供体血浆回冲LRS室防止CD4+和CD8+T淋巴细胞减少的研究

Donor plasma reinfusion flushing of the LRS chamber to prevent CD4+and CD8+T lymphopenia

目的探讨Trima Accel自动化采血系统最后回输时使用供体血浆回冲白细胞减少系统(LRS)室对预防CD4+、CD8+T淋巴细胞减少效果。方法本实验设计了纵向随访和横断面研究。我们选择CD4+计数<200个细胞/μL、CD8+计数<125个细胞/μL作为缺乏的判断标准。对18名初次单采血小板献血者进行随访,并于最近300 d内献血者第0次、3~6次、7~14次献血前检测淋巴细胞计数。以170名未献过血的健康献血者为对照组。按回输模式调整为使用供体血浆回冲的时间(2021年10月)为分界点,将88名最近365 d内(中位献血次数17.5次以上)主要使用自动化采血系统采集捐献单采血小板的既往频繁献血者分为3组并获血液样本:A、B、C各组开始捐献单采血小板的时间分别为2019年10月前、2019年10月至2021年9月、2021年10月后。对血液样本进行分析,以获取包含CD4+、CD8+T淋巴细胞在内的血细胞计数。通过对比分析,随访组不同献血次数时检测指标和对照组与A、B、C各组检测指标有无统计学差异,从而推断供体血浆回冲白细胞减少系统(LRS)室对预防CD4+、CD8+T淋巴细胞减少效果。结果调整回输模式后,18名初次献血者转化的频繁单采献血者,在第5、11次(中位献血次数)献血时没有出现CD4+和CD8+T淋巴细胞减少的情况,且上述指标与其0次献血时无统计学差异。既往频繁献血者中,B、C组CD4+、CD8+T淋巴细胞计数均高于判断标准值,与对照组没有统计学差异。A组CD4+T淋巴细胞正常,仅A组1人CD8+T淋巴细胞低于125个细胞/μL,其累计捐献单采血小板281次,其所在的组在回输模式调整前2~21年(中位数为5年)已经开始献血。A组CD4+、CD8+T淋巴细胞计数与对照组差异明显,其CD4+、CD8+T淋巴细胞计数中位数(A组/对照组)分别为359/521、257/372,P<0.001。A组0%(0/35)CD4+计数<200个细胞/μL,2.85%(1/35)的献血者CD8+<125个细胞/μL,远低于John M.Gansner和Mahboubeh Rahmani研究发现的频繁单采献血者CD4+、CD8+T细胞缺乏的比例。研究表明,回输模式调整后捐献单采血小板不但没有使献血者T淋巴细胞进一步降低,反而频繁献血者T淋巴细胞得到进一步恢复。这表明回输模式调整后献血者献血时可能没有CD4+、CD8+T淋巴细胞的损失,或者只有少量损失且献血者即使频繁捐献单采血小板也可以恢复。结论Trima Accel自动化采血系统使用供体血浆回冲白细胞减少系统(LRS)室对预防CD4+、CD8+T淋巴细胞减少有很好的效果。

Objective To explore the effectiveness of using donor plasma reinfusion to flush the leukoreduction system(LRS)chamber during the final reinfusion phase with the Trima Accel automated blood collection system in preventing the reduction of CD4+and CD8+T lymphocytes.Methods A longitudinal and cross-sectional study was designed.CD4+count<200 cells/μL and CD8+count<125 cells/μL were considered as the criteria for deficiency.Eighteen first-time platelet donors were followed up.The lymphocyte count was measured at 0,3-6 and 7-14 times of blood donation in the last 300 days.170 healthy blood donors who have not donated blood were selected as the control group.According to the cut-off point(October 2021),88 blood donors who mainly used automatic blood collection system to donate platelet apheresis in the last 365 days(median blood donation times≥17.5)were divided into three groups(A,B and C)and blood samples were obtained.The time for Groups A,B and C started donating platelet apheresis were as follows:Group A:before October 2019,Group B:from October 2019 to September 2021,Group C:after October 2021.Blood samples were analyzed to obtain blood counts including CD4+and CD8+T lymphocytes.Blood samples were analyzed to obtain blood cell counts including CD4+and CD8+T lymphocytes.Through a comparative analysis,this study aimed to determine if there are any statistical differences in the detection indices between the follow-up groups with varying frequencies of blood donation,the control group,and groups A,B,and C.This approach was employed to infer the efficacy of donor plasma reinfusion in flushing the leukoreduction system(LRS)chamber for preventing the decline of CD4+and CD8+T lymphocytes.Results Eighteen first-time blood donors who were converted to regular platelet apheresis donors did not show a decrease of CD4+and CD8+T lymphocytes in the 5 th and 11 th blood donation(median number of blood donation),and there was no significant difference between the above indexes and those in the 0 th blood donation.Among the previous frequent blood donors,the CD4+and CD8+T lymphocyte counts in Group B and Group C are both higher than the standard value,showing no statistical difference from the control group.Among regular blood donors,the CD4+and CD8+T lymphocyte counts in groups B and C were higher than the criteria values,and had no statistical difference compared to the control group.The CD4+T lymphocyte count in Group A was normal,with only one donor in Group A having a CD8+T lymphocyte count below 125 cells/μL.This donor has donated 281 times of platelet apheresis,and the group he belongs to has started blood donation 2-21 years(median of 5 years)before the adjustment of reinfusion mode.The CD4+and CD8+T lymphocyte counts in Group A showed significant differences compared to the control group,with median counts(Group A/Control Group)of 359/521 and 257/372,respectively,P<0.001.In Group A,0%(0/35)had a CD4+count below 200 cells/μL,and 2.85%(1/35)of donors had a CD8+count below 125 cells/μL,which was far lower than the proportion of CD4+and CD8+T cell deficiency found in regular apheresis donors by John M.Gansner and Mahboubeh Rahmani.The study showed that the adjustment of the plasma reinfusion mode did not further reduce the T lymphocyte counts in blood donors,but instead further restored the T lymphocyte counts in regular blood donors.This indicated that after the adjustment of plasma reinfusion mode,blood donors might not have lost CD4+and CD8+T lymphocytes during blood donation,or only lost a small amount,and can recover even if they donate platelet apheresis frequently.Conclusion Trima Accel automated blood collection system has a good effect on preventing CD4+and CD8+T lymphocytes from being reduced by flushing the LRS chamber with donor plasma.