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Risk factors for T-cell lymphopenia in frequent platelet donors: The BEST collaborative study.

Richard M Kaufman1, Denese C Marks2, Yael Flamand3

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Summary

Frequent apheresis platelet donors can develop T-cell lymphopenia, especially when using the Trima Accel system with a leukoreduction system (LRS) chamber. Plasma rinseback can mitigate this risk in donors.

Keywords:
donorshematology-white cellsimmunology (other than RBC serology)

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Area of Science:

  • Hematology
  • Immunology
  • Transfusion Medicine

Background:

  • Frequent apheresis platelet donors may experience T-cell lymphopenia of unknown clinical significance.
  • Plateletpheresis instruments like Trima Accel (with LRS) and Fenwal Amicus (without LRS) are commonly used.

Purpose of the Study:

  • To compare T-cell populations in frequent platelet donors using Trima (LRS+) versus Amicus (LRS-) instruments.
  • To identify risk factors for T-cell lymphopenia in platelet donors.

Main Methods:

  • International, multicenter, observational study.
  • Compared T-cell counts in frequent platelet donors (Trima n=131, Amicus n=77) and controls (whole blood donors n=126).
  • Multivariable analysis to assess risk factors for lymphopenia.

Main Results:

  • Lower CD4+ T-cell counts (<200 cells/μL) were observed in 9.9% of Trima donors vs. 4.4% of Amicus donors (p<.0001).
  • Lymphopenia occurred in donors with ≥200 lifetime donations; age, lifetime donations, and instrument type were independent risk factors.
  • Plasma rinseback in Trima donors prevented lymphopenia (0% vs. 14.3%, p=.01).

Conclusions:

  • Recurrent lymphocyte removal during apheresis contributes to T-cell lymphopenia in frequent donors.
  • Leukoreduction systems (LRS) increase lymphopenia risk, but it can occur without LRS.
  • Plasma rinseback is a viable strategy to mitigate T-cell lymphopenia in LRS users.