Mathur Gagan, Mott Sarah L, Collins Laura, Nelson Gail A, Knudson C Michael, Schlueter Annette J
Department of Pathology, University of Iowa.
Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.
Transfusion. 2017 May;57(5):1142-1151. doi: 10.1111/trf.14022. Epub 2017 Feb 1.
Platelet clumping is a common occurrence during peripheral blood hematopoietic stem cell (HSC) collection using the Spectra Optia mononuclear cell (MNC) protocol. If clumping persists, it may prevent continuation of the collection and interfere with proper MNC separation. This study is the first to report the incidence of clumping, identify precollection factors associated with platelet clumping, and describe the degree to which platelet clumping interferes with HSC product yield.
In total, 258 HSC collections performed on 116 patients using the Optia MNC protocol were reviewed. Collections utilized heparin in anticoagulant citrate dextrose to facilitate large-volume leukapheresis. Linear and logistic regression models were utilized to determine which precollection factors were predictive of platelet clumping and whether clumping was associated with product yield or collection efficiency.
Platelet clumping was observed in 63% of collections. Multivariable analysis revealed that a lower white blood cell count was an independent predictor of clumping occurrence. Chemotherapy mobilization and a lower peripheral blood CD34+ cell count were predictors of the degree of clumping. Procedures with clumping had higher collection efficiency but lower blood volume processed on average, resulting in no difference in collection yields. Citrate toxicity did not correlate with clumping.
Although platelet clumping is a common technical problem seen during HSC collection, the total CD34+ cell-collection yields were not affected by clumping. WBC count, mobilization approach, and peripheral blood CD34+ cell count can help predict clumping and potentially drive interventions to proactively manage clumping.
在使用Spectra Optia单核细胞（MNC）方案进行外周血造血干细胞（HSC）采集过程中，血小板聚集是常见现象。如果聚集持续存在，可能会妨碍采集的继续进行，并干扰MNC的正确分离。本研究首次报告了聚集的发生率，确定了与血小板聚集相关的采集前因素，并描述了血小板聚集对HSC产品产量的干扰程度。
回顾了对116例患者使用Optia MNC方案进行的258次HSC采集。采集过程中使用肝素抗凝枸橼酸盐葡萄糖以促进大容量白细胞单采。采用线性和逻辑回归模型来确定哪些采集前因素可预测血小板聚集，以及聚集是否与产品产量或采集效率相关。
63%的采集出现了血小板聚集。多变量分析显示，较低的白细胞计数是聚集发生的独立预测因素。化疗动员和较低的外周血CD34+细胞计数是聚集程度的预测因素。出现聚集的采集效率较高，但平均处理的血量较低，导致采集产量无差异。枸橼酸盐毒性与聚集无关。
尽管血小板聚集是HSC采集过程中常见的技术问题，但总的CD34+细胞采集产量不受聚集影响。白细胞计数、动员方法和外周血CD34+细胞计数有助于预测聚集，并可能推动采取干预措施来主动管理聚集。
