Status:
Ready to upload
Record number:
2234
Adverse Occurrence type:
MPHO Type:
Estimated frequency:
A CD4-positive T-cell lymphocyte count of less than 200 cells/uL is a concerning lab result and used to define AIDS in the setting of HIV infection. In this study, former frequent apheresis platelet donors (defined as those who donated platelets 20 to 24 times in a 365-day period) who stopped donating platelets for at least one year were contacted. Of the 50 potential candidates, 15 participated in the study. Two of 15 participants had CD4-positive lymphocyte counts of less than 200 cells/uL. Three of 15 participants had CD4 counts between 200 and 300 cells/uL.
The authors point out in a previous study assessing CD4-positive lymphocyte counts in current apheresis platelet donors (defined as those who donated 20 to 24 times in the prior 365-day period), six of 24 current platelet donors had CD4 counts less than 200 cells/uL. In addition, two of nine apheresis donors who were currently donating platelets less frequently but had a history of frequent plateletpheresis had CD4 counts less than 200 cells/uL (PMID: 30429159).
Of note, all collections were performed using the Trima Accel (Terumo BCT) automated blood collection system, which removes leukocytes continuously with a leukoreduction system chamber.
Time to detection:
When comparing CD4-positive lymphocyte counts of former versus current plateletpheresis donors, the CD4 count was significantly higher in the former platelet donor group than in the current platelet donor group (p=0.0497). Given the small number of study participants, the authors acknowledge that it is not possible to discern the relative impact of a number of variables on CD4 positive counts: length of time between last plateletpheresis session and assessment of cell counts, age at time of last plateletpheresis session, total number of plateletpheresis sessions, most frequent type of donation (ie, single, double, or triple units), and time of frequent (20-24 sessions in a 365-day period) donation relative to discontinuation of plateletpheresis.
Alerting signals, symptoms, evidence of occurrence:
The authors highlight that frequent plateletpheresis collections using a device with a leukoreduction system chamber may lead to severe lymphopenia in donors who had stopped donating platelets for more than one year. However, there was no evidence that the severe lymphopenia predisposed donors to opportunistic infections or to malignancies associated with immune dysregulation.
Demonstration of imputability or root cause:
Drawing definitive conclusions from a study with a limited sample size is challenging. Frequent plateletpheresis collections (defined as 20-24 donations in a 365-day period) may cause CD4-positive T-cell lymphopenia in some donors. Although a CD4 count of less than 200 cells/uL can be clinically concerning, potential harms/health consequences were not observed in the otherwise healthy former platelet donors. Larger studies are needed to better quantify the lymphopenia that may result from frequent plateletpheresis collections and understand any subsequent health consequences.
Imputability grade:
1 Possible
Groups audience:
References:
Suggest new keywords:
plateletpheresis, platelets, platelet donation, lymphopenia
Reference attachment:
Suggest references:
https://pubmed.ncbi.nlm.nih.gov/30747442 (this is the article reviewed, #2234):
Gansner J. Severe CD4+ T-cell lymphopenia is not observed in frequent plateletpheresis donors collected on the Fenwal Amicus. Transfusion 59(9);2783-87. 2019.
Zhao J, et al. Frequent platelet donation is associated with lymphopenia and risk of infections: A nationwide cohort study. Transfusion 61(2);464-73. 2021
Note:
Authors point out their data suggests frequent plateletpheresis-associated lymphopenia is not harmful to donors, however larger studies are needed to fully assess the risks. Because of this, under the "adverse outcome type," I selected "other" - or should "infection" be selected since this is a potential harm?
A larger study conducted in 2021 by Zhao J, et al, "Frequent platelet donation is associated with lymphopenia and risk of infections: A nationwide cohort study," could be considered for Living Donor review. PMID: 33186486
Question of EP: can comercial device names be used?
Expert comments for publication:
Although frequent plateletpheresis may cause severe CD4-positive T-cell lymphopenia in some donors (2 of 15 study participants), the authors acknowledge that there was no evidence of harm to donors. Larger studies are needed to understand platepheresis-associated lymphopenia and the potential health consequences. In addition, recent studies have shown that severe CD4-positive T-cell lymphopenia is not observed with the Fenwal Amicus collection device, likely because this device does not employ a leukoreduction system chamber. (PMID 31271458)