终产品中血小板的含量。结论　供者采前血小板计数与机采血小板的全血处理量有密切关系 ,为保证单采血小板质量 ,机采前应将供者血小板计数、血细胞比容等相关参数输入血细胞分离机     

机采血小板者采前与采后血小板计数观察

随着成分输血在临床的广泛开展 ,血小板的临床应用在近年来也有了很大发展 ,需求量在不断增加。特别是机采血小板 ,因其制品纯度高 ,剂量高 ,临床治疗效果好 ,输血传播疾病的机率及输血副作用少 ,而日益被临床重视。笔者近期对献机采血小板前和献机采血小板后第 1 2天血小板数量进行观察 ,对恢复二次机采的时间进行初步研究。现介绍如下。材料与方法1　材料　 AC90 0血细胞计数仪 (瑞典倍肯 ) ;百特CS- 30 0 0 Plus血细胞分离机 (美国 Baxter) ;溶血素、稀释液 :南昌百特实业公司生产 ;全血质控物 :四川迈克科技有限公司生产。2　观察对…     

100例机采血小板采集前后计数观察

随着成分输血的发展，血小板的临床需求量在不断增加。特别是机采血小板，因其制品纯度高、剂量大，临床治疗效果好，输血传播疾病的概率及输血副作用小，日益受到重视。笔者对100例献机采血小板者采前和采后12d的血小板数量进行对比，对2次机采的时间进行初步研究，现报道如下。     

影响血细胞分析仪计数血小板的因素探讨

我们在应用血细胞计数仪过程中,对影响血小板准确性的因素,进行了如下探讨。     

Description and use of the CS-3000 blood cell separator for single- donor platelet collection

A new computer-controlled seal less continuous flow blood cell separator has been developed to harvest platelets, plasma, or leukocytes and perform plasma exchange. One hundred seven platelet collection procedures were performed using an instrument prototype during developmental evaluation of a number of differently configured platelet collection chambers. An average of 3.6 (range 2.6-5.5) × 10¹¹ platelets was collected during a 90-minute period (blood withdrawl rate, 32 ml/minute) with the best chamber. Only a small number of other cells, from 0.1 to 0.2 times 10⁹ white blood cells and 0.7 to 1.0 times 10⁹ red cells was collected with the platelets. Total procedure time averaged 115 to 120 minutes and included 5 minutes to install the blood processing pathway, 10 minutes to prime the system under computer control, 5 minutes to return donor erythrocytes at the completion of the procedure, and 5 minutes to remove the processing set and resuspend the platelets. The average donor platelet count declined 48 times10³per μ (19%) by the completion of the procedure, and, with the exception of a decline in inorganic phosphorus from 3.4 to 2.5 mg per dl, no unexpected changes in serum chemistry levels were seen. Use of either of two larger separation chambers in a production version of the instrument permitted more rapid blood processing rates (?45 ml/minute); an average of 4.2 (range 2.1–7.8) × 10¹¹ platelets was collected in 90 minutes using a larger chamber designed for platelet separation (n = 164). Platelets could also be collected using the chamber designed for white blood cell collection by omitting the use of hydroxyethyl starch and by selecting the platelet collection computer program rather than the white cell collection program. Using that chamber, an average of 4.3 ± 1.8 times 10¹¹ platelets was collected in 90 minutes (56% collection efficiency; n = 31). Leukocyte contamination of platelets was greater using the larger chambers. Infusion of autologous platelets labeled with ⁵¹Cr demonstrated a 70 percent average recovery and a mean survival of 9.1 days (n = 10). Seven nonalloimmunized thrombocytopenic patients were transfused with platelets collected using the prototype cell separator and an average of 86 percent of the expected number of platelets was present in the circulation 2 hours after transfusion with 63 percent of the cells remaining in the circulation at 24 hours. Template bleeding times were corrected in six of seven recipients following transfusion, and hemostasis was achieved in three bleeding recipients. Therapeutically useful numbers of functionally effective platelets can be collected using this blood processing instrument.     

Status of platelet collection and platelet transfusion.

Platelet product derived from single donor plateletpheresis is required to reduce the risks of adverse reactions by blood transfusion. The objectives of this study are to evaluate the status of platelet collection and its efficacy by various kinds of plateletpheresis equipment and to assess the achievement of platelet transfusion by platelet product derived from a single donor. Since the blood centers have introduced some kinds of efficient plateletpheresis equipment, large units of platelet products have been supplied mainly for the patients. Amicus and CCS might be preferable plateletpheresis machines because of their collection efficiencies and wider indication for donors. The average number of donors of platelet product per patient has recently reached nearly 1.0, and around 90% of patients have received platelet product derived from a single donor in the recent several years. However, platelet transfusion derived from a single donor has not yet been completely achieved. Each regional blood center should seriously consider the efficacy of each plateletpheresis equipment and arrange the equipment to collect platelets more effectively to achieve platelet transfusion from a single donor.     

Feasibility study on donor apheresis red cell and platelet simultaneous collection for blood center routine use.

This study was conducted to determine if single donor platelet and red cell simultaneous collection by apheresis technique can be applied to routine blood product collection at blood centers. Both apheresis red cell product and platelet product were successfully collected and mannitol, adenine, and phosphate (MAP) additive solution was added to the red cell concentrates during collection. During a 49 day storage study period, the red cell product quality was maintained and found to be equivalent to that of red cell products derived from whole blood collected by the traditional method. This study demonstrated the possibility of applying this collection method for routine use for single donor apheresis platelet product and red cell product preparation at blood centers.     

供血者性别对血小板激活标志物含量的影响

目的 探讨浓缩血小板保存过程中血小板激活的性别差异。方法 采用PRP法制备浓缩血小板,并于常规条件下保存5天,间隔取样,分别用RIA、ELISA方法检测血小板表面P-selectin分子数及血浆中可溶性P-selectin(sP-se-lectin)含量。结果 血浆中sP-selectin含量在保存1天后即明显升高,而血小板表面P-selectin分子数在保存3天后明显升高,二者与保存前比较均有显著性差异(P<0.05)。在保存期内,男女供血者的血小板表面P-selectin分子数之间比较无统计学差异(P>0.05),而女性供血者血浆中sP-selectin含量明显高于男性(P<0.05)。结论 在相同刺激因素影响下,女性供血者之血小板更易释放sP-selectin,因此在应用sP-selectin作为浓缩血小板质控指标及临床疾病的诊断时,应考虑供血者性别差异。     

The effect of donor red cell sedimentation rate on efficiency of granulocyte collection by centrifugal leukapheresis

BACKGROUND: Granulocyte collection relies on the use of a red cell- sedimenting agent and is influenced by poorly defined intrinsic donor characteristics. The donor's baseline red cell (erythrocyte) sedimentation rate (ESR), a readily measurable intrinsic donor variable, may influence the effectiveness of red cell-sedimenting agents and affect the granulocyte yield. STUDY DESIGN AND METHODS: The in vitro and in vivo effects of 6-percent hydroxyethyl starch on the donor ESR were prospectively studied in 67 granulocytapheresis procedures with a blood cell separator, and the findings were correlated with granulocyte collection efficiency (GCE). A relationship that predicts the GCE on the basis of the donor ESR was then derived and tested. RESULTS: The 3.7-fold mean increase in the donor ESR measured after in vitro addition of hydroxyethyl starch approximated the 3.3-fold increase measured when it was administered to the donors. Higher baseline ESR correlated with larger in vitro and in vivo hydroxyethyl starch-induced increases in ESR and predicted more efficient cell collections and greater cell yields. Furthermore, both ESR and GCE, which varied significantly among donors, remained constant for a given donor undergoing repeat procedures. The results could be summarized by a simple predictive formula that relates the GCE (%) to the ESR (mm/hour): GCE = 1.3ESR + 45. The GCE and yield as predicted by the formula were accurate within 10 percent of the observed values in six subsequent procedures. CONCLUSION: In granulocyte harvests using a blood cell separator with hydroxyethyl starch as the sedimenting agent, 1) both ESR and GCE vary widely among donors yet may remain relatively constant for a given donor; 2) the baseline ESR correlates with hydroxyethyl starch-modified ESR and with GCE; and 3) it may be possible to predict GCE and yield from the donor's baseline ESR.     

Peripheral blood stem cell collection with reduced platelet loss to the patient/donor

Apheresis procedures that optimize peripheral blood stem cell (PBSC) harvesting also result in a significant loss of platelets to the patient/donor because of their similar densities. We compared the percent drop in platelet count and hemoglobin concentration in the patients before and after PBSC collection using two different collection chambers with the CS-3000^TM. A modified plateletpheresis procedure was utilized. Seven patients underwent 38 PBSC collections during steady state hematopoiesis using the standard A-35 collection chamber. At the end of the procedure, a second low-speed centrifugation of the PBSC concentrate was performed in the manual mode, with siphoning out and return of the PRP to the patient through a transfer pack. For 14 patients who underwent 113 PBSC collections, a small volume collection chamber (SVCC) was substituted for the A-35 chamber and the second centrifugation step was omitted. These patients were also primed with 4 g/m² of cyclophosphamide. The percent drop in platelet count in the patients after the collection procedures was significantly less in the SVCC group (20.4 ± 9.1 vs. 36.0 ± 12.3, P = 0.000), even after correction for the difference in the volume of blood processed between the two groups (3.2 ± 1.4 vs. 3.9 ± 1.3, P = 0.006). The percent drop in hemoglobin concentration was also less with the SVCC both before (5.4 ± 3.8 vs. 11.7 ± 3.0, P = 0.000) and after (0.8 ± 0.6 vs. 1.3 ± 0.3, P = 0.000) correction for the difference in the volume of blood processed. The cellular contents of the PBSC concentrates were similar in both groups although mononuclear cell (MNC) purity was slightly higher in the A-35 group (95.6 ± 5.9% vs. 91.0 ± 13.0%, P = 0.037). The MNC extraction efficiency was similar with both collection chambers (60.2 ± 17.4% for the SV and 64.6 ± 18.5% for the A-35). The advantages of the SVCC and the possible reasons for the observed differences are discussed.     

不同型号血细胞分离机对献血者细胞参数与机采血小板采集效率比较

目的比较不同型号血细胞分离机对献血者细胞参数与机采血小板采集效率。方法选取2018年1月至2019年11月我站的318例献血者,其中159名献血者应用AmiCORE、MCS+及Trima血细胞分离机捐献双份血小板,平均分为3组,另外159名献血者应用AmiCORE、MCS+及Trima血细胞分离机捐献单份血小板,平均分为3组。比较三组的单份及双份血小板细胞参数不合格率及分离机性能。结果MCS+组单份血小板细胞参数不合格率低于AmiCORE组和Trima组,差异具有统计学意义(P<0.05)。MCS+组单份血小板采集效率及时间高于AmiCORE组及Trima组,差异具有统计学意义(P<0.05);Trima组抗凝剂使用量及全血处理量多于MCS+组及AmiCORE组(P<0.05)。三组双份血小板细胞参数不合格率比较,差异均无统计学意义(P>0.05)。MCS+组双份血小板采集效率高于AmiCORE组及Trima组,差异具有统计学意义(P<0.05);AmiCORE组采集时间长于MCS+及Trima组,Trima组抗凝剂使用量及全血处理量多于MCS+及AmiCORE组,差异具有统计学意义(P<0.05)。结论AmiCORE、MCS+及Trima血细胞分离机对产品采集具有较高采集效率,符合国家有关标准,血液制备和采集过程可供,各机型血小板细胞参数不合格率、血小板分离机性能存在区别。血液制备及血液采集过程具有可控性,应依据献血者自身特点选择不同血细胞分离机。