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srichar3

Leukocyte reduction of Platelets

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Are there any sites that receive platelets non Leukocyte reduced and then perform the leukocyte reduction on site? 

If so do you do this in the laboratory prior to issue to the wards, or do you provide the nurses with the filter for them to perform at the bedside?

Thanks

 

 

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My understanding is that  leukocyte reduction in a hospital setting is not possible as firstly the filters function is based on differences in deformability and adhesiveness between different cells; this decreases with time so the filtration must be done within a specific time after collection, probably before the platelet can be released. Secondly I think leukocyte reduction is a manufacturing process and would therefore require an FDA licence and a lot of QC to prove you have achieved leukocyte reduction to a certain standard.

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When leukodepletion first became "popular" in the UK, before the NHSBT and other Blood Services performed universal leukodepletion, we used to provide the ward with an "in-line" filter.  As Ensis01 says above, there were several drawbacks with this, but, in terms of whether it was actually efficacious, it was marginal then, because part of the problem involved with febrile non-haemolytic transfusion reactions (this is a problem separate from the fact that we want to prevent "HLA" type sensitisation) is the release of such things as cytokines, in particular tumour/tissue necrosis factor-alpha, interleukin-1-alpha, interleukin-1-beta and interleukin-6.  These are released from white cells upon storage and, of course, by the time the platelet concentrates reach the hospital blood bank, these will already have been released, and so it is too late, and leukodepletion will not prevent FNHTR.

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Posted (edited)
On 3/25/2019 at 1:46 PM, Ensis01 said:

My understanding is that  leukocyte reduction in a hospital setting is not possible as firstly the filters function is based on differences in deformability and adhesiveness between different cells; this decreases with time so the filtration must be done within a specific time after collection, probably before the platelet can be released. Secondly I think leukocyte reduction is a manufacturing process and would therefore require an FDA licence and a lot of QC to prove you have achieved leukocyte reduction to a certain standard.

No you can buy inline filters for post storage leukocyte reduction, our blood supplier does not offer leukocyte reduction of platelets unless they bare apheresis units but they are not always available so we sometimes have to resort to using these filters. 

https://www.terumobct.com/imugard 

"MUGARD III-PL for Platelets

The IMUGARD III-PL filter is a hard-housing filter designed to remove leukocytes and microaggregates from platelet preparations. Each filter system is equipped with a spike, clamps and tubing. The filter housing material is semitransparent to make monitoring the filtration process easier.

Available in lab and bedside versions, the IMUGARD III-PL features a bypass line on the lab version to remove air from the transfer bag. The bedside version features a drip chamber and a roller clamp below the filter to adjust flow to the patient.

  • Filters platelet concentrate for volumes equivalent to platelets produced from six Buffy Coats
  • Offers greater than 90 percent platelet recovery"

The efficiency is reported to be not as good as pre storage with these but this is not an option we always have. My issue is currently we are giving the filters to the nurses to do at the bedside which I don't feel is the best option and I would like to bring it into the lab, mainly because of training as its much harder to train all the nurses to do it properly than it is for the lab and of cause the lab can QC the process which would be impossible at the time of administration. 

Edited by srichar3

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