title: How do I provide leukapheresis products? Blood center experience and evidence for process improvement.
abstract: BACKGROUND
  The past few decades have seen a resurgence of interest in leukapheresis products to improve the survival of infected patients with neutropenia. These products have a short shelf life and require donor stimulation with dexamethasone before collection. Additionally, a system with good communications and logistical support is essential. A recent survey of blood centers in North America revealed that the majority of centers collecting leukapheresis products use steroid-stimulated donors. The survey results suggested that an analysis of the process and potential process improvement would be of interest to the transfusion medicine community.
  
  
  METHODS
  Data from 2008 to 2011 regarding donor selection, donor dexamethasone stimulation, leukapheresis collection, and correlations between potentially pertinent variables for process improvement were analyzed. Results from an analysis of cost are also included.
  
  
  RESULTS
  We evaluate 432 leukapheresis donations and demonstrate correlations between 1) pre- and poststimulation white blood cell (WBC) count (p<0.0001), 2) interval (donor stimulation to collection) and poststimulation WBC count (p<0.0001), and 3) poststimulation WBC count and leukapheresis product granulocyte yield (p<0.0001).
  
  
  CONCLUSIONS
  Significant improvement in granulocyte quality and yield can be accomplished in dexamethasone-stimulated donors, by selecting eligible donors with relatively high normal prestimulation WBC counts and/or previously good responses to dexamethasone, increasing the duration between dexamethasone stimulation and granulocyte collection, and maintaining optimal hematocrit (5%-10%) in granulocyte collections. Because the majority of surveyed blood centers collecting stimulated granulocytes use steroids alone, modifications presented here may prove useful. Further assessment of correlation between granulocyte yield and clinical outcome will await results of additional studies.
authors.affiliation: New York Blood Center, New York, New York.
authors.forename: Yelena
authors.initials: Y
authors.lastname: Ginzburg
authors.forename: Debra
authors.initials: D
authors.lastname: Kessler
authors.forename: Manlio
authors.initials: M
authors.lastname: Narici
authors.forename: Melinda
authors.initials: M
authors.lastname: Caltabiano
authors.forename: Mark
authors.initials: M
authors.lastname: Rebosa
authors.forename: Donna
authors.initials: D
authors.lastname: Strauss
authors.forename: Beth
authors.initials: B
authors.lastname: Shaz
mesh_terms: D000293:Adolescent; D000328:Adult; D001782:Blood Donors; D001803:Blood Transfusion; D002648:Child; D003907:Dexamethasone / Q000494:pharmacology; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D006801:Humans; D007937:Leukapheresis; D007958:Leukocyte Count; D008297:Male
chemical_list: D016179:Granulocyte Colony-Stimulating Factor; D003907:Dexamethasone