ISSN:0733-2459    

DOI:10.1002/jca.2920020104

出版商:John Wiley&Sons, Inc.    

年代:1984

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920020105

出版商:John Wiley&Sons, Inc.    

年代:1984

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920020106

出版商:John Wiley&Sons, Inc.    

年代:1984

数据来源: WILEY

摘要:

AbstractWith the advent of sophisticated automated blood processors, the collection of large numbers of granulocytes for transfusion has been made more practical in the past ten years. Harvesting granulocytes by filtration leukapheresis has been abandoned in most centers because of adverse reactions in both donors and recipients. Currently, both continuous and discontinuous flow centrifugation leukapheresis techniques are available. However, both corticosteroids and hydroxyethyl starch are required for optimal granulocyte collection. In this paper, we critically compare the three major cell separators used for the collection of granulocytes by centrifugation leukapheresis.All three instruments separate blood cells by centrifugation; the IBM‐2997 and the Fenwal CS‐3000 function by continuous‐flow centrifugation, and the Haemonetics Model 30 by discontinuous‐flow centrifugation. Factors such as the donor preapheresis white blood cell count, the blood flow rate through the machine and the centrifuge speed effect granulocyte collection. Comparisons will be made of the cost of the software for each machine, the time required for granulocyte collection, the convenience of set‐up and tear‐down, the amount of skill and experience demanded of the operator. Donor factors will be discussed. Since the blood processor may be used for other procedures including plateletpheresis, therapeutic plasma exchange, lymphocytapheresis and erthrocytapheresis, the pros and cons of each machine as used for some of these procedures will be included in the discussion.In our experience, total leukocytes and granulocytes (neutrophils) collected with the three different instruments varied only slightly when unstimulated donors were studied. Total WBC × 109per granulocyte pack were 16.7 ± 0.85 for CS‐3000 (N=37), 16.3 ±0.95 for IBM‐2997 (N=47) and 13.3 ±0.09 for Model 30 (N=179). Neutrophils × 109per pack were 8.4 ± 0.42, 8.2 ± 0.47 and 7.4 ± 0.28, respectively. Granulocyte yields can be increased 2–3 fold when donors are stimulated with corticosteroids, particularly with the continuous‐flow machines. Platelet collection varied greatly. The largest number of platelets per granulocyte pack was collected with the Haemonetics Model 30 (7.5 × 10″ ±0.13). The Fenwal CS‐3000 had the next highest platelet yield with 3.6 × 10″ ±0.12, the IBM‐2997 collected 2.6 × 10″±0.16. Erthrocyte c

ISSN:0733-2459    

DOI:10.1002/jca.2920020107

出版商:John Wiley&Sons, Inc.    

年代:1984

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920020108

出版商:John Wiley&Sons, Inc.    

年代:1984

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920020109

出版商:John Wiley&Sons, Inc.    

年代:1984

数据来源: WILEY

摘要:

AbstractCenters throughout the world have utilized various erythrocyte sedimenting macromolecules to improve the collection of neutrophils from normal donors, but in the United States, high‐molecular weight hydroxyethyl starch (HES 450/0.70) is presently the only agent approved by the Food and Drug Administration for use during leukocytapheresis. HES 450/0.70, prepared from a waxy species of either maize or sorghum, is hydrolysed by alpha‐amylase present in the bloodstream following intravenous administration. The major portion (70 to 80%) of the injected dose of HES 450/0.70 is eliminated through the kidneys; a smaller portion (20 to 30%) becomes extravasated, and a minor amount is eliminated through the gastrointestinal tract. If HES 450/0.70 is given as asingle500 ml dose, the erythrocyte sedimentation rate (ESR) will be increased and difficulties in blood typing and crossmatching may be encountered. Concentrations of most blood and plasma components will decrease, usually in direct proportion to the amount of HES 450/0.70 and other fluids administered. Determinations, both of hepatic and of renal function, will remain within normal limits, although the levels of an alpha‐amylase in plasma will become elevated. Serious bleeding complications are normally not observed when the dose of HES 450/0.70 does not exceed 1.0 to 1.5 g/kg body weight. Rarely, anaphylactoid reactions may be encountered. If HES 450/0.70 is given on more than one occasion, and especially if administered over a relatively short period of time, mild untoward effects related to expansion of the plasma volume may occur. When HES 450/0.70 is givechronically, tests of hepatic and renal function remain within normal limits, but certain tests of coagulation may become slightly prolonged. HES 450/0.70 has an excellent record of safety and is highly recommended for use during leukocytaphe

ISSN:0733-2459    

DOI:10.1002/jca.2920020110

出版商:John Wiley&Sons, Inc.    

年代:1984

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920020111

出版商:John Wiley&Sons, Inc.    

年代:1984

数据来源: WILEY

摘要:

AbstractModern techniques of mechanical hemapheresis have made it possible to selectively remove vast quantities of lymphocytes and plasma immunoglobulins, and the concentration of these substances in donor blood can fall below the normal range. It is feared that this may lead to immunosuppression; a condition associated in some clinical settings with infections, malignancy and autoimmune diseases. Using primary immunodeficiency diseases and induced immunodeficiency states (for example, therapeutic lymphocytapheresis, chronic thoracic duct drainage and intestinal lymphangiectasia) as models to judge competency of the immune system, it can be predicted that body defense mechanisms can become defective when serum IgG levels are<200 mg/dl or the blood lymphocyte count is<1000/μl. However, impaired immunologic function can occur in the presence of normal quantities of these substances in the blood stream; conditions that may be related either to imbalances of immune regulatory factors or to qualitative (rather than quantatitive) abnormalities of the immune system.A number of investigators have documented the losses of lymphocytes and plasma immunoglobulins incurred by donors experiencing mechanical hemapheresis. In addition, both the immediate and long‐term decreases in the concentration of these substances in donor blood have been reported. In summary, the immediate decreases in blood lymphocyte counts and serum immunoglobulin concentrations are of slight to moderate degree and are without known adverse effects. Less information is available regarding long‐term alterations of the immune system, and little data have been collected from prospective studies in which large numbers of donors have been thoroughly evaluated by modern techniques. In general, results of many laboratory studies have been altered. However, these abnormalities have been transient for the most part, and it has been difficult to document clinically significant adverse effects. Thus, the quantities of blood lymphocytes and plasma immunoglobulins that can be removed from healthy donors without causing significant immediate or long‐term harm is unknown.Bearing these limitations in mind, the following recommendations are suggested regarding the frequency of repeated mechanical plasma‐and‐cytapheresis. 1) The usual requirements for whole blood donation must be met if the frequency of mechanical hemapheresis does not exceed once every eight weeks. 2) Individuals expected to experience mechanical apheresis at more frequent intervals should comply with the following additional requirements in an attempt to avoid severe lymphocytopenia (blood lymphocytes<1000/μl): a) subjects should not be permitted to donate with a preapheresis lymphocyte count<1200/ 1; b) donor blood lymphocyte counts should be measured initially and again after each cumulative loss of 5 × 1010lymphocytes; c) donors who develop lymphocytopenia (<1000/μl of blood) should be excluded from donation until the blood lymphocyte cou

ISSN:0733-2459    

DOI:10.1002/jca.2920020112

出版商:John Wiley&Sons, Inc.    

年代:1984

数据来源: WILEY

ISSN:0733-2459    

DOI:10.1002/jca.2920020113

出版商:John Wiley&Sons, Inc.    

年代:1984

数据来源: WILEY