Safety issues of plateletpheresis: comparison of the effects of two cell separators on the activation of coagulation, fibrinolysis, and neutrophils and on the formation of neutrophil-platelet aggregates
Petra Stohlawetz MD
Resident
Clinic of Blood Group Serology and Transfusion Medicine, Department of Transfusion Medicine, University of Vienna, Vienna, Austria
Search for more papers by this authorStylianos Kapiotis MD
Associate Professor
Clinical Institute of Medical and Chemical Laboratory Diagnostics, University of Vienna, Vienna, Austria
Search for more papers by this authorDagmar Seidl MD
Research Fellow
Department of Clinical Pharmacology-TARGET, Vienna University Hospital School of Medicine, Vienna, Austria
Search for more papers by this authorNicole Hergovich MD
Research Fellow
Department of Clinical Pharmacology-TARGET, Vienna University Hospital School of Medicine, Vienna, Austria
Search for more papers by this authorMaria Zellner MSc
Research Fellow
Department of Clinical Pharmacology-TARGET, Vienna University Hospital School of Medicine, Vienna, Austria
Search for more papers by this authorHans-Georg Eichler MD
Professor and Head
Department of Clinical Pharmacology-TARGET, Vienna University Hospital School of Medicine, Vienna, Austria
Search for more papers by this authorGabriele Stiegler MD
Resident
Clinic of Blood Group Serology and Transfusion Medicine, Department of Transfusion Medicine, University of Vienna, Vienna, Austria
Search for more papers by this authorGerda Leitner MD
Consultant
Clinic of Blood Group Serology and Transfusion Medicine, Department of Transfusion Medicine, University of Vienna, Vienna, Austria
Search for more papers by this authorPaul Höcker MD
Professor and Head
Clinic of Blood Group Serology and Transfusion Medicine, Department of Transfusion Medicine, University of Vienna, Vienna, Austria
Search for more papers by this authorCorresponding Author
Bernd Jilma MD
Resident and Head
The Adhesion Research Group Elaborating Therapeutics (TARGET), Department of Clinical Pharmacology-TARGET, Vienna University Hospital School of Medicine, Währinger Gürtel 18–20, A-1090 Vienna, Austria. e-mail: [email protected]
The Adhesion Research Group Elaborating Therapeutics (TARGET), Department of Clinical Pharmacology-TARGET, Vienna University Hospital School of Medicine, Währinger Gürtel 18–20, A-1090 Vienna, Austria. e-mail: [email protected]Search for more papers by this authorPetra Stohlawetz MD
Resident
Clinic of Blood Group Serology and Transfusion Medicine, Department of Transfusion Medicine, University of Vienna, Vienna, Austria
Search for more papers by this authorStylianos Kapiotis MD
Associate Professor
Clinical Institute of Medical and Chemical Laboratory Diagnostics, University of Vienna, Vienna, Austria
Search for more papers by this authorDagmar Seidl MD
Research Fellow
Department of Clinical Pharmacology-TARGET, Vienna University Hospital School of Medicine, Vienna, Austria
Search for more papers by this authorNicole Hergovich MD
Research Fellow
Department of Clinical Pharmacology-TARGET, Vienna University Hospital School of Medicine, Vienna, Austria
Search for more papers by this authorMaria Zellner MSc
Research Fellow
Department of Clinical Pharmacology-TARGET, Vienna University Hospital School of Medicine, Vienna, Austria
Search for more papers by this authorHans-Georg Eichler MD
Professor and Head
Department of Clinical Pharmacology-TARGET, Vienna University Hospital School of Medicine, Vienna, Austria
Search for more papers by this authorGabriele Stiegler MD
Resident
Clinic of Blood Group Serology and Transfusion Medicine, Department of Transfusion Medicine, University of Vienna, Vienna, Austria
Search for more papers by this authorGerda Leitner MD
Consultant
Clinic of Blood Group Serology and Transfusion Medicine, Department of Transfusion Medicine, University of Vienna, Vienna, Austria
Search for more papers by this authorPaul Höcker MD
Professor and Head
Clinic of Blood Group Serology and Transfusion Medicine, Department of Transfusion Medicine, University of Vienna, Vienna, Austria
Search for more papers by this authorCorresponding Author
Bernd Jilma MD
Resident and Head
The Adhesion Research Group Elaborating Therapeutics (TARGET), Department of Clinical Pharmacology-TARGET, Vienna University Hospital School of Medicine, Währinger Gürtel 18–20, A-1090 Vienna, Austria. e-mail: [email protected]
The Adhesion Research Group Elaborating Therapeutics (TARGET), Department of Clinical Pharmacology-TARGET, Vienna University Hospital School of Medicine, Währinger Gürtel 18–20, A-1090 Vienna, Austria. e-mail: [email protected]Search for more papers by this authorSupported in part by a grant from the Jubiläumsfonds der Oesterreichischen Nationalbank.
Abstract
BACKGROUND: Although many donors undergo repeated plateletpheresis, data on the consequences of plateletpheresis for the donor's health remain scarce. Thus, the effect of plateletpheresis on the activation of coagulation, fibrinolysis, and neutrophils was investigated.
STUDY DESIGN AND METHODS: Part 1: Sixteen healthy men were randomly assigned to undergo plateletpheresis on a cell separator (AMICUS, Fenwal Baxter; or MCS 3p, Haemonetics). The effects of plateletpheresis on plasma levels of prothrombin fragment (F1+2), d-dimer, plasmin-plasmin inhibitor (PPI) complexes, and plasminogen activator inhibitor (PAI-1); on the activation of neutrophils (% l-selectin+); and on the frequency of platelet-neutrophil aggregates (% CD41 + neutrophils) were compared. Part 2: Ten healthy men received infusions of ACD-A and placebo without apheresis in a randomized, double-blind crossover study to control for the pharmacologic effects of citrate.
RESULTS: Part 1: No change in F1+2 occurred (p>0.05), which indicated that plateletpheresis did not enhance coagulation. Levels of d-dimer, PPI, and PAI-1 decreased over time on the AMICUS (p<0.001). Plateletpheresis did not activate neutrophils (p>0.05), but it decreased the percentage of CD41+ neutrophils (p<0.003). An approximately 80-percent drop in mononuclear cells was observed in the extracorporeal circulation of the AMICUS (p<0.001 vs. baseline and p = 0.005 vs. MCS 3p), and circulating lymphocyte and monocyte counts decreased concomitantly. Part 2: Infusion of ACD-A slightly decreased d-dimer levels (p<0.05), and both infusions decreased the circulating lymphocyte counts.
CONCLUSION: Plateletpheresis can be regarded as safe with respect to the activation of coagulation or neutrophils. The consequences for the donor's health of the decrease in d-dimer, PPI, and PAI-1 may deserve further investigation.
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