title: Reduced use of allogeneic platelets through high-yield perioperative autologous plateletpheresis and reinfusion.
abstract: BACKGROUND
  Intraoperative autologous platelet (PLT) collection as part of a multimodal blood conservation program carries a Class IIa recommendation from the Societies of Thoracic Surgeons and Cardiovascular Anesthesiologists, but achieving a suitable PLT yield limits its application. A novel, autologous, intraoperative, high-yield plateletpheresis collection program was established and retrospectively analyzed to identify potential improvements over previously reported plateletpheresis protocols.
  Targeting complex cardiothoracic surgery patients without recent anti-PLT agents, thrombocytopenia, or severe anemia, the program aimed to achieve a PLT yield of at least one standard apheresis unit (3.0 × 10(11) ) within 60 to 90 minutes and using an automated plateletpheresis device (Trima, Terumo BCT). Anesthetized and invasively monitored patients underwent plateletpheresis via a large-bore, indwelling central line placed for the surgery. Collection-related data for quality control purposes and subsequent PLT transfusion requirements were analyzed and reported.
  
  
  RESULTS
  Forty-two patients donated autologous PLTs between 2011 and 2012. PLT yield was 4.5 (3.9-5.0) × 10(11) , which significantly exceeds previously reported yields, and procedure duration was 53.2 (48.4-57.9) minutes. As anticipated, postcollection PLT count decreased from 268 (242-293) × 10(9) to 182 (163-201) × 10(9) /L; hypocalcemia was minimized by infusion of 1 g of CaCl2 . Autologous PLT yield was inversely correlated with allogeneic PLT use, and avoidance of allogeneic PLT transfusion was increased when the autologous yield was the equivalent of 2 or more apheresis units.
  
  
  CONCLUSIONS
  High-yield, intraoperative autologous PLT collection is achievable using an automated plateletpheresis device. Initial experience shows a reduction in reliance on allogeneic PLTs for complex cardiothoracic surgery.
authors.affiliation: Perfusion Services, Durham, North Carolina.
authors.forename: Melissa
authors.initials: M
authors.lastname: Alberts
authors.forename: Nicholas
authors.initials: N
authors.lastname: Bandarenko
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Gaca
authors.forename: Evelyn
authors.initials: E
authors.lastname: Lockhart
authors.forename: Carmelo
authors.initials: C
authors.lastname: Milano
authors.forename: Stanlin
authors.initials: S
authors.lastname: Alexander
authors.forename: Dean
authors.initials: D
authors.lastname: Linder
authors.forename: Frederick W
authors.initials: FW
authors.lastname: Lombard
authors.forename: Ian J
authors.initials: IJ
authors.lastname: Welsby
mesh_terms: D015982:Bias; D002469:Cell Separation / Q000379:methods; D006801:Humans; D017713:Platelet Transfusion; D010983:Plateletpheresis / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies