Transfusion medicine is a broad discipline, encompassing not just use of blood components, but many areas of donor recruitment and safeguarding, apheresis, and novel cellular therapies. This roadmap ...provides a framework for discussion of research priorities in transfusion medicine moving forward. Although one could highlight many future research areas of direct relevance to donor and patient care, important themes remain centered on minimizing risks to patients and donors, and for the development of stratified or personalized transfusion strategies. It is clear that wide-scale genetic typing of donors and patients can now be delivered at low-cost, and the introduction of these technologies heralds a new era for transfusion medicine, which has been grounded in serological tests.
Mathematics of apheresis Tjoelker, Linda; Neyrinck, Marleen; Vrielink, Hans
Transfusion and apheresis science,
April 2023, 2023-Apr, 2023-04-00, 20230401, Letnik:
62, Številka:
2
Journal Article
Recenzirano
Odprti dostop
Mathematics is related to apheresis medicine. The safety of donor and patient in taking blood components is utterly important. Knowledge of total blood and plasma volume is needed and have to be ...calculated. By increasing quality, the safety of not only the donor and patient, but also the operator will increase, as well as the efficiency of operating an apheresis collection facility. Various concepts, formulas and calculations methods and their significance in apheresis are given in this paper.
1 Sanquin Research, and Landsteiner Laboratory, Academic Medical Centre (AMC), University of Amsterdam, Amsterdam
2 Emma Childrens Hospital, AMC, Amsterdam
3 Wilhelmina Childrens Hospital, ...Department of Pediatric Immunology/Hematology and BMT, University Medical Center Utrecht (UMCU), Utrecht
4 Sanquin Blood Bank, Northwest Region, Amsterdam
5 Sophia Childrens Hospital, Department of Pediatric Hemato-Oncology, Erasmus University Medical Center, Rotterdam
6 Willem Alexander Children and Adolescent Unit, Department of Pediatric Immunology, Hemato-oncology, BMT and Autoimmune Disease, Leiden University Medical Center (LUMC), Leiden, The Netherlands
Correspondence: Agata Drewniak MSc, Sanquin, Research Institute, Plesmanlaan, 125, 1066 CX Amsterdam, The Netherlands, E-mail: a.drewniak{at}sanquin.nl
Background: Granulocyte transfusion has been proposed as a bridging therapy for patients with prolonged periods of chemotherapy-induced neutropenia, who suffer from severe fungal and bacterial infections. To recover, adequate numbers of granulocytes are required when the patients are refractory to standard treatment. The aim of this study was to assess the functional characteristics and efficacy of granulocyte colony-stimulating factor/dexamethasone-mobilized granulocytes used for transfusions.
Design and Methods: Granulocytes from the leukapheresis products were tested for the expression of cell-surface antigens, interactions with endothelial cells, motility, killing of microbes and survival. The granulocytes were used in vivo for transfusion in 16 severely ill children, who were – apart from a patient with a granulocyte dysfunction – all suffering from prolonged neutropenia.
Results: Mobilization of granulocytes with granulocyte colony-stimulating factor and dexamethasone caused phenotypic changes (decreased CD62L expression and increased levels of CD66b and CD177). The ability of the granulocytes to interact with endothelial cells (rolling, adhesion, transmigration) and to kill various types of pathogens was not affected by the mobilization, leukapheresis and irradiation procedures. The granulocytes were functionally indistinguishable from those isolated from untreated donors, even after 24 hours of storage. Granulocyte transfusion seemed to benefit 70% of patients, as 11 out of the 16 children showed clinical recovery within 1–2 weeks after beginning the transfusions.
Conclusions: Although CD62L expression is downregulated on granulocytes used for granulocyte transfusions, concomitant CD177 upregulation may explain the intact interactions with endothelial cells. All other granulocyte functions tested were intact, including the ability to kill fungi. Granulocyte concentrates can be stored without loss of in vitro viability and functionality for at least 24 hours. As demonstrated in vivo , granulocyte transfusions may be an effective therapy for neutropenic pediatric patients suffering from life-threatening infections.
Key words: granulocytes, granulocyte colony-stimulating factor, phenotype, function, transfusion.
Basics of apheresis and equipment Vrielink, Hans; Neyrinck, Marleen M.
Transfusion and apheresis science,
April 2023, 2023-Apr, 2023-04-00, 20230401, Letnik:
62, Številka:
2
Journal Article
Recenzirano
Apheresis is a method of obtaining one or more blood components by machine processing of whole blood in which the residual components are returned to the donor or patient during or at the end of the ...process. To achieve this, the desired blood component is separated from the whole blood using centrifugal, filtration and or adsorption techniques. Although the apheresis equipment from various manufacturers look from the outside very different, the working is rather similar with separation in a one-use disposable, connected with bacterial filters to the machine, and various safety features to achieve optimal safety for donor / patient, operator and product.
A training program for apheresis nurses in leukocyte collection and therapeutic apheresis was developed by the Joint Task Force for Apheresis Education and Certification. This is a modular program ...with theoretical and practical information and knowledge. On request of the Indonesian authorities, in the capital of Indonesia Jakarta, a certification course for apheresis nurses/operators based on the training program described above was organized in December 2013. The course existed of themes related to apheresis, such as hematology, anatomy, physiology, calculations, adverse events, basics of apheresis, nursing aspects, quality, collection of cells for cellular therapies, pediatrics, and therapeutic collections (cell reductions and exchange procedures). A pretest and post-test regarding the knowledge and judgment in the themes described was taken in Bahasa Indonesia or in English. In total, 38 apheresis nurses and 32 physicians participated in the course. In the post-test, the nurses scored in a mean 72/100 and the physicians 77/100 (nurses vs. physicians: P = 0.005), which was significantly better than the results of the pretest (54/100 and 53/100, respectively (P < 0.0001 for both). In conclusion, with this course, 38 apheresis nurses/operators proved a significant increase of knowledge in the theory behind apheresis. This educational program provides an approach to educate and certificate apheresis nurses. It is also shown that also for physicians working in the field of apheresis, this course is of use increasing their knowledge regarding apheresis.
Autologous chimeric antigen receptor-modified T-cells (CAR-T) provide meaningful benefit for otherwise refractory malignancies. As clinical indications for CAR-T cells are expanding, hospitals ...hitherto not active in the field of immune effector cell therapy will need to build capacity and expertise. The GoCART Coalition seeks to disseminate knowledge and skills to facilitate the introduction of CAR-T cells and to standardize management and documentation of CAR-T cell recipients, in order to optimize outcomes and to be able to benchmark clinical results against other centers. Apheresis generates the starting material for CAR-T cell manufacturing. This guide provides some initial suggestions for patient's apheresis readiness and performance to collect starting material and should thus facilitate the implementation of a CAR-T-starting material apheresis facility. It cannot replace, of course, the extensive training needed to perform qualitative apheresis collections in compliance with national and international regulations and assess their cellular composition and biological safety.
In developing countries, like Indonesia, apheresis is still a relative new procedure. Nowadays, therapeutic apheresis procedures are performed in the field of hematology and neurology, especially in ...the teaching hospitals in Indonesia. Therapeutic apheresis procedure, that is, leukocytapheresis, therapeutic plasma exchange (TPE), and thrombocytapheresis are already performed. In the period 2009-2013, 204 apheresis procedures in 137 patients to reduce the leukocytes, 72 TPE procedures in 17 patients, and 14 thrombocyte reductions were performed in the Sardjito hospital, Yogyakarta, Indonesia. In the future, to improve the therapeutic apheresis implementation, it is important to increase the insurance coverage and also should be considered to introduce the apheresis medicine into the curriculum of appropriate physician programs in Indonesia. Especially in Indonesia, a lot of efforts are still being needed to improve implementation of therapeutic apheresis.
PDF
