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National audit of citrate toxicity in plateletpheresis donors
Yvette F Makar1, M O Butler, G M Cockersole
1Manchester Blood Centre, Plymouth Grove, Manchester M13 9LL, UK. yvette.makar@nbs.nhs.uk
Insights
Citrate toxicity during plateletpheresis is rare, with severe reactions occurring in 0.03% of procedures. Warning donors once about symptoms of citrate toxicity is sufficient to manage reactions effectively.
Area of Science:
- Transfusion Medicine
- Apheresis Technology
Background:
- Citrate toxicity is a known complication of plateletpheresis.
- The frequency and severity of citrate toxicity have not been previously quantified.
- Understanding risk factors is crucial for donor safety in apheresis procedures.
Purpose of the Study:
- To determine the scale and severity of citrate toxicity during plateletpheresis.
- To investigate variables influencing citrate toxicity, including apheresis device type, procedure type, and donor instructions.
- To establish the safety profile of plateletpheresis in relation to citrate toxicity.
Main Methods:
- A national audit of 13,070 plateletpheresis procedures across 17 apheresis centers in England.
- Data collected over a 3-month period (April-June 2000).
- Standardized forms used to record and grade citrate toxicity symptoms (grades 1-5).
Main Results:
- Severe citrate toxicity occurred in 0.03% of procedures.
- This incidence is comparable to severe faints after whole blood donation, indicating a similar safety margin.
- Donors should be informed of symptoms only at their first attendance to avoid over-reporting mild reactions.
Conclusions:
- Plateletpheresis is a safe procedure when severe reactions are appropriately managed.
- The incidence of severe citrate toxicity is low.
- Optimized donor communication regarding citrate toxicity symptoms is recommended.
Unlabelled:
Citrate toxicity complicating plateletpheresis is not uncommon. However, the scale and severity of the problem have never been formally addressed. In order to answer these questions we undertook a national audit of 13 070-platelet procedures throughout 17 apheresis centres in England over a 3-month period from 1 April to 30 June 2000. A standard form was distributed to each centre to record the symptoms/signs of citrate toxicity which were then graded (grades 1-5) according to their severity. The following variables were studied to determine whether they influenced the frequency and severity of citrate toxicity: 1. The type of manufacturer's cell separator used (Cobe Spectra, Haemonetics, Baxter Amicus and Trima). 2 The type of procedure: single needle, dual needle, single, double or triple dose. 3 The way in which donors were instructed to report symptoms of citrate toxicity.
Outcome:
Plateletpheresis is a relatively safe procedure provided that donors who experience severe reactions receive appropriate treatment. The incidence of severe citrate toxicity (0.03% procedures) is comparable to that of severe faints following whole blood donation, indicating a comparable margin of safety. Donors should be warned of the symptoms of citrate toxicity at their first attendance only. More frequent reminders encourage donors to over-report symptoms of mild citrate toxicity.