Journal of Medical and Biomedical Laboratory Sciences Research 2021; Vol 1:3 ORIGINAL RESEARCH

CORRELATION OF DONOR CHARACTERISTICS AND APHAERETIC PLATELET

YIELD USING THE TRIMA ACCEL MACHINE AT THE AGA KHAN UNIVERSITY
HOSPITAL, NAIROBI, KENYA
Annie W. Githiiyi *1, Stanley K. Waithaka 2, Kennedy M. Kuria 3, Nancy Okinda1, Elizabeth Kagotho1
1
Aga Khan University Hospital, Nairobi, Kenya.
2
Mount Kenya University P.O Box 342-01000 Thika, Kenya.
3
Murang’a University of Technology P.O Box 75-10200 Murang’a, Kenya.

Abstract
Background: One of the devices dedicated to the collection of leukoreduced single-donor platelets is the Trima Accel cell separator.
Improved efficiency of apheresis and increased flexibility in the collection of leukoreduced platelets has been enhanced by the new
Universal Platelet protocol. The aim of this study was to determine the correlation between donor characteristics and apheresis platelet
yield using the Trima Accel machine at the Aga Khan University Hospital.
Methodology: This was a cross-sectional study carried out at the blood transfusion department of the Aga Khan University Hospital,
Nairobi. The study population comprised all persons who came to voluntarily donate platelets and gave informed consent at the hospital
and comprised of 120 donors. The first phase was to determine the donors' gender, hemoglobin count, platelet count, weight, and height.
Upon qualification, the donors donated platelets through the Trima Accel machine. The platelet count of the donated platelets was
determined using the Sysmex XN-1000 then the yield was calculated.
Results: The mean platelet yield was 4.07 ×1011. The platelet yield correlated with donor pre-platelet count (r=0.413), but did not
correlate with age (r=0.096), height (r=0.024), weight (r=0.068), gender (0.096), hematocrit (0.134) and hemoglobin (r=0.134).
Discussion: Variables such as age, height, weight hemoglobin, and hematocrit showed no correlation with the yield while pre-donation
platelet count correlated with the yield.
Key words: Donor Characteristics, Platelet yield, Apheresis, Trima Accel Machine.
* Corresponding author: [email protected]
Published in the issue of November, 2021

1. Introduction Therapeutic platelet transfusions are usually indicated in the non-

Apheresis is a Greek word that means to separate or remove from surgical arena when bleeding reaches the WHO grade 2 level
blood whereby products like platelets, plasma, or packed blood (evidence of hemorrhage not requiring excess red cell transfusions
cells can be collected from an individual donor (1). Therapeutic (5).
apheresis normally includes the exchange of plasma and Platelet apheresis procedure has emerged as one of the most
cytapheresis. The procedure involves withdrawing blood from a important procedures in determining the outcome of the apheresis
donor or patient in an anticoagulant solution and separating it into product quality. Based on previous studies, this method of platelet
components like plasma, packed red blood cell, and platelets. One collection was able to produce a better platelet yield in terms of
or more component is retained and the remaining constituents are volume and concentration. Studies illustrated the possible
returned to the individual (2). variations involved in contributions to the outcome of the platelet
The basic principle behind the preparation of components from apheresis yield. There are many factors involved which could be
whole blood is that each component has its specific gravity and by donor-related or machine-related. The factors include the donor's
applying centrifugation, each component is separated and age, gender, height, weight, pre-donation hemoglobin level, and
removed, thus allowing the transfusion of the desired component pre-donation platelet count. Previous studies demonstrated that the
according to the need of the patient. pre-donation platelet count had a significant influence on the
The majority of prophylactic platelet transfusions are given to platelet yield (6). Apheresis donors with pre-donation platelet
patients with severe thrombocytopenia in surgical and non- count > 250× 109/L have been determined to produce a desired
surgical settings. Most data suggest that prophylactic platelet hemostatic platelet dose for the recipient. Chaudhary et al, 2006
transfusions should be given to non-surgical patients with chronic found no correlation between the pre-donation Hb and the yield (r
thrombocytopenia when counts are below 10,000 plts/μl and in the = - 0.10, p > 0.005). Some donors with Hb above 16 g/dl gave a
face of active bleeding. Spontaneous bleeding due to lower yield compared with those with Hb lower than 16g/dl.
thrombocytopenia alone does not occur until the platelet count is Guerrero-Rivera et al., 2003 and Osmanovic (2017) concluded
below 10,000 plts/μl (3). Patients with heparin-induced that this could be related to the greater amount of plasma processed
thrombocytopenia or chronic thrombocytopenia caused by in donors with lower Hb.
increased platelet destruction (e.g., idiopathic thrombocytopenic There is no significant relationship between donor weight and
purpura) are not supposed to be administered prophylactic platelet yield (Chaudhary et al.'s, (2006). According to the AABB
platelets. Transfusion may be ineffective due to refractoriness in a requirements, 75% of the plateletpheresis products prepared must
substantial percentage of these patients (4).

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Journal of Medical and Biomedical Laboratory Sciences Research 2021; Vol 1:3 ORIGINAL RESEARCH

contain ≥ 3 x 1011 platelets per unit, while the European guidelines Platelet yield calculation
recommend a platelet count of ≥ 2×1011/Unit (10). Platelet Yield = Platelet count x Platelet Volume
In another study, one hundred and twenty-seven procedures of 100000
apheresis have been considered. Gender, age, volume processed, Platelet count: The count of platelets in the collection bag done
PLT pre-counts, and Hb were considered as predicting variables. using the Sysmex xn 1000 machine (count×109/l)
The AC infusion rate, plasma volume, and processing time Platelet Volume: Volume platelets collected in the bag (mls).
collected with the PLTs were examined as machine parameters. =Weight of collected platelets (mgs) - Weight of an empty bag (mgs)
The researchers then evaluated the post-transfusion effectiveness 1.03
in patients who had thrombocytopenia, assessing the effect of PLT Key
dose, PLT storage time, and ABO group. The findings from the 1.03: A Constant for converting weight of blood (mgs) to volume
study showed that females have a higher yield when compared to (mls)
males. Further, the AC infusion rate and processing time generated 100000: A constant for converting count/µl to count/ L .
a positive influence on the PLT yield. The study also showed that
most of the complications related to citrate. Further, PLT 3 Results
increments in patients who had undergone transfusion presented a The cases included 120 transfusion donations made during the
positive correlation with the units that were transfused and period of the study. The response rate for the study was therefore
negatively with the storage days for PLT (11). Studies show that 100%.
donors who have Hb levels that are greater than 12 g/dl can be able Demographics
to donate safely. Majority of the respondents were male (95.83%) while female
In another study that was assessing the Haemonetics cell separator, blood donors who participated in the study made 4.17%. The pie
researchers noted that the machine was able to collect apheresis chart below presents the distribution in terms of gender in detail.
platelets effectively with a mean of 3.7 × 1011, and mean CR of
0.063±0.013 × 1011/min. Further, in other literature for assessing
the Trima cell separator, the machine has been shown to Female to Male APHERETIC PALTELETS YIELD
effectively collect the platelets with a median of 3.7 × 1011 (12).
In this study it sought to correlate donor characteristics and
apheresis platelet yield using the Trima Accel machine at the Aga
4%
khan university hospital.

2. Materials and methods

This was a cross-sectional study that involved the collection of
data during one point in time. The collection of platelets from the 96%
subjects using the Trima Accel machine at Agha Khan University
was done at one point in time and the findings used in assessing
the variables in the study.
Female Male
Donor platelet count and yield, laboratory tests, and structured
donor questionnaires were used in gathering data. The structured
Figure 1: Distribution of donors in terms of gender
donor questionnaires were developed from a review of tools used
Most of the blood donors were aged between 30 and 39 (43.3%)
in assessing the donor characteristics associated with platelet yield
years while those aged between 20 and 29 years were also
in the platelet apheresis process. Laboratory tests were used to
significant (37.5%). The main focus was on the dependent
analyze the donor's platelet count and yield while donor
variables (the yield) and how it was affected by the independent
questionnaires were used in the assessment of donors.
variable that is age, gender, weight, height, hemoglobin,
Laboratory Tests and Techniques
hematocrit, and the pre-donation platelet count. The required age
Full Haemogram on donor sample pre-donation.
bracket for a person to donate is 18 years to 65 years of age. The
Blood was collected from the donor before donation and a full
ages of the donors varied with the youngest being 18 years, the
haemogram was run using the Sysmex XN-1000 Haematology
oldest donor being 61 years and the average being 32.4 years.
analyzer for estimation of platelet, hemoglobin, and hematocrit.
The full hemogram serves as one way of ensuring the donor meets
the minimum qualification for platelet donation. Once the donor
qualified i.e. a hemoglobin count of 12 mg/dl for women and 13
mg/dl for men, Haematocrit count of 40% to 52%, and a platelet
count of 250×109/L they were scheduled for platelet donation
through the apheretic machine for platelet collection.
Platelet count after they had been donated.
After donation, the platelets collected in a platelet bag pouch were
analyzed using the Sysmex XN-1000 hematology analyzer.

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Journal of Medical and Biomedical Laboratory Sciences Research 2021; Vol 1:3 ORIGINAL RESEARCH

Table 1: Basic summary statistics of the Age groups. 4.03×1011 platelets and the heaviest being 121.42 Kgs giving a
N yield of 4.2×1011 platelets.
e) Objective 5: To determine the effects of hematocrit
Background characteristics 120 n (%) count on apharetic platelet yield.
Age-group Hematocrit was also found not to be significant to the yield. (r=
0.413). The highest level being 53.7% and the lowest levels being
Below 20 years 1 (0.83%) 37.8%. In comparison women have an average of 41.6% while
men had 45.%.
20 – 29 45 (37.50%) f) Objective 6: To determine the effects of age and
gender of the donors on aphaeretic platelet yield.
30 – 39 52 (43.33%) The required age bracket for a person to donate is 18 years to 65
years of age. The ages of the donors varied with the youngest being
40 – 49 19 (15.83%) 18 years, the oldest donor being 61 years and the average being
32.4 years. Most of the blood donors were aged between 30 and
50 – 59 2 (1.67%) 39 (43.3%) years while those aged between 20 and 29 years were
also significant (37.5%). There were more male (95.83%) than
60 and Above 1 (0.83%) female donors (4.17%). The study findings showed that the
Source Field Data (2019) average yield for the female donors was 4.59×1011 platelets while
the average yield for the male donors was 4.04×1011 platelets.
Platelet Yield and Donors Background Characteristics. Further, the results indicated an average yield of both male and
a) Objective 1: To determine the effects of platelet female of 4.07×1011 platelets. This is an indication that female
count on aphaeretic platelet yield. donors have a higher yield when compared to the male donors
Pre-donation platelet count serves as one of the parameters that are even though it is a possible confounding effect of the sample size.
tested prior to platelet apheresis. The more the amount, the more Further, an analysis of the platelet yield and donor characteristics
there is to harvest and the least the amount the less there is to was done in order to understand the relationship between the
harvest. The pre-donation platelet average count for female donors dependent and independent variables. From the analysis, it was
was 367×109/L with an average yield of 4.59×1011 platelets and determined that there was a correlation between donor
male donor was 315×109/L with an average yield of 4.04×1011 characteristics and aphaeretic platelets yield with pre-donation
platelets, with the highest among the whole group of donors being platelet count (r=0.413, CI = 0.0037, 0.0054). The table below
484×109/L with a yield of 5.0×1011 platelets. The combined pre- presents the findings in greater detail.
donation platelet average was 317×109/L giving an average yield
of 4.07×1011 platelets.
Table 2: Platelet yield and donor characteristics
b) Objective 2: To determine the effects of hemoglobin Std.
count on aphaeretic platelet yield. r Adjusted Error of 95% Conf.
Yield R
Hemoglobin count is a parameter that must be determined before square r square the Interval
Estimate
a donor donates because quit a huge amount of blood needs to be
processed. Female donors must have a hemoglobin value of at Donated 0.0037
least 12 g/dl while male donors must have a hemoglobin value of 0.413 0.171 0.037 1.361 0.0054
platelet count -
0.096 0.009 0.001 1.387 .0048224
at least 13.0 g/dl. The average hemoglobin count was 15.3 g/dl. Gender .0094053
The highest hemoglobin count was 18.4 g/dl with a yield of -
3.3×1011 platelets while the lowest hemoglobin count was 13.6 Weight (Kgs) 0.068 0.005 -0.004 1.390 .0065673
.0020282
g/dl with a yield of 4.07×1011 platelets. -
c) Objective 3: To determine the effects of donor height Height (cms) 0.024 0.001 0.008 1.393 .0053065
.0072412
on aphaeretic platelet yield. Hemoglobin 0.134 0.018 0.010 1.382 -.02817 .1322787
Height of donors is done prior to donating and is a parameter that
-.0420
the machine uses to determine the duration of the procedure. The HCT 0.134 0.018 0.010 1.381 .0001667
-
average height was 170.9 cm. The tallest person was 190 cm and Age 0.096 0.009 0.001 1.387 .0048224
.0094053
donated platelets with a yield of 4.1×1011 platelets while the
Source: Field Data (2019)
shortest person was 115 cm and donated platelets with a yield of
The analysis reveals that gender, age, height, weight, hemoglobin,
4.0×1011 platelets.
and hematocrit show no correlation with the yield while pre-
d) Objective 4: To determine the effects of donor
donation platelet count values had an association with the yield.
weight on aphaeretic platelet yield.
Anticoagulant Citrate Dextrose is used to prevent blood from
Weight is also another parameter that is used by the machine to
clotting ones outside the body. The longer the time it takes for the
determine the duration of the procedure. The average weight was
collection procedure the more the anticoagulant is used and the
80.2 Kgs with the lightest donor being 54 Kgs giving a yield of
more the volume of blood is processed. The lowest actual

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Journal of Medical and Biomedical Laboratory Sciences Research 2021; Vol 1:3 ORIGINAL RESEARCH

Anticoagulant to donor in milliliters was 200 milliliters while the The average weight was 80.2 Kgs and the r-value was (r = 0.068)
highest was 421 milliliters. Looking at the duration of time taken showing no correlation between weight and the platelet yield.
to donate the average was 58.5 mins with the fastest being done in There were more males (95.83%) than female donors (4.17%).
40 mins while the longest time taken was 92 mins. In terms of The correlation coefficient value for gender was (r =0.096)
blood, volume processed the average was 3361 mls with the least showing no correlation between gender and platelet yield.
processed being 2130 and the most processed being 5230. These results led to the conclusion that gender, hemoglobin,
hematocrit, weight, height, and age have no correlation with
Table 3: Actual Anticoagulant to donor (mls), duration of aphaeretic platelets. Other studies done can confirm this statement
time (mins) taken to donate platelets and blood volume (mls) showing there is no correlation between the yield and these listed
processed. variables. Chaudhary et al, 2006 found no correlation between the
Activity Volume in ml pre-donation Hb and the yield (r = - 0.10, p > 0.005). Some donors
with Hb above 16 g/dl gave a lower yield compared with those
Average Actual AC to donor 280.3 with Hb lower than 16g/dl. Guerrero –Rivera et al, 2003 and
(milliliters) Landžo & Petrovi (2015) concluded that this could be related to
The average duration of 58.5 the greater amount of plasma processed in donors with lower Hb.
minutes taken to get yield Bahadur et al (16) also studied the effect of donor weight on
Average blood volume 3361 platelets yield and found no significant correlation. According to
processed (milliliters) the AABB requirements, 75% of the plateletpheresis products
Source: Field Data (2019) prepared must contain ≥ 3 x 1011 platelets per unit, while the
European guidelines (Council of Europe publishing, 2006)
recommends platelet count of ≥ 2×1011/Unit.
4. Discussions Pre-donation platelet count has a significant linear correlation with
the platelet yield (r = 0.413). The higher the platelet count means
In this study, the demographics showed that the respondents were more platelets are available for collection. Out of the 120 donors
between 18 and 61 years. This is a convention for blood donation. assessed for the pre-donation platelet count effect on platelet yield,
The findings from the study showed that the pre-donation platelet 24 (20%) had a pre-donation platelet count <250×109/L. The mean
count of the donor and the platelet count of the donated platelets yield of the platelets from these donors was 2.3×1011/Unit.
had a significant difference but other donor characteristics did not 22(18%) had a pre-donation platelet count of 250-300×109/L and
account for the significant difference. Mangwana (13) presents the mean yield in the product from these donors was
almost similar results noting that weight, height, platelet count, 3.9×1011/Unit. 74(62%) had a pre-donation platelet count
and total leukocyte count do not have a significant correlation with >300×109/L and the mean yield in the products was 4.4×1011/Unit.
the platelet yield, blood volume, and processing time while Chaudhary (9), in a study of 94 plateletpheresis procedures, found
hemoglobin particularly in females shows significant correlation a mean yield of 2.8±0.73×1011/Unit and they found that when the
(13). Another research shows that platelet yield correlates pre-donation platelet count was greater >300×103/µl, the yield was
significantly with pre platelet count of the donor and negatively greater than 3×1011/Unit in 80% of the products. They also
with the pre-Hb of the donor (14). This is an indication that reported that the mean yield was 2.5±0.59×1011/Unit when the pre-
transfusion centres should have their own plateletpheresis based donation platelet count was <200×103/µl. The results obtained in
on hematological and demographic characteristics of the donor this research are in accordance with these observations and the
target population to ensure safety and quality. platelet yield correlated linearly with the pre-donation platelet
Further, data was analyzed using multiple linear regressions count of the donor. Goodnough et al, 1999 studied 708
comparing the significance level of each independent variable plateletpheresis procedures, and a direct correlation between yield
compared to the dependent variable the yield. Using a 95% and pre-donation platelet count was observed. In 12% of the
confidence interval, results were deduced that variables modeled procedures, the mean yield was <3×1011/Unit when the pre-
affect the yield. On the assessment of the donor variables on donation platelet count was <200×103/µl.
platelet yields, we found that there is a significant correlation with Hematocrit was also found not to correlate with the yield. (r
the pre-donation platelet count (r = 0.434). According to the data, =0.134). The highest level is 53.7% and the lowest levels being
women had more yield compared to men. This could be attributed 37.8%. In comparison, women had an average of 41.6% while the
to the high platelet count in women as well as the fact that women men had 45.18%. Elveden (15) concluded that increased values of
have fewer hemoglobin values hence more plasma volume in hematocrit reduce the efficiency of platelet collection hence the
women is processed than in men, even though the findings might platelet yield. He concluded that it's preferable to collect platelets
have been confounded by my sample size. The average from donors with higher baseline platelet counts and lower Hct
hemoglobin count was 15.3g/dl. The r-value for hemoglobin was counts because they give a higher yield.
r = 0.134). This shows that there is no correlation between
hemoglobin and the platelet yield. The r-value of age was
5. Conclusion
(r=0.096) and the average age was 32.4. There was no correlation
between age and apheretic platelet yield. The r-value for height In conclusion variables such as gender, age, height, weight, and
was (r=0.024) and the average height was 170.9. There was no hemoglobin showed no correlation with the platelet yield while
correlation between Height and the platelet yield. pre-donation platelet count had an association with the platelet

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Journal of Medical and Biomedical Laboratory Sciences Research 2021; Vol 1:3 ORIGINAL RESEARCH

yield. HCT values had no association with the yield. The Trima J. Hemoglobin and Platelet Count Effect on Platelet Yields
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