Streamlining Apheresis: A Dual‐Intervention Quality Improvement Initiative to Increase the Efficiency in Stem Cell CollectionVerriet, Ivy E.; Dickey, Renee; Sinclair, Sue; Schebesch, Karla; Philip, Shona; Xenocostas, Anargyros; Deotare, Uday
doi: 10.1002/jca.70066pmid: 41128425
Autologous stem cell transplantation (ASCT) requires efficient collection of peripheral blood stem cells. At London Health Sciences Centre (LHSC), high‐risk multiple myeloma patients are routinely booked for three‐day apheresis collections to meet higher CD34+ cell count targets, though many do not require all scheduled days, leading to resource inefficiencies. A quality improvement initiative was implemented to reduce unnecessary apheresis sessions through two interventions: (1) lowering CD34+ cell count target thresholds (from 6 × 106 to 5 × 106 cells/kg for tandem collections and from 3 × 106 to 2.5 × 106 for single collections), and (2) increasing total blood volume (TBV) processed from 3× to 4× for patients within certain target thresholds. Two Plan‐Do‐Study‐Act (PDSA) cycles were conducted between March 2024 and March 2025 involving 76 patients. Outcome measures included collection days saved and cost savings, and post‐transplant engraftment times served as a balancing measure. A total of 39.4% of patients avoided at least one collection day due to these interventions. Third‐day collection usage in high‐risk myeloma patients decreased from 25% to 5.9%. Mean collection days fell significantly in this group (2.21–1.8; p = 0.0015), with total cost savings of CAD $72 734.97. No significant differences were observed in neutrophil or platelet engraftment times, confirming preserved clinical efficacy. Implementing lower CD34+ cell count targets and increased TBV processing significantly reduced apheresis sessions and costs without compromising engraftment outcomes. These changes have become the standard of care at LHSC and may serve as a feasible model for other transplant centers.
Therapeutic Plasma Exchange After Spontaneous Intracranial Hemorrhage for a Patient With Antiphospholipid Syndrome and Lupus Anticoagulant HypoprothrombinemiaNicholas, Joshua; Wali, Junaid; Ellis‐Caleo, Timothy; Virk, Mrigender Singh; Yunce, Muharrem
doi: 10.1002/jca.70064pmid: 41116301
Antiphospholipid syndrome (APS) is characterized by the presence of antiphospholipid antibodies (aPL), macro‐ and micro‐vascular thromboembolic complications. Lupus anticoagulant‐hypoprothrombinemia (LAHPS) may confound the diagnosis and management of bleeding. Catastrophic APS has a category 1 indication for therapeutic plasma exchange (TPE). However, in patients with APS, LAHPS, and intracranial hemorrhage (ICH), TPE is not well described. A 47‐year‐old man with known APS anticoagulated on warfarin was transferred for diffuse spontaneous subdural hemorrhages (SDH) with somnolence. aPL levels were elevated on presentation; anti‐β2‐glycoprotein‐I antibody (aβ2GPI) IgG was higher than the reportable range. Factor II activity level was 20% despite holding warfarin: concerning for LAHPS. TPE was initiated to minimize risk of thromboembolism while holding anticoagulation. Level of consciousness improved by the second TPE. An acute lacunar infarct was detected on MRI, but this may have occurred before initiating TPE. Measures of lupus anticoagulant and anticardiolipin (aCL) IgG decreased initially, but aβ2GPI IgG remained above the reportable range. Both aCL and aβ2GPI IgM titers increased initially but decreased by day 31. Factor II activity level improved but remained below normal. Serial imaging showed resolution of SDH without new infarction. In patients with APS and recurrent thromboembolic disease, assessment and treatment of ICH may be confounded by LAHPS. Reversal of anticoagulation is reserved for patients in extremis, and treatment of LAHPS has previously been associated with thrombosis. In this context, TPE may be considered in combination with steroids and rituximab to bridge overlapping thromboembolic and hemorrhagic risk.
A Prospective Comparative Study of High‐Yield Plateletpheresis Using Haemonetics MCS+, Trima Accel, and Spectra Optia Devices in a Resource‐Constrained SettingHussein, Eiman; Enein, Azza A. Aboul
doi: 10.1002/jca.70054pmid: 40910186
In a resource‐constrained setting, maximizing plateletpheresis efficiency is critical. We believe leveraging advanced apheresis device software to enhance platelet yield, reduce consumables, and shorten procedure times offers significant advantages. This study compared Haemonetics, Trima, and Optia apheresis devices, analyzing donor and machine parameters. It also assessed how high‐yield collections and recent software updates on Trima and Haemonetics devices impact donor safety. The goal was to find the best practices for optimizing both donor safety and platelet collection. Analyzing 900 procedures (300 per device), Trima and Optia yielded significantly more platelets (9 × 1011) in less time compared to Haemonetics (5.7 × 1011) (p < 0.05). Trima collected10–12 × 1011 platelets from significantly more donors with lower pre‐donation counts than Optia (p < 0.05). Optia led to the fewest adverse events (0.7%). Donor weight was significantly higher for yields > 9 × 1011 on Optia and Trima (p < 0.05). Haemonetics' 3.6–3.8 × 1011 yield group had significantly lower session time, donor weight, and presession platelet counts (p < 0.05). Software updates (200 sessions/device) significantly boosted Trima's yields to 14.8 × 1011 while reducing adverse events (1% vs. 2.3% pre‐update). Haemonetics also saw improved yields and fewer adverse events (1% vs. 4.3%), though its overall yield remained lower (6.3 × 1011, p < 0.05). Both maintained safe post‐procedure platelet counts (> 130 000/μL). However, Trima's predicted yields for very high collections (> 12 × 1011) significantly differed from lab‐determined yields. Trima and Optia provide better platelet collection efficiency than Haemonetics. Software updates improved both Trima and Haemonetics' performance and safety; however, Trima's high‐yield predictions need refining. Optimal settings, updated software, and careful donor selection are essential for maximizing platelet yield and donor safety in resource‐limited areas.
Double Filtration Plasmapheresis for Thyroid Storm With Encephalopathy: A Case ReportLin, Qisheng; Jin, Haijiao; Xu, Yao; Xie, Yuanyuan; Zhou, Yijun; Lu, Renhua
doi: 10.1002/jca.70063pmid: 41103187
Thyroid storm is a life‐threatening endocrine emergency with a mortality rate of up to 17%. Standard treatment includes antithyroid drugs (ATD), β‐blockers, and glucocorticoids. However, some patients may require blood purification therapies, such as plasmapheresis, due to the ineffectiveness of standard treatments or contraindications like agranulocytosis. We report the case of a 38‐year‐old female with Graves' disease who was admitted for thyroid storm (Burch–Wartofsky score of 70) combined with encephalopathy, presenting with impaired consciousness, seizures, and leukopenia (1.82 × 109/L). Due to contraindications for ATD, she was treated with double filtration plasmapheresis (DFPP). After three sessions, her anti‐thyrotropin receptor antibodies (TRAb > 40–29.8 IU/L) and thyroid hormones (FT4 88.7–19.7 pmol/L) significantly decreased, and her consciousness improved. She was later transitioned successfully to oral ATD upon discharge. Plasmapheresis can rapidly remove thyroid hormones and autoantibodies, particularly useful in cases where ATD is ineffective or contraindicated. While international reports predominantly describe plasma exchange (PE), this case is the first to suggest the efficacy and safety of DFPP in treating thyroid storm with thyrotoxic encephalopathy. DFPP selectively removes large‐molecule antibodies while minimizing the use of blood products and albumin loss. For severe thyroid storm patients, early plasmapheresis may improve prognosis; however, the optimal timing, modality, and dosing require further investigation.
Plasma Exchange in the Setting of Immune‐Mediated Multiple Organ Failure in the Cardiac ICU During ECMO: A Case SeriesLabarinas, Sonia; Norbisrath, Kalpana; Nnaemeka, Ibeh; Bai, Yu; Tint, Hlaing; Johnson, Dana; Brady, Ken; Karam, Oliver
doi: 10.1002/jca.70061pmid: 41046521
Extracorporeal membrane oxygenation (ECMO) is a last resort treatment for children with cardio‐respiratory failure. Some of these patients will develop thrombocytopenia‐associated multiple organ failure (TAMOF), which is sometimes managed with therapeutic plasma exchange (TPE). Our objective is to describe critically ill children on ECMO who underwent TPE for TAMOF. We conducted a single‐center retrospective case series of seven children with congenital cardiac disease, requiring ECMO, diagnosed with TAMOF, and treated with TPE between 12/2023 and 6/2024. A centrifugation‐based apheresis instrument was used to process 1.5 total blood volume. One packed red blood cell was used to prime the apheresis circuit. Systemic bivalirudin was used for anticoagulation. Seven patients (median age: 55 days, median weight: 4.0 kg, median bypass time: 172 min, 100% VA ECMO, 85% central cannulation, 100% bivalirudin) underwent a total of 30 TPE sessions. The median number of sessions per patient was 3, with a median time to first session of 27.3 h after cannulation. Plasma was used as the replacement fluid in all sessions, with a median volume of 168 mL/kg. The median platelet count increased from 45 × 109/L (38; 54) pre‐TPE to 64 (IQR: 45; 75, p < 0.001) post‐TPE, despite no platelet transfusions during TPE. The modified organ severity index decreased significantly from 13 to 12 (p < 0.001). The mortality rate was 71%. TPE may improve platelet counts and reduce organ severity scores in critically ill children with TAMOF on ECMO.