US20040199098A1 - Blood collection systems and methods that derive estimated effects upon the donor's blood volume and hematocrit - Google Patents
Blood collection systems and methods that derive estimated effects upon the donor's blood volume and hematocrit Download PDFInfo
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- US20040199098A1 US20040199098A1 US10/827,951 US82795104A US2004199098A1 US 20040199098 A1 US20040199098 A1 US 20040199098A1 US 82795104 A US82795104 A US 82795104A US 2004199098 A1 US2004199098 A1 US 2004199098A1
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
- A61M1/3693—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits using separation based on different densities of components, e.g. centrifuging
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- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/02—Blood transfusion apparatus
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- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
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- A61M1/0209—Multiple bag systems for separating or storing blood components
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- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
- A61M1/30—Single needle dialysis ; Reciprocating systems, alternately withdrawing blood from and returning it to the patient, e.g. single-lumen-needle dialysis or single needle systems for hemofiltration or pheresis
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- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/14—Dialysis systems; Artificial kidneys; Blood oxygenators ; Reciprocating systems for treatment of body fluids, e.g. single needle systems for hemofiltration or pheresis
- A61M1/30—Single needle dialysis ; Reciprocating systems, alternately withdrawing blood from and returning it to the patient, e.g. single-lumen-needle dialysis or single needle systems for hemofiltration or pheresis
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- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
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- A61M1/30—Single needle dialysis ; Reciprocating systems, alternately withdrawing blood from and returning it to the patient, e.g. single-lumen-needle dialysis or single needle systems for hemofiltration or pheresis
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- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
- A61M1/3601—Extra-corporeal circuits in which the blood fluid passes more than once through the treatment unit
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- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
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- A61M1/3696—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits using separation based on different densities of components, e.g. centrifuging with means for adding or withdrawing liquid substances during the centrifugation, e.g. continuous centrifugation
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- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
- A61M1/38—Removing constituents from donor blood and storing or returning remainder to body, e.g. for transfusion
- A61M1/382—Optimisation of blood component yield
- A61M1/385—Optimisation of blood component yield taking into account of the patient characteristics
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- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
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- A61M1/3627—Degassing devices; Buffer reservoirs; Drip chambers; Blood filters
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- A61M2202/00—Special media to be introduced, removed or treated
- A61M2202/04—Liquids
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- A61M2202/00—Special media to be introduced, removed or treated
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- A61M2205/00—General characteristics of the apparatus
- A61M2205/33—Controlling, regulating or measuring
- A61M2205/3379—Masses, volumes, levels of fluids in reservoirs, flow rates
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- A61M2205/00—General characteristics of the apparatus
- A61M2205/60—General characteristics of the apparatus with identification means
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- A61M2230/00—Measuring parameters of the user
- A61M2230/20—Blood composition characteristics
- A61M2230/207—Blood composition characteristics hematocrit
Definitions
- the invention relates to centrifugal blood processing systems and apparatus.
- On line blood separation systems are today used to collect large numbers of platelets to meet this demand.
- On line systems perform the separation steps necessary to separate concentration of platelets from whole blood in a sequential process with the donor present.
- On line systems establish a flow of whole blood from the donor, separate out the desired platelets from the flow, and return the remaining red blood cells and plasma to the donor, all in a sequential flow loop.
- the invention provides blood processing systems and methods that separate blood drawn from a donor through a blood processing circuit to perform a desired blood collection procedure. During the procedure, a volume of the targeted blood component is collected. The systems and methods derive an estimated effect of the procedure upon the donor. The systems and methods present the estimated effect to an operator.
- the estimated effect is expressed in terms of a net blood fluid volume loss.
- the estimated effect takes into account blood loss due to the volume of targeted blood component collected and a residual fluid volume of the blood processing circuit.
- a volume of replacement fluid is conveyed to the donor during the desired blood collection procedure, and the estimated effect takes into account the volume of replacement fluid conveyed to the donor.
- the estimated effect expresses the net blood fluid volume loss as a percentage of a blood volume of the donor that existed prior to the desired blood processing procedure.
- the estimated effect expresses the net blood fluid volume loss as a percentage of weight of the donor.
- the estimated effect is expressed in terms of a hematocrit of the donor after completion of the desired blood collection procedure.
- blood can be conveyed through the blood processing circuit to collect a volume of red blood cells, or a volume of platelets, a volume of plasma, or combinations thereof.
- platelets in a first mode, platelets are collected while returning red blood cells to the donor and, in a second mode, platelets and red blood cells are collected without returning platelets or red blood cells to the donor.
- the estimated effect can be presented in a visual display, or in printed form, or in a data form suitable for offloading, or combinations thereof.
- FIG. 1 is a diagrammatic view of an on-line blood processing system
- FIG. 2 is a schematic view of a controller that governs the operation of the blood processing system shown in FIG. 1;
- FIG. 3 is a diagrammatic view of the blood processing system shown in FIG. 1 conditioned by the controller to perform a draw cycle during a non-concurrent collection mode;
- FIG. 4 is a diagrammatic view of the blood processing system shown in FIG. 1 conditioned by the controller to perform a return cycle during a non-concurrent collection mode;
- FIG. 5 is a diagrammatic view of the blood processing system shown in FIG. 1 conditioned by the controller to perform a concurrent collection mode;
- FIG. 6 is a diagrammatic view of the blood processing system shown in FIG. 1 conditioned by the controller to perform a blood volume trimming function;
- FIG. 7 is a front view of a blood collection set, which, in use, receives red blood cells after collection in the system shown in FIG. 1 for further processing prior to storage.
- FIG. 1 shows in diagrammatic form an on line blood processing system 10 for carrying out an automated blood collection procedure.
- the system 10 comprises a single needle blood collection network, although a double needle network could also be used.
- the system 10 includes an arrangement of durable hardware elements, whose operation is governed by a processing controller 18 .
- the hardware elements include a centrifuge 12 , in which whole blood (WB) from a donor is separated into platelets, plasma, and red blood cells.
- WB whole blood
- a representative centrifuge that can be used is shown in Brown et al U.S. Pat. No. 5,690,602, which is incorporated herein by reference.
- the hardware elements will also include various pumps, which are typically peristaltic (designated P 1 to P 7 ); and various in line clamps and valves (designated V 1 to V 7 ).
- various pumps which are typically peristaltic (designated P 1 to P 7 ); and various in line clamps and valves (designated V 1 to V 7 ).
- P 1 to P 7 peristaltic
- V 1 to V 7 various in line clamps and valves
- FIG. 1 does not show, like solenoids, pressure monitors, and the like.
- the system 10 typically also includes some form of a disposable fluid processing assembly 14 used in association with the hardware elements.
- the assembly 14 includes a processing chamber 16 having two stages 24 and 32 .
- the centrifuge 12 rotates the processing chamber 16 to centrifugally separate blood components.
- the construction of the two stage processing chamber 16 can vary. For example, it can take the form of double bags, like the processing chambers shown and described in Cullis et al. U.S. Pat. No. 4,146,172, which is incorporated herein by reference. Alternatively, the processing chamber 16 can take the form of an elongated two stage integral bag, like that shown and described in Brown U.S. Pat. No. 5,632,893, which is also incorporated herein by reference.
- the processing assembly 14 also includes an array of flexible tubing that forms a fluid circuit.
- the fluid circuit conveys liquids to and from the processing chamber 16 .
- the pumps P 1 -P 7 and the valves V 1 -V 7 engage the tubing to govern the fluid flow in prescribed ways.
- the fluid circuit further includes a number of containers (designated C 1 to C 5 ) to dispense and receive liquids during processing.
- a controller 18 governs the operation of the various hardware elements to carry out one or more processing tasks using the assembly 14 .
- the controller 18 also performs real time evaluation of processing conditions and outputs information to aid the operator in maximizing the separation and collection of blood components.
- FIG. 1 shows the system 10 configured to carry out an automated procedure using a single needle 22 to collect from a single donor (i) a desired yield of concentrated platelets suspended in plasma (PC)(e.g., upwards to two therapeutic units), which (if desired) can be provided essentially free of leukocytes, (ii) a desired volume of concentrated red blood cells (RBC) (e.g., upwards to about 200 ml at a hematocrit of about 100% or upwards to about 230 ml at a hematocrit of about 85%), which (if desired) can also be provided essentially free of leukocytes, and (iii) a desired volume (if desired) of platelet-poor plasma (PPP).
- PC concentrated platelets suspended in plasma
- PPP platelet-poor plasma
- the system 10 can collect various volumes of PC, PPP, and RBC products as governed by applicable regulations for allowable blood volumes.
- component volume iterations that the system 10 can presently provide include, e.g.:(i) one therapeutic unit each of PC, PPP, and RBC, or (ii) one therapeutic unit each of PC and RBC, or (iii) two therapeutic units of PC and one unit of RBC.
- the controller 18 carries out the overall process control and monitoring functions for the system 10 as just described.
- the controller comprises a main processing unit (MPU) 44 .
- the MPU 44 comprises a type 68030 microprocessor made by Motorola Corporation, although other types of conventional microprocessors can be used.
- the MPU 44 employs conventional real time multi-tasking to allocate MPU cycles to processing tasks.
- a periodic timer interrupt (for example, every 5 milliseconds) preempts the executing task and schedules another that is in a ready state for execution. If a reschedule is requested, the highest priority task in the ready state is scheduled. Otherwise, the next task on the list in the ready state is schedule.
- the MPU 44 includes an application control manager 46 .
- the application control manager 46 administers the activation of a library 48 of control applications.
- Each control application prescribes procedures for carrying out given functional tasks using the system hardware (e.g., the centrifuge 12 , the pumps P 1 -P 7 , and the valves V 1 -V 7 ) in a predetermined way.
- the applications reside as process software in EPROM's in the MPU 44 .
- An instrument manager 50 also resides as process software in EPROM's in the MPU 44 .
- the instrument manager 50 communicates with the application control manager 46 .
- the instrument manager 50 also communicates with low level peripheral controllers 52 for the pumps, solenoids, valves, and other functional hardware of the system.
- the application control manager 46 sends specified function commands to the instrument manager 50 , as called up by the activated application.
- the instrument manager 50 identifies the peripheral controller or controllers 52 for performing the function and compiles hardware-specific commands.
- the peripheral controllers 52 communicate directly with the hardware to implement the hardware-specific commands, causing the hardware to operate in a specified way.
- a communication manager 54 manages low-level protocol and communications between the instrument manager 50 and the peripheral controllers 52 .
- the instrument manager 50 also conveys back to the application control manager 46 status data about the operational and functional conditions of the processing procedure.
- the status data is expressed in terms of, for example, fluid flow rates, sensed pressures, and fluid volumes measured.
- the application control manager 46 transmits selected status data for display to the operator.
- the application control manager 46 transmits operational and functional conditions to the procedure application A 1 and the performance monitoring application A 2 .
- the MPU 44 also includes an interactive user interface 58 .
- the interface 58 allows the operator to view and comprehend information regarding the operation of the system 10 .
- the interface 58 also allows the operator to select applications residing in the application control manager 46 , as well as to change certain functions and performance criteria of the system 10 .
- the interface 58 includes an interface screen 60 and, preferably, an audio device 62 .
- the interface screen 60 displays information for viewing by the operator in alpha-numeric format and as graphical images.
- the audio device 62 provides audible prompts either to gain the operator's attention or to acknowledge operator actions.
- the interface screen 60 also serves as an input device. It receives input from the operator by conventional touch activation. Alternatively or in combination with touch activation, a mouse or keyboard could be used as input devices.
- An interface manager 64 communicates with the interface screen 60 and audio device 62 .
- the interface manager 64 in turn, communicates with the application control manager 46 .
- the interface manager 64 resides as process software in EPROM's in the MPU 44 .
- the library 48 includes at least one system control application A 1 .
- the system control application A 1 contains several specialized, yet interrelated utility functions. Of course, the number and type of utility functions can vary.
- a utility function F 1 derives the platelet yield (Yld) of the system 10 .
- the utility function F 1 ascertains both the instantaneous physical condition of the system 10 in terms of its separation efficiencies and the instantaneous physiological condition of the donor in terms of the number of circulating platelets available for collection. From these, the utility function F 1 derive the instantaneous yield of platelets continuously over the processing period.
- Another utility function F 2 relies upon the calculated platelet yield (Yld) and other processing conditions to generate selected informational status values and parameters. These values and parameters are displayed on the interface 58 to aid the operator in establishing and maintaining optimal performance conditions.
- the status values and parameters derived by the utility function F 2 can vary. For example, in the illustrated embodiment, the utility function F 2 reports remaining volumes to be processed, remaining processing times, and the component collection volumes and rates.
- Other utility functions generate control variables based upon ongoing processing conditions for use by the applications control manager 46 to establish and maintain optimal processing conditions. For example, one utility function F 3 generates control variables to optimize platelet separation conditions in the first stage 24 . Another utility function F 4 generates control variables to control the rate at which citrate anticoagulant is returned with the PPP to the donor to avoid potential citrate toxicity reactions.
- the system 10 is conditioned to achieve at least three processing objectives.
- the first objective is the collection of a desired yield of concentrated platelets (PC).
- the second objective is the collection of a desired volume of PPP to serve as a storage medium for the collected PC.
- the third objective is the collection of a desired volume of red blood cells (RBC).
- Other objectives may be established, e.g., to collect an additional volume of PPP for storage.
- the utility function F 1 conditions the system 10 to collect and process blood in at least three different operating modes.
- the system 10 is conditioned to process whole blood and collect PC and PPP.
- RBC are not concurrently collected, but are returned to the donor.
- PPP in excess of that desired may also be returned to the donor.
- the system 10 is conditioned to process whole blood and concurrently collect RBC along with the associated additional volumes of PC and PPP. During the second mode, no blood components are returned to the donor.
- the system 10 is conditioned to perform a final blood volume trimming function.
- a portion of the collected RBC volume, or all or some of the collected PPP volume, or both, can be returned to the donor.
- the volume trimming function assures that component volumes actually collected do not exceed the volumes targeted for collection.
- the operator uses the interface 58 to input the desired PC yield to be collected (Yld Goal ), the desired RBC volume to be collected(RBC Goal ), and the desired PPP volume to be collected (PPP Goal ).
- the controller 18 conditions the system 10 to proceed with blood processing in the first operating mode.
- the controller 18 takes into account two processing variables in commanding a change from the first operating mode to the second operating mode, and from the second operating mode to the third operating mode.
- the first processing variable is the remaining whole blood volume needed to achieve the desired platelet yield, or Vb rem (in ml).
- the second processing variable is the volume of whole blood that is needed to be processed to achieve the desired volume of red blood cells RBC Goal , or Vb RBC .
- Vb rem Vb RBC
- the controller 18 switches from the first operating mode to the second operating mode.
- Vb rem becomes zero
- the controller switches from the second operating mode to the third operating mode.
- the utility function F 2 relies upon the calculation of Yld by the first utility function F 1 to derive the whole blood volume needed to be processed to achieve Yld Goal .
- the utility function F 2 continuously derives the additional processed volume needed to achieve the desired platelet yield Vb rem (in ml) by dividing the remaining yield to be collected by the expected average platelet count over the remainder of the procedure, with corrections to reflect the current operating efficiency ⁇ Plt .
- Yld Goal is the desired platelet yield (k/ ⁇ l)
- Vb rem is the additional processing volume (ml) needed to achieve Yld Goal .
- Yld Current is the current platelet yield (k/ ⁇ l) calculated by the utility function F 1 based upon current processing values (as set forth in the Summary that follows).
- ⁇ plt is the present (instantaneous) platelet collection efficiency, which can be calculated based upon current processing values (as set forth in the Summary that follows).
- ACDil is an anticoagulant dilution factor (as set forth in the Summary that follows).
- Plt Current is the current (instantaneous) circulating donor platelet count, calculated based upon current processing values (as set forth in the Summary that follows).
- Plt post is the expected donor platelet count after processing, also calculated based upon total processing values (as set forth in the Summary that follows).
- the utility function F 2 derives Vb RBC based upon RBC Goal , and also by taking into account the donor's whole blood hematocrit (Hct).
- the donor's whole blood hematocrit Hct can comprise a value measured at the outset of the procedure, or a value that is sensed on-line during the course of the procedure.
- Hct is not directly measured or sensed. Instead, the controller 18 relies upon an apparent hematocrit value H b of whole blood entering the separation chamber. H b is derived by the controller 18 based upon sensed flow conditions and theoretical consideration. The derivation of H b is described in more detail in the Summary that follows.
- Vb RBC RBC Goal + Buf H b
- Buf is a prescribed buffer volume, e.g., 20 ml.
- the utility function F 2 provides a further volume buffer, by rounding up the calculated volume of Vb RBC , e.g., to the next highest integer divisible by ten.
- the utility function F 2 also compares the calculated value of Vb RBC to a prescribed maximum volume (e.g., 600 mL). If Vb RBC equals or exceeds the prescribed maximum, the utility function F 2 rounds the value down to a prescribed lesser amount, e.g., to 595 mL.
- a prescribed maximum volume e.g. 600 mL.
- the system 10 processes whole blood and collects PC and PPP for storage. During the first mode, RBC and the uncollected volume of PPP are returned to the donor.
- the system 10 shown in FIG. 1 employs one, single lumen phlebotomy needle 22 .
- the controller 18 operates the system 10 in successive draw and return cycles.
- the controller 18 supplies the donor's WB through the needle 22 to the chamber 16 for processing.
- the controller 18 returns the RBC and PPP blood components to the donor through the same needle 22 .
- the system 10 is configured to enable separation to occur in the chamber 16 without interruption during a succession of draw and return cycles. More particularly, the system 10 includes a draw reservoir 66 . During a draw cycle (FIG. 3), a quantity of the donor's WB is pooled in the reservoir 66 , in excess of the volume which is sent to the chamber 16 for processing. The system 10 also includes a return reservoir 68 . A quantity of RBC collects in the return reservoir 68 during the draw cycle for periodic return to the donor during the return cycle (see FIG. 4). During the return cycle, WB is conveyed from the draw reservoir 66 to the chamber 16 to sustain uninterrupted separation.
- the whole blood pump Pi direct WB from the needle 22 through a first tubing branch 20 and into the draw reservoir 66 .
- an auxiliary tubing branch 26 meters anticoagulant from the container C 1 to the WB flow through the anticoagulant pump P 3 .
- ACDA ACDA
- a container C 2 holds saline solution.
- Another auxiliary tubing branch 28 conveys the saline into the first tubing branch 20 , via the in line valve V 1 , for use in priming and purging air from the assembly 14 before processing begins. Saline solution is also introduced again after processing ends to flush residual components from the assembly 14 for return to the donor.
- the processing controller 18 receives processing information from a weigh scale 70 .
- the weigh scale 70 monitors the volume of WB collected in the draw reservoir 66 . Once the weigh scale 70 indicates that a desired volume of WB is present in the draw reservoir 66 , the controller 18 commands the whole blood processing pump P 2 to operate to continuously convey WB from the draw reservoir 66 into the first stage 24 of the processing chamber 16 through inlet branch 36 .
- the controller 18 operates the whole blood pump P 1 at a higher flow rate (at, for example, 100 ml/min) than the whole blood processing pump P 2 , which operates continuously (at, for example, 50 ml/min), so a volume of anticoagulated blood collects in the reservoir 66 .
- the controller intermittently operates the whole blood inlet pump P 1 to maintain a desired volume of WB in the draw reservoir 66 .
- Anticoagulated WB enters and fills the first stage 24 of the processing chamber 16 . There, centrifugal forces generated during rotation of the centrifuge 12 separate WB into red blood cells (RBC) and platelet-rich plasma (PRP).
- RBC red blood cells
- PRP platelet-rich plasma
- a PRP pump P 4 operates to draw PRP from the first stage 24 of the processing chamber 16 into a second tubing branch 30 for transport to the second stage 32 of the processing chamber 16 . There, the PRP is separated into platelet concentrate (PC) and platelet-poor plasma (PPP).
- PC platelet concentrate
- PPP platelet-poor plasma
- the controller 18 optically monitors the location of the interface between RBC and PRP within the first stage 24 of the processing chamber 16 .
- the controller 18 operates the PRP pump P 4 to keep the interface at a desired location within the first stage 24 of the processing chamber 24 . This keeps a substantial portion of the leukocytes, which occupy the interface, from entering the flow of PRP.
- the PRP can also be conveyed through a filter F to remove leukocytes before separation in the second stage 32 .
- the filter F can employ filter media containing fibers of the type disclosed in Nishimura et al U.S. Pat. No. 4,936,998, which is incorporated herein by reference. Filter media containing these fibers are commercially sold by Asahi Medical Company in filters under the trade name SEPACELL.
- the system 10 includes a recirculation tubing branch 34 and an associated recirculation pump P 5 .
- the processing controller 18 operates the pump P 5 to divert a portion of the PRP exiting the first stage 24 of the processing chamber 16 for remixing with the WB entering the first stage 24 of the processing chamber 16 .
- the recirculation of PRP establishes desired conditions in the entry region of the first stage 24 to provide maximal separation of RBC and PRP.
- a RBC branch 38 conveys the RBC from the first stage 24 of the processing chamber 16 to the return reservoir 68 (which is controlled by valve V 3 ).
- a weigh scale 72 monitors the volume of PPP collected in the container C 4 .
- a PPP branch 40 conveys PPP from the second stage 32 of the processing chamber 16 , by operation of the PPP pump P 7 .
- PPP pump P 7 By opening valve V 5 , all or a portion of the PPP can be directed to a collection container C 4 , depending upon the flow rate of the pump P 7 .
- a weigh scale 74 monitors the volume of PPP collected in the container C 4 . The PPP that is not collected flow into the return reservoir 68 , where it mixes with the RBC.
- the controller 16 limits the rate at which PPP is collected during the first mode. This avoids the collection of a surplus volume of PPP at the end of the procedure.
- the controller 18 reduces the time of the subsequent blood volume trimming function, thereby reducing the overall procedure time.
- the small volume of surplus PPP also allows the use of higher return flow rates during the blood volume trimming function, as the amount of anticoagulant (carried in the PPP) that is returned to the donor during the blood volume trimming function is reduced.
- the controller 18 receives processing information from the weigh scale 72 , monitors the volume of RBC and PPP in the return reservoir 68 . When a preselected volume exists, the controller 18 shifts the operation of the system 10 from a draw cycle to a return cycle.
- the controller 18 stops the whole blood inlet pump P 1 and anticoagulant pump P 3 and starts a blood return pump P 6 .
- a return branch 42 conveys RBC and PPP in the return reservoir 68 to the donor through the needle 22 .
- the controller 18 keeps the WB processing pump P 2 , the PRP pump P 4 , and recirculation pump P 5 in operation to continuously process the WB pooled in the draw reservoir 66 through the first stage and second stages 24 and 32 of the chamber 16 .
- the controller 18 shifts operation of the system 10 to another draw cycle.
- Vb rem Vb RBC
- the controller 18 commands a final return cycle, to return the contents of the return reservoir 68 to the donor.
- the controller 18 switches from the first operating mode to the second operating mode.
- a second or concurrent collection mode the controller 18 conditions to system 10 to operate in a sustained draw cycle, to process whole blood and concurrently collect the targeted volume of RBC, along with associated additional volumes of PC and PPP.
- the controller 18 does not switch operation of the system 10 to a return cycle. There is only one sustained draw cycle during the concurrent collection mode, and no components are returned to the donor.
- the controller 18 avoids the collection of a large surplus volume of whole blood in the draw reservoir 66 .
- the controller 18 achieves this objective by maintaining a smaller flow rate differential between the whole blood inlet pump P 1 and the whole blood processing pump P 2 , compared to the differential maintained during the draw cycle of non-concurrent collection mode.
- the whole blood inlet pump P 1 is operated at a minimal differential of, e.g., only 1 mL/min, above the whole blood processing pump P 2 .
- the weight scale 70 toggles the whole blood inlet pump P 1 and anticoagulant pump P 3 off whenever the sensed volume of blood in the draw reservoir 66 exceeds a specified minimum buffer amount , e.g., 5 g.
- red blood cells are directed into a collection container C 4 , via the valve V 4 , which is opened for this purpose (return valve V 3 is closed, so no RBC collect in the return reservoir 68 ).
- a weigh scale 108 monitors the weight of the collection container C 4 .
- the controller 18 continuously derives Vb rem during the sustained draw cycle of concurrent collection mode. When Vb rem becomes zero, the controller 18 terminates the concurrent collection mode.
- the controller 18 assesses the volumes of RBC and PPP that have been collected, using weigh scales 108 and 74 , respectively.
- the controller 18 commands the system 10 to enter a return cycle to return the excess RBC volume to the donor from the collection container C 4 , through the branch path 43 (valve V 6 being opened), and into the return path 42 (valve V 2 being closed), by operation of the in-line return pump P 6 .
- the controller 18 commands the system 10 to enter a return cycle to return the excess PPP volume to the donor from the collection container C 3 , through the branch path 45 (valve V 7 being opened and valve V 5 being closed), and into the return path 42 , by operation of the in-line return pump P 6 .
- the controller 18 commands a saline reinfusion operation to return residual blood in the system 10 to the donor, along with a prescribed fluid replacement volume.
- the retention of PPP can serve multiple purposes, both during and after the component separation process.
- PPP contains most of the anticoagulant that is metered into WB during the component separation process.
- PPP contains most of the anticoagulant that is metered into WB during the component separation process.
- the overall volume of anticoagulant received by the donor during processing is reduced. This reduction is particularly significant when large blood volumes are processed.
- the retention of PPP during processing also keeps the donor's circulating platelet count higher and more uniform during processing.
- the system 10 can also derive processing benefits from the retained PPP.
- the system 10 can, in an alternative recirculation mode, recirculate a portion of the retained PPP, instead of PRP, for mixing with WB entering the first compartment 24 .
- the system 10 can draw upon the retained volume of PPP as an anticoagulated “keep-open” fluid to keep fluid lines patent.
- the system 10 can draw upon the retained volume of PPP as a “rinse-back” fluid, to resuspend and purge RBC from the first stage compartment 24 for return to the donor through the return branch 42 .
- the system 10 also operates in a resuspension mode to draw upon a portion of the retained PPP to resuspend PC in the second stage 24 for transfer and storage in the collection container(s) C 5 . Resuspension and transfer of PC to the collection containers C 5 can be accomplished manually or on line.
- the container(s) C 5 intended to store the PC are made of materials that, when compared to DEHP-plasticized polyvinyl chloride materials, have greater gas permeability that is beneficial for platelet storage.
- materials that, when compared to DEHP-plasticized polyvinyl chloride materials, have greater gas permeability that is beneficial for platelet storage.
- polyolefin material as disclosed in Gajewski et al U.S. Pat. No. 4,140,162
- TSHTM tri-2-ethylhexyl trimellitate
- a disposable collection set 76 is provided to process the RBC volume collected for storage.
- the set 76 includes a transfer path 78 .
- the transfer path 78 has a sealed free end 80 designed to be connected in a sterile fashion to a sealed tube segment 82 on the RBC collection container C 4 (see FIG. 7).
- Known sterile connection mechanisms (not shown) like that shown in Spencer U.S. Pat. No. 4,412,835 can be used for connecting the transfer path 78 to the tube segment 82 . These mechanisms form a molten seal between tubing ends, which, once cooled, forms a sterile weld.
- a first bag 84 communicates with the transfer path 78 through a length of sample tubing 86 .
- the first bag 84 contains a red blood cell additive solution S, e.g., SAG-M or ADSOL® Solution (Baxter Healthcare Corporation).
- a conventional in-line frangible cannula 106 in the sample tubing 86 is opened, and the red blood cell additive solution S is transferred from the first bag 84 into the collection container C 4 for mixing with the collected RBC volume.
- the mixture of additive solution and RBC can then be transferred back into the first bag 84 .
- Residual air in the first bag 84 can be vented into an in-line air venting chamber 88 , which communicates with the transfer path 78 . At the same time, an aliquot of the collected RBC volume present in the first bag 84 can be expressed into the sample tubing 86 .
- the tubing 86 preferably carries an identification code 90 which is identical to a code 90 printed on or otherwise applied to the first bag 84 .
- the tubing 86 is then closed with a conventional snap-apart seal, and the first bag 84 is detached from the collection set 76 for storing the RBC volume.
- the tubing 86 can be further sealed in segments, using conventional tube sealers, to isolate multiple samples of the RBC for analysis and cross-matching.
- the set 76 also includes a second bag 92 , which communicates with the transfer path 78 downstream of the first bag 84 through a branch path 94 .
- the branch path 94 includes an in-line filter 96 .
- the in-line filter 96 carries a filtration medium 98 that selectively removes leukocytes from red blood cells.
- the filter can comprise, e.g., a R-3000 Red Blood Cell Filter (Asahi Medical)
- the mixture of red blood cells and additive solution can be transferred from the collection bag C 4 to the second bag 92 through the in-line filter 96 , by-passing the first bag 84 .
- the set 76 provides red blood cells essentially free of leukocytes, suitable for long term storage.
- An air venting path 100 extends from the second bag 92 to the transfer path 78 , bypassing the in-line filter 96 .
- a conventional break-away cannula 106 in the path 100 By opening a conventional break-away cannula 106 in the path 100 , residual air in the second bag 92 can be vented through the path 100 into the in-line air venting chamber 88 .
- a one-way valve 104 in the path 100 allows air and liquid flow in the path 100 away from the bag 92 , but not in the opposite direction.
- venting path 100 an aliquot of the collected RBC present in the second bag 92 can be expressed into the venting path 100 .
- the venting path 100 carries an identification code 102 which is identical to a code 102 printed on or otherwise applied to the second bag 92 .
- the venting path 100 and branch path 94 can be closed with a conventional snap-apart seal, to allow detachment of the second bag 92 from the transfer path 78 .
- the path 100 can also be sealed in segments, to provide multiple samples of the RBC for analysis and cross-matching.
- the collection set 76 provides the flexibility to provide a red blood cell product suitable for long term storage, which is either non-leukocyte reduced or leukocyte reduced before storage.
- the controller 18 can also include utility functions F 5 and F 6 , which provide additional information before, during, or after the procedure, estimating the effect of the selected procedure upon the donor's blood volume and hematocrit. More particularly, additional utility function F 5 provides an estimation of the donor's net fluid volume deficit as a result of the procedure, which will be called the Post-Intravascular Volume Deficit or Post-IVD. The additional utility function F 6 provides an estimation of the hematocrit of the donor's blood after the procedure, which will be called the Post-Hematocrit.
- the utility functions F 5 and F 6 can be performed after any selected blood processing procedure, e.g., after a procedure that collects platelets without collecting red blood cells, or after a procedure that collects both platelets and red blood cells.
- Post-IVD or Post-Hematocrit can be derived by the utility functions F 5 or F 6 at the beginning of the selected procedure based upon the operating parameters existing at that time.
- Post-IVD or Post-Hematocrit can be updated by the utility functions F 5 or F 6 at any time during the selected procedure as operating parameters change or are changed by the operator.
- the controller 18 desirably displays the values of the Post-Intravascular Volume Deficit, or other expressions thereof, and the Post-Hematocrit on the interface 58 .
- the information can also be presented in printed form, e.g., for paper record filing, or in data form for offloading, e.g., to a centralized donor database.
- Access to this information before, during, or after the selected procedure aids the operator in assessing the effect of the procedure on the donor's blood volume.
- This information allows a blood center to assess the effect of a given procedure upon the donor, so that a blood center can optimize its collection of blood products from a donor, without compromising donor safety or regulatory requirements.
- A. Utility Function F 5 Deriving Post-Intravascular Volume Deficit
- Post-Intravascular Volume Deficit is defined as the total maximum blood volume that the intended procedure will remove from the donor, minus replacement volume of fluids (TotVolReplaced) provided to the donor over the course of the procedure.
- TotVolReplaced replacement volume of fluids
- Post-IVD is an assessment of the donor's net fluid volume deficit resulting from the procedure.
- the utility function F 5 derives the donor's total blood volume (DonVol) at the start of the procedure.
- DonVol is based upon the donor's gender, height, and weight.
- DonVol can be derived empirically, e.g., according to Equation (13) in the Summary below.
- the utility function F 5 also derives the total volume of blood products to be removed from the donor during the procedure. This comprises the sum of the desired PC yield to be collected (Yld Goal ), the desired RBC volume to be collected(RBC Goal ), and the desired PPP volume to be collected (PPP Goal ). Of course, depending upon objectives of the particular selected procedure, one or more of these blood volumes may be zero, if that blood product is not targeted for collection by the procedure. These targeted values are inputted by the operator at the beginning of a given procedure, and can be modified by the operator during the course of the procedure.
- the utility function F 5 also desirably accounts for other blood losses the donor will experience, due to, e.g., the residual red blood cell volume of the blood processing system, any cycle volume (for single needle systems), or any other blood volumes (Res-Vol) that will not be returned to the donor at the end of the procedure.
- the utility function F 5 conducts a “worst case” blood loss scenario, one that goes beyond accounting for only the volume of blood products collected, and one that also accounts for blood loss from other sources, to assess an actual total blood volume loss from all sources.
- the utility function F 5 also derives the total volume of replacement fluid (TotVolReplaced) that will be returned to the donor during the procedure. This includes the volume of saline given to the donor at the beginning of the procedure due to saline prime, plus the estimated volume of anticoagulant ACD to be used during the procedure. The sum of these volumes comprise the total replacement fluid volume for the procedure (TotVolReplaced).
- Post-IVD is desirably expressed to the operator in one or more different formats, which relay the information in the context of, e.g., a blood center policy or a regulatory requirement.
- Post Procedure Net Fluid Deficit Information can express Post-IVD as the percentage of the donor's total blood volume prior to the procedure (DonVol), that is:
- Post Procedure Net Fluid Deficit Information can express Post-IVD as a fraction of the donor's weight (Wgt) (in kg), that is:
- the controller 18 can include programming that compares Post-IVD or Post Procedure Net Fluid Deficit Information to prescribe standards.
- the controller 18 can produce a cautionary output based upon the comparison, if the derived value is not consistent with the prescribed standards.
- the Post-Hematocrit is defined as an estimation of the donor's total red blood cell volume remaining after the intended procedure divided by an estimation of the donor's total blood fluid volume remaining after the intended procedure.
- the utility function F 6 relies upon three estimated quantities: (i) the donor's red blood cell volume existing prior to the procedure (Pre-RBC-Vol), which is a function of the donor's blood hematocrit measured prior to the procedure (Pre-Hct); (ii) the donor's red blood cell volume remaining after the procedure (Post-RBC-Vol), which is a function of the desired RBC volume to be collected (RBC Goal ) and system residual red blood cell volume (Res-Vol) (also used by utility function F 5 above); and (iii) the donor's total blood volume after the procedure (Post-Tot-Vol), which is a function of donor's total blood volume existing prior to the procedure (DonVol) and the Post-Intravascular Volume Deficit (Post-IVD), as derived by utility function F 5 .
- Pre-Hct an actual measurement of the donor's blood hematocrit (Pre-Hct) before the procedure is preferably relied upon.
- the value of Pre-Hct is inputted to the controller 18 for processing by the utility function F 6 .
- an accurate estimation of the donor's blood hematocrit before the procedure can be used as Pre-Hct.
- the utility function F 6 multiplies the donor's total blood volume (DonVol) prior to procedure (derived in the same manner as utility function F 5 ) by the donor's blood hematocrit prior to the procedure (Pre-Hct), expressed as follows:
- the utility function F 6 subtracts the sum of the desired RBC volume to be collected (RBC Goal ) and the system residual blood volume (Res-Vol) (also used by utility function F 5 above) from the donor's pre-procedure red blood cell volume (Pre-RBC-Vol), expressed as follows:
- the utility function F 6 subtracts from the donor's total blood volume existing prior to the procedure (DonVol), the Post-Intravascular Volume Deficit (Post-IVD), as derived by utility function F 5 , expressed as follows:
- the utility function F 6 divides the estimation of the donor's red blood cell volume existing after the procedure (Post-RBC-Vol) by the estimation of the donor's total blood volume existing after the procedure (Post-Tot-Vol), expressed as follows:
- Information pertaining to Post-Hematocrit is desirably processed for display to the operator, along with the information pertaining to Post-IVD. Such information can also be presented in printed form or downloaded in electronic form for data storage and manipulation.
- the controller 18 can include programming that compares Post-Hematocrit to prescribe standards.
- the controller 18 can produce a cautionary output based upon the comparison, if the derived value is not consistent with the prescribed standards.
- the utility function F 1 makes continuous calculations of the platelet separation efficiency ( ⁇ plt ) of the system 10 .
- the utility function F 1 treats the platelet separation efficiency ⁇ ptl as being the same as the ratio of plasma volume separated from the donor's whole blood relative to the total plasma volume available in the whole blood.
- the utility function F 1 thereby assumes that every platelet in the plasma volume separated from the donor's whole blood will be harvested.
- ⁇ Vol proc is the incremental whole blood volume being processed
- AC is the selected ratio of whole blood volume to anticoagulant volume (for example 10:1 or “10”).
- AC may comprise a fixed value during the processing period. Alternatively, AC may be varied in a staged fashion according to prescribed criteria during the processing period.
- AC can be set at the outset of processing at a lesser ratio for a set initial period of time, and then increased in steps after subsequent time periods; for example, AC can be set at 6:1 for the first minute of processing, then raised to 8:1 for the next 2.5 to 3 minutes; and finally raised to the processing level of 10:1.
- the introduction of anticoagulant can also staged by monitoring the inlet pressure of PRP entering the second processing stage 32 .
- AC can be set at 6:1 until the initial pressure (e.g. at 500 mmHg) falls to a set threshold level (e.g., 200 mmHg to 300 mmHg). AC can then be raised in steps up to the processing level of 10:1, while monitoring the pressure to assure it remains at the desired level.
- the utility function F 1 also makes continuous estimates of the donor's current circulating platelet count (Plt Circ ), expressed in terms of 1000 platelets per microliter ( ⁇ l) of plasma volume (or k/ ⁇ l). Like ⁇ plt , Plt Circ will change during processing due to the effects of dilution and depletion.
- the utility function F 1 incrementally monitors the platelet yield in increments, too, by multiplying each incremental cleared plasma volume ⁇ ClrVol (based upon an instantaneous calculation of ⁇ plt ) by an instantaneous estimation of the circulating platelet count Plt Cir .
- Yld Old is the last calculated Yld Current
- ⁇ ⁇ ⁇ Yld ⁇ ⁇ ⁇ ClrVol ⁇ Plt Current 100 , 000 Eq ⁇ ⁇ ( 4 )
- Plt current is the current (instantaneous) estimate of the circulating platelet count of the donor.
- ⁇ Yld is divided by 100,000 in Eq (4) to balance units.
- the overall system efficiency ⁇ plt is the product of the individual efficiencies of the parts of the system, as expressed as follows:
- ⁇ 1stSep is the efficiency of the separation of PRP from WB in the first separation stage.
- ⁇ 2ndSep is the efficiency of separation PC from PRP in the second separation stage.
- ⁇ Anc is the product of the efficiencies of other ancillary processing steps in the system.
- Q b is the measured whole blood flow rate (in ml/min).
- Q p is the measured PRP flow rate (in ml/min).
- H b is the apparent hematocrit of the anticoagulated whole blood entering the first stage separation compartment.
- H b is a value derived by the utility based upon sensed flow conditions and theoretical considerations. The utility function F 1 therefore requires no on-line hematocrit sensor to measure actual WB hematocrit.
- H b H rbc ⁇ ( Q b - Q p ) Q b Eq ⁇ ⁇ ( 7 )
- H rbc is the apparent hematocrit of the RBC bed within the first stage separation chamber, based upon sensed operating conditions and the physical dimensions of the first stage separation chamber.
- q b is inlet blood flow rate (cm 3 /sec), which is a known quantity which, when converted to ml/min, corresponds with Q b in Eq (6).
- q p is measured PRP flow rate (in cm 3 /sec), which is a known quantity which, when converted to ml/min corresponds with Q p in Eq (6).
- ⁇ is a shear rate dependent term
- S ⁇ is the red blood cell sedimentation coefficient (sec).
- A is the area of the separation chamber (cm 2 ), which is a known dimension.
- g is the centrifugal acceleration (cm/sec 2 ), which is the radius of the first separation chamber (a known dimension) multiplied by the rate of rotation squared ⁇ 2 (rad/sec 2 ) (another known quantity).
- the utility function F 1 also derives ⁇ 2ndsep continuously over the course of a procedure based upon an algorithm, derived from computer modeling, that calculates what fraction of log-normally distributed platelets will be collected in the second separation stage 32 as a function of their size (mean platelet volume, or MPV), the flow rate (Q p ), area (A) of the separation stage 32 , and centrifugal acceleration (g, which is the spin radius of the second stage multiplied by the rate of rotation squared ⁇ 2 ).
- the algorithm can be expressed in terms of a function, which expressed ⁇ 2ndSep in terms of a single dimensionless parameter gAS p /Q p ,
- MPV is the mean platelet volume (femtoliters, fl, or cubic microns), which can be measured by conventional techniques from a sample of the donor's blood collected before processing.
- the utility function therefore may include a look up table to standardize MPV for use by the function according to the type of counter used.
- MPV can be estimated based upon a function derived from statistical evaluation of clinical platelet precount Plt PRE data, which the utility function can use. The inventor believes, based upon his evaluation of such clinical data, that the MPV function can be expressed as:
- ⁇ Anc takes into account the efficiency (in terms of platelet loss) of other portions of the processing system.
- ⁇ Anc takes into account the efficiency of transporting platelets (in PRP) from the first stage chamber to the second stage chamber; the efficiency of transporting platelets (also in PRP) through the leukocyte removal filter; the efficiency of resuspension and transferral of platelets (in PC) from the second stage chamber after processing; and the efficiency of reprocessing previously processed blood in either a single needle or a double needle configuration.
- the utility function F 1 relies upon a kinetic model to predict the donor's current circulating platelet count Plt Circ during processing.
- the model estimates the donor's blood volume, and then estimates the effects of dilution and depletion during processing, to derive Plt Circ , according to the following relationships:
- Plt Pre is the donor's circulating platelet count before processing begins (k/ ⁇ l), which can be measured by conventional techniques from a sample of whole blood taken from the donor before processing.
- Plt pre There can be variations in Plt pre due to use of different counters (see, e.g., Peoples et al., “A Multi-Site Study of Variables Affecting Platelet Counting for Blood Component Quality Control,” Transfusion (Special Abstract Supplement, 47th Annual Meeting), v. 34, No. 10S, October 1994 Supplement).
- the utility function therefore may include a look up table to standardize all platelet counts (such as, Plt Pre and Pltpost, described later) for use by the function according to the type of counter used.
- Dilution is a factor that reduces the donor's preprocessing circulating platelet count Plt Pre due to increases in the donor's apparent circulating blood volume caused by the priming volume of the system and the delivery of anticoagulant. Dilution also takes into account the continuous removal of fluid from the vascular space by the kidneys during the procedure.
- Depletion is a factor that takes into account the depletion of the donor's available circulating platelet pool by processing. Depletion also takes into account the counter mobilization of the spleen in restoring platelets into the circulating blood volume during processing.
- Prime is the priming volume of the system (ml).
- ACD is the volume of anticoagulant used (current or end-point, depending upon the time the derivation is made)(ml).
- PPP is the volume of PPP collected (current or goal) (ml).
- DonVol (ml) is the donor's blood volume based upon models that take into account the donor's height, weight, and sex. These models are further simplified using empirical data to plot blood volume against donor weight linearized through regression to the following, more streamlined expression:
- Wgt is the donor's weight (kg).
- Yld is the current instantaneous or goal platelet yield (k/ ⁇ l). In Eq (14), Yld is multiplied by 100,000 to balance units.
- Eq (14) does not take into account splenic mobilization of replacement platelets, which is called the splenic mobilization factor (or Spleen).
- Spleen indicates that donors with low platelets counts nevertheless have a large platelet reserve held in the spleen.
- the spleen releases platelets it holds in reserve into the blood, thereby partially offsetting the drop in circulating platelets.
- the inventor has discovered that, even though platelet precounts vary over a wide range among donors, the total available platelet volume remains remarkably constant among donors.
- An average apparent donor volume is 3.10 ⁇ 0.25 ml of platelets per liter of blood.
- the coefficient of variation is 8.1%, only slightly higher than the coefficient of variation in hematocrit seen in normal donors.
- the mobilization factor Spleen is derived from comparing actual measured depletion to Depl (Eq (14)), which is plotted and linearized as a function of Plt Pre .
- Spleen (which is restricted to a lower limit of 1) is set forth as follows:
- the operator will not always have a current platelet pre-count Plt pre for every donor at the beginning of the procedure.
- the utility function F 1 allows the system to launch under default parameters, or values from a previous procedure.
- the utility function F 1 allows the actual platelet pre-count Plt Pre , to be entered by the operator later during the procedure.
- the utility function F 1 recalculates platelet yields determined under one set of conditions to reflect the newly entered values.
- the utility function F 1 uses the current yield to calculate an effective cleared volume and then uses that volume to calculate the new current yield, preserving the platelet pre-count dependent nature of splenic mobilization.
- ClrVol is the cleared plasma volume.
- DonVol is the donor's circulating blood volume, calculated according to Eq (13).
- Yld Current is the current platelet yield calculated according to Eq (3) based upon current processing conditions.
- Prime is the blood-side priming volume (ml).
- ACD is the volume of anticoagulant used (ml).
- PPP is the volume of platelet-poor plasma collected (ml).
- Pre Old is the donor's platelet count before processing entered before processing begun (k/ ⁇ l).
- Spleen Old is the splenic mobilization factor calculated using Eq (16) based upon Pre Old .
- Pre New is the revised donor platelet pre-count entered during processing (k/ ⁇ l).
- Yld New is the new platelet yield that takes into account the revised donor platelet pre-count Pre New .
- ClrVol is the cleared plasma volume, calculated according to Eq (17).
- DonVol is the donor's circulating blood volume, calculated according to Eq (13), same as in Eq (17).
- Prime is the blood-side priming volume (ml), same as in Eq (17).
- ACD is the volume of anticoagulant used (ml), same as in Eq (17).
- PPP is the volume of platelet-poor plasma collected (ml), same as in Eq (17).
- Spleen New is the splenic mobilization factor calculated using Eq (15) based upon Pre New
- Vb rem is the remaining volume to be processed, calculated using Eq (19) based upon current processing conditions.
- Qb is the whole blood flow rate, which is either set by the user or otherwise derived by the controller 18 .
- the utility function F 2 adds the various plasma collection requirements to derive the plasma collection volume (PPP Goal ) (in ml) as follows:
- PPP Goal PPP PC +PPP Source +PPP Reinfuse +PPP Waste +PPP CollCham Eq (20)
- PPP PC is the platelet-poor plasma volume selected for the PC product, which can have a typical default value of 250 ml, or be otherwise calculated by the controller 18 based upon current processing conditions.
- PPP source is the platelet-poor plasma volume selected for collection as source plasma.
- PPP Reinfuse is the platelet-poor plasma volume that will be reinfusion during processing.
- the utility function F 2 calculates the plasma collection rate (Q ppp ) (in ml/min) as follows:
- Q PPP PPP Goal - PPP Current t re ⁇ ⁇ m Eq ⁇ ⁇ ( 21 )
- PPP Goal is the desired platelet-poor plasma collection volume (ml).
- PPP Current is the current volume of platelet-poor plasma collected (ml).
- t rem is the time remaining in collection, calculated using Eq (19) based upon current processing conditions.
- ACD Current is the current volume of anticoagulant used (ml).
- AC is the selected anticoagulant ratio
- Q b is the whole blood flow rate, which is either set by the user or otherwise calculated by the controller 18 based upon current processing conditions.
- t rem is the time remaining in collection, calculated using Eq (19) based upon current processing conditions.
Abstract
Description
- This application is a divisional of copending patent application Ser. No. 09/789,183 filed 20 Feb. 2001, which is a continuation-in-part of application Ser. No. 09/419,742, filed Oct. 16, 1999, and entitled “Automated Collection Systems and Methods for Obtaining Red Blood Cells, Platelets, And Plasma From Whole Blood,” which is incorporated herein by reference.
- The invention relates to centrifugal blood processing systems and apparatus.
- Certain therapies transfuse large volumes of blood components. For example, some patients undergoing chemotherapy require the transfusion of large numbers of platelets on a routine basis. Manual blood bag systems simply are not an efficient way to collect these large numbers of platelets from individual donors.
- On line blood separation systems are today used to collect large numbers of platelets to meet this demand. On line systems perform the separation steps necessary to separate concentration of platelets from whole blood in a sequential process with the donor present. On line systems establish a flow of whole blood from the donor, separate out the desired platelets from the flow, and return the remaining red blood cells and plasma to the donor, all in a sequential flow loop.
- Large volumes of whole blood (for example, 2.0 liters) can be processed using an on line system. Due to the large processing volumes, large yields of concentrated platelets (for example, 4×1011 platelets suspended in 200 ml of fluid) can be collected.
- Nevertheless, a need still exists to further improve systems and methods for collecting cellular-rich concentrates, like red blood cells, from blood components, in a way that lends itself to use in high volume, on line blood collection environments, where higher yields of critically needed cellular blood components like platelets and red blood cells can be realized.
- The invention provides blood processing systems and methods that separate blood drawn from a donor through a blood processing circuit to perform a desired blood collection procedure. During the procedure, a volume of the targeted blood component is collected. The systems and methods derive an estimated effect of the procedure upon the donor. The systems and methods present the estimated effect to an operator.
- According to one aspect of the invention, the estimated effect is expressed in terms of a net blood fluid volume loss. In one embodiment, the estimated effect takes into account blood loss due to the volume of targeted blood component collected and a residual fluid volume of the blood processing circuit. In one embodiment, a volume of replacement fluid is conveyed to the donor during the desired blood collection procedure, and the estimated effect takes into account the volume of replacement fluid conveyed to the donor. In one embodiment, the estimated effect expresses the net blood fluid volume loss as a percentage of a blood volume of the donor that existed prior to the desired blood processing procedure. In one embodiment, the estimated effect expresses the net blood fluid volume loss as a percentage of weight of the donor.
- According to another aspect of the invention, the estimated effect is expressed in terms of a hematocrit of the donor after completion of the desired blood collection procedure.
- According to either aspect of the invention, blood can be conveyed through the blood processing circuit to collect a volume of red blood cells, or a volume of platelets, a volume of plasma, or combinations thereof. In one embodiment, in a first mode, platelets are collected while returning red blood cells to the donor and, in a second mode, platelets and red blood cells are collected without returning platelets or red blood cells to the donor.
- According to either aspect of the invention, the estimated effect can be presented in a visual display, or in printed form, or in a data form suitable for offloading, or combinations thereof.
- The invention may be embodied in several forms without departing from its spirit or essential characteristics. The scope of the invention is defined in the appended claims, rather than in the specific description preceding them. All embodiments that fall within the meaning and range of equivalency of the claims are therefore intended to be embraced by the claims. The invention is not limited to the details of the construction and the arrangements of parts set forth in the following description or shown in the drawings. The invention can be practiced in other embodiments and in various other ways. The terminology and phrases are used for description and should not be regarded as limiting.
- FIG. 1 is a diagrammatic view of an on-line blood processing system;
- FIG. 2 is a schematic view of a controller that governs the operation of the blood processing system shown in FIG. 1;
- FIG. 3 is a diagrammatic view of the blood processing system shown in FIG. 1 conditioned by the controller to perform a draw cycle during a non-concurrent collection mode;
- FIG. 4 is a diagrammatic view of the blood processing system shown in FIG. 1 conditioned by the controller to perform a return cycle during a non-concurrent collection mode;
- FIG. 5 is a diagrammatic view of the blood processing system shown in FIG. 1 conditioned by the controller to perform a concurrent collection mode;
- FIG. 6 is a diagrammatic view of the blood processing system shown in FIG. 1 conditioned by the controller to perform a blood volume trimming function; and
- FIG. 7 is a front view of a blood collection set, which, in use, receives red blood cells after collection in the system shown in FIG. 1 for further processing prior to storage.
- FIG. 1 shows in diagrammatic form an on line
blood processing system 10 for carrying out an automated blood collection procedure. - As illustrated, the
system 10 comprises a single needle blood collection network, although a double needle network could also be used. - The
system 10 includes an arrangement of durable hardware elements, whose operation is governed by aprocessing controller 18. The hardware elements include acentrifuge 12, in which whole blood (WB) from a donor is separated into platelets, plasma, and red blood cells. A representative centrifuge that can be used is shown in Brown et al U.S. Pat. No. 5,690,602, which is incorporated herein by reference. - The hardware elements will also include various pumps, which are typically peristaltic (designated P1 to P7); and various in line clamps and valves (designated V1 to V7). Of course, other types of hardware elements may typically be present, which FIG. 1 does not show, like solenoids, pressure monitors, and the like.
- The
system 10 typically also includes some form of a disposablefluid processing assembly 14 used in association with the hardware elements. In the illustrated embodiment, theassembly 14 includes aprocessing chamber 16 having twostages centrifuge 12 rotates theprocessing chamber 16 to centrifugally separate blood components. - The construction of the two
stage processing chamber 16 can vary. For example, it can take the form of double bags, like the processing chambers shown and described in Cullis et al. U.S. Pat. No. 4,146,172, which is incorporated herein by reference. Alternatively, theprocessing chamber 16 can take the form of an elongated two stage integral bag, like that shown and described in Brown U.S. Pat. No. 5,632,893, which is also incorporated herein by reference. - In the illustrated
blood processing system 10, theprocessing assembly 14 also includes an array of flexible tubing that forms a fluid circuit. The fluid circuit conveys liquids to and from theprocessing chamber 16. The pumps P1-P7 and the valves V1-V7 engage the tubing to govern the fluid flow in prescribed ways. The fluid circuit further includes a number of containers (designated C1 to C5) to dispense and receive liquids during processing. - A
controller 18 governs the operation of the various hardware elements to carry out one or more processing tasks using theassembly 14. Thecontroller 18 also performs real time evaluation of processing conditions and outputs information to aid the operator in maximizing the separation and collection of blood components. - The
system 10 can be configured to accomplish diverse types of blood separation processes. FIG. 1 shows thesystem 10 configured to carry out an automated procedure using asingle needle 22 to collect from a single donor (i) a desired yield of concentrated platelets suspended in plasma (PC)(e.g., upwards to two therapeutic units), which (if desired) can be provided essentially free of leukocytes, (ii) a desired volume of concentrated red blood cells (RBC) (e.g., upwards to about 200 ml at a hematocrit of about 100% or upwards to about 230 ml at a hematocrit of about 85%), which (if desired) can also be provided essentially free of leukocytes, and (iii) a desired volume (if desired) of platelet-poor plasma (PPP). - The
system 10 can collect various volumes of PC, PPP, and RBC products as governed by applicable regulations for allowable blood volumes. For example, in the United States, component volume iterations that thesystem 10 can presently provide include, e.g.:(i) one therapeutic unit each of PC, PPP, and RBC, or (ii) one therapeutic unit each of PC and RBC, or (iii) two therapeutic units of PC and one unit of RBC. - Further details of the operation of the
system 10 to achieve these blood processing objectives will be described later. - The
controller 18 carries out the overall process control and monitoring functions for thesystem 10 as just described. - In the illustrated and preferred embodiment (see FIG. 2), the controller comprises a main processing unit (MPU)44. In the preferred embodiment, the
MPU 44 comprises a type 68030 microprocessor made by Motorola Corporation, although other types of conventional microprocessors can be used. - In the preferred embodiment, the
MPU 44 employs conventional real time multi-tasking to allocate MPU cycles to processing tasks. A periodic timer interrupt (for example, every 5 milliseconds) preempts the executing task and schedules another that is in a ready state for execution. If a reschedule is requested, the highest priority task in the ready state is scheduled. Otherwise, the next task on the list in the ready state is schedule. - A. Hardware Control
- The
MPU 44 includes anapplication control manager 46. Theapplication control manager 46 administers the activation of alibrary 48 of control applications. Each control application prescribes procedures for carrying out given functional tasks using the system hardware (e.g., thecentrifuge 12, the pumps P1-P7, and the valves V1-V7) in a predetermined way. In the illustrated and preferred embodiment, the applications reside as process software in EPROM's in theMPU 44. - An
instrument manager 50 also resides as process software in EPROM's in theMPU 44. Theinstrument manager 50 communicates with theapplication control manager 46. Theinstrument manager 50 also communicates with low levelperipheral controllers 52 for the pumps, solenoids, valves, and other functional hardware of the system. - As FIG. 2 shows, the
application control manager 46 sends specified function commands to theinstrument manager 50, as called up by the activated application. Theinstrument manager 50 identifies the peripheral controller orcontrollers 52 for performing the function and compiles hardware-specific commands. Theperipheral controllers 52 communicate directly with the hardware to implement the hardware-specific commands, causing the hardware to operate in a specified way. Acommunication manager 54 manages low-level protocol and communications between theinstrument manager 50 and theperipheral controllers 52. - As FIG. 2 also shows, the
instrument manager 50 also conveys back to theapplication control manager 46 status data about the operational and functional conditions of the processing procedure. The status data is expressed in terms of, for example, fluid flow rates, sensed pressures, and fluid volumes measured. - The
application control manager 46 transmits selected status data for display to the operator. Theapplication control manager 46 transmits operational and functional conditions to the procedure application A1 and the performance monitoring application A2. - B. Operator Interface In the illustrated embodiment, the
MPU 44 also includes aninteractive user interface 58. Theinterface 58 allows the operator to view and comprehend information regarding the operation of thesystem 10. Theinterface 58 also allows the operator to select applications residing in theapplication control manager 46, as well as to change certain functions and performance criteria of thesystem 10. Theinterface 58 includes aninterface screen 60 and, preferably, anaudio device 62. Theinterface screen 60 displays information for viewing by the operator in alpha-numeric format and as graphical images. Theaudio device 62 provides audible prompts either to gain the operator's attention or to acknowledge operator actions. - In the illustrated and preferred embodiment, the
interface screen 60 also serves as an input device. It receives input from the operator by conventional touch activation. Alternatively or in combination with touch activation, a mouse or keyboard could be used as input devices. - An
interface manager 64 communicates with theinterface screen 60 andaudio device 62. Theinterface manager 64, in turn, communicates with theapplication control manager 46. Theinterface manager 64 resides as process software in EPROM's in theMPU 44. - Further details of the
MPU 44 andinterface 58 are disclosed in Lyle et al. U.S. Pat. No. 5,581,687, which is incorporated herein by reference. - C. System Control Functions
- In the illustrated embodiment (as FIG. 2 shows), the
library 48 includes at least one system control application A1. The system control application A1 contains several specialized, yet interrelated utility functions. Of course, the number and type of utility functions can vary. - In the illustrated embodiment, a utility function F1 derives the platelet yield (Yld) of the
system 10. The utility function F1 ascertains both the instantaneous physical condition of thesystem 10 in terms of its separation efficiencies and the instantaneous physiological condition of the donor in terms of the number of circulating platelets available for collection. From these, the utility function F1 derive the instantaneous yield of platelets continuously over the processing period. - Another utility function F2 relies upon the calculated platelet yield (Yld) and other processing conditions to generate selected informational status values and parameters. These values and parameters are displayed on the
interface 58 to aid the operator in establishing and maintaining optimal performance conditions. The status values and parameters derived by the utility function F2 can vary. For example, in the illustrated embodiment, the utility function F2 reports remaining volumes to be processed, remaining processing times, and the component collection volumes and rates. - Other utility functions generate control variables based upon ongoing processing conditions for use by the
applications control manager 46 to establish and maintain optimal processing conditions. For example, one utility function F3 generates control variables to optimize platelet separation conditions in thefirst stage 24. Another utility function F4 generates control variables to control the rate at which citrate anticoagulant is returned with the PPP to the donor to avoid potential citrate toxicity reactions. - Further details of these and other utility functions can be found in Brown U.S. Pat. No. 5,676,841, which is incorporated herein by reference. A summary of various utility functions relied upon is found at the end of the Specification.
- In the illustrated embodiment, the
system 10 is conditioned to achieve at least three processing objectives. The first objective is the collection of a desired yield of concentrated platelets (PC). The second objective is the collection of a desired volume of PPP to serve as a storage medium for the collected PC. The third objective is the collection of a desired volume of red blood cells (RBC). Other objectives may be established, e.g., to collect an additional volume of PPP for storage. - To achieve these objectives, the utility function F1 conditions the
system 10 to collect and process blood in at least three different operating modes. - In the first operating mode, the
system 10 is conditioned to process whole blood and collect PC and PPP. In the first mode, RBC are not concurrently collected, but are returned to the donor. PPP in excess of that desired may also be returned to the donor. - In the second operating mode, the
system 10 is conditioned to process whole blood and concurrently collect RBC along with the associated additional volumes of PC and PPP. During the second mode, no blood components are returned to the donor. - In the third operating mode, the
system 10 is conditioned to perform a final blood volume trimming function. During the volume trimming function, a portion of the collected RBC volume, or all or some of the collected PPP volume, or both, can be returned to the donor. The volume trimming function assures that component volumes actually collected do not exceed the volumes targeted for collection. - At the outset of the processing procedure, the operator uses the
interface 58 to input the desired PC yield to be collected (YldGoal), the desired RBC volume to be collected(RBCGoal), and the desired PPP volume to be collected (PPPGoal). - The
controller 18 conditions thesystem 10 to proceed with blood processing in the first operating mode. Thecontroller 18 takes into account two processing variables in commanding a change from the first operating mode to the second operating mode, and from the second operating mode to the third operating mode. The first processing variable is the remaining whole blood volume needed to achieve the desired platelet yield, or Vbrem (in ml). The second processing variable is the volume of whole blood that is needed to be processed to achieve the desired volume of red blood cells RBCGoal, or VbRBC. - When Vbrem=VbRBC, the
controller 18 switches from the first operating mode to the second operating mode. When Vbrem becomes zero, the controller switches from the second operating mode to the third operating mode. - A. Calculating Vbrem
- The utility function F2 relies upon the calculation of Yld by the first utility function F1 to derive the whole blood volume needed to be processed to achieve YldGoal. During blood processing, the utility function F2 continuously derives the additional processed volume needed to achieve the desired platelet yield Vbrem (in ml) by dividing the remaining yield to be collected by the expected average platelet count over the remainder of the procedure, with corrections to reflect the current operating efficiency ηPlt.
-
- where:
- YldGoal is the desired platelet yield (k/μl),
- Vbrem is the additional processing volume (ml) needed to achieve YldGoal.
- YldCurrent is the current platelet yield (k/μl) calculated by the utility function F1 based upon current processing values (as set forth in the Summary that follows).
- ηplt is the present (instantaneous) platelet collection efficiency, which can be calculated based upon current processing values (as set forth in the Summary that follows).
- ACDil is an anticoagulant dilution factor (as set forth in the Summary that follows).
- PltCurrent is the current (instantaneous) circulating donor platelet count, calculated based upon current processing values (as set forth in the Summary that follows).
- Pltpost is the expected donor platelet count after processing, also calculated based upon total processing values (as set forth in the Summary that follows).
- B. Calculating VbRBC
- The utility function F2 derives VbRBC based upon RBCGoal, and also by taking into account the donor's whole blood hematocrit (Hct). The donor's whole blood hematocrit Hct can comprise a value measured at the outset of the procedure, or a value that is sensed on-line during the course of the procedure.
- In the illustrated embodiment, Hct is not directly measured or sensed. Instead, the
controller 18 relies upon an apparent hematocrit value Hb of whole blood entering the separation chamber. Hb is derived by thecontroller 18 based upon sensed flow conditions and theoretical consideration. The derivation of Hb is described in more detail in the Summary that follows. -
- where:
- Buf is a prescribed buffer volume, e.g., 20 ml.
- In the illustrated embodiment, the utility function F2 provides a further volume buffer, by rounding up the calculated volume of VbRBC, e.g., to the next highest integer divisible by ten.
- In the illustrated embodiment, the utility function F2 also compares the calculated value of VbRBC to a prescribed maximum volume (e.g., 600 mL). If VbRBC equals or exceeds the prescribed maximum, the utility function F2 rounds the value down to a prescribed lesser amount, e.g., to 595 mL.
- C. The First Operating Mode
- In the first or non-concurrent operating mode, the
system 10 processes whole blood and collects PC and PPP for storage. During the first mode, RBC and the uncollected volume of PPP are returned to the donor. - The
system 10 shown in FIG. 1 employs one, singlelumen phlebotomy needle 22. During the non-concurrent mode, thecontroller 18 operates thesystem 10 in successive draw and return cycles. During the draw cycle (FIG. 3), thecontroller 18 supplies the donor's WB through theneedle 22 to thechamber 16 for processing. During the return cycle (FIG. 4), thecontroller 18 returns the RBC and PPP blood components to the donor through thesame needle 22. - In the illustrated embodiment, the
system 10 is configured to enable separation to occur in thechamber 16 without interruption during a succession of draw and return cycles. More particularly, thesystem 10 includes adraw reservoir 66. During a draw cycle (FIG. 3), a quantity of the donor's WB is pooled in thereservoir 66, in excess of the volume which is sent to thechamber 16 for processing. Thesystem 10 also includes areturn reservoir 68. A quantity of RBC collects in thereturn reservoir 68 during the draw cycle for periodic return to the donor during the return cycle (see FIG. 4). During the return cycle, WB is conveyed from thedraw reservoir 66 to thechamber 16 to sustain uninterrupted separation. - In a draw cycle of the non-concurrent mode FIG. 3), the whole blood pump Pi direct WB from the
needle 22 through afirst tubing branch 20 and into thedraw reservoir 66. Meanwhile, anauxiliary tubing branch 26 meters anticoagulant from the container C1 to the WB flow through the anticoagulant pump P3. While the type of anticoagulant can vary, the illustrated embodiment uses ACDA, which is a commonly used anticoagulant for pheresis. - A container C2 holds saline solution. Another
auxiliary tubing branch 28 conveys the saline into thefirst tubing branch 20, via the in line valve V1, for use in priming and purging air from theassembly 14 before processing begins. Saline solution is also introduced again after processing ends to flush residual components from theassembly 14 for return to the donor. - The
processing controller 18 receives processing information from aweigh scale 70. Theweigh scale 70 monitors the volume of WB collected in thedraw reservoir 66. Once theweigh scale 70 indicates that a desired volume of WB is present in thedraw reservoir 66, thecontroller 18 commands the whole blood processing pump P2 to operate to continuously convey WB from thedraw reservoir 66 into thefirst stage 24 of theprocessing chamber 16 throughinlet branch 36. Thecontroller 18 operates the whole blood pump P1 at a higher flow rate (at, for example, 100 ml/min) than the whole blood processing pump P2, which operates continuously (at, for example, 50 ml/min), so a volume of anticoagulated blood collects in thereservoir 66. By monitoring weight using theweigh scale 70, the controller intermittently operates the whole blood inlet pump P1 to maintain a desired volume of WB in thedraw reservoir 66. - Anticoagulated WB enters and fills the
first stage 24 of theprocessing chamber 16. There, centrifugal forces generated during rotation of thecentrifuge 12 separate WB into red blood cells (RBC) and platelet-rich plasma (PRP). - A PRP pump P4 operates to draw PRP from the
first stage 24 of theprocessing chamber 16 into asecond tubing branch 30 for transport to thesecond stage 32 of theprocessing chamber 16. There, the PRP is separated into platelet concentrate (PC) and platelet-poor plasma (PPP). - The
controller 18 optically monitors the location of the interface between RBC and PRP within thefirst stage 24 of theprocessing chamber 16. Thecontroller 18 operates the PRP pump P4 to keep the interface at a desired location within thefirst stage 24 of theprocessing chamber 24. This keeps a substantial portion of the leukocytes, which occupy the interface, from entering the flow of PRP. - Optionally, the PRP can also be conveyed through a filter F to remove leukocytes before separation in the
second stage 32. The filter F can employ filter media containing fibers of the type disclosed in Nishimura et al U.S. Pat. No. 4,936,998, which is incorporated herein by reference. Filter media containing these fibers are commercially sold by Asahi Medical Company in filters under the trade name SEPACELL. - The
system 10 includes arecirculation tubing branch 34 and an associated recirculation pump P5. Theprocessing controller 18 operates the pump P5 to divert a portion of the PRP exiting thefirst stage 24 of theprocessing chamber 16 for remixing with the WB entering thefirst stage 24 of theprocessing chamber 16. The recirculation of PRP establishes desired conditions in the entry region of thefirst stage 24 to provide maximal separation of RBC and PRP. - A
RBC branch 38 conveys the RBC from thefirst stage 24 of theprocessing chamber 16 to the return reservoir 68 (which is controlled by valve V3). Aweigh scale 72 monitors the volume of PPP collected in the container C4. - A
PPP branch 40 conveys PPP from thesecond stage 32 of theprocessing chamber 16, by operation of the PPP pump P7. By opening valve V5, all or a portion of the PPP can be directed to a collection container C4, depending upon the flow rate of the pump P7. Aweigh scale 74 monitors the volume of PPP collected in the container C4. The PPP that is not collected flow into thereturn reservoir 68, where it mixes with the RBC. - During the second operating mode (which will be described later), a relatively large volume of PPP (i.e., from about 50% to 75% of PPPGoal) will typically be collected without return to the donor. In anticipation of this, the
controller 16 limits the rate at which PPP is collected during the first mode. This avoids the collection of a surplus volume of PPP at the end of the procedure. By limiting the rate at which PPP is collected during the first operating mode, thecontroller 18 reduces the time of the subsequent blood volume trimming function, thereby reducing the overall procedure time. The small volume of surplus PPP also allows the use of higher return flow rates during the blood volume trimming function, as the amount of anticoagulant (carried in the PPP) that is returned to the donor during the blood volume trimming function is reduced. - The
controller 18 receives processing information from theweigh scale 72, monitors the volume of RBC and PPP in thereturn reservoir 68. When a preselected volume exists, thecontroller 18 shifts the operation of thesystem 10 from a draw cycle to a return cycle. - In the return cycle (FIG. 4), the
controller 18 stops the whole blood inlet pump P1 and anticoagulant pump P3 and starts a blood return pump P6. Areturn branch 42 conveys RBC and PPP in thereturn reservoir 68 to the donor through theneedle 22. - Meanwhile, while in the return cycle, the
controller 18 keeps the WB processing pump P2, the PRP pump P4, and recirculation pump P5 in operation to continuously process the WB pooled in thedraw reservoir 66 through the first stage andsecond stages chamber 16. - When the
weigh scale 72 indicates that the contents of thereturn reservoir 68 have been conveyed to the donor, thecontroller 18 shifts operation of thesystem 10 to another draw cycle. - The
controller 18 toggles between successive draw and return cycles until Vbrem=VbRBC. When Vbrem=VbRBC, thecontroller 18 commands a final return cycle, to return the contents of thereturn reservoir 68 to the donor. Upon returning the contents of thereturn reservoir 68, thecontroller 18 switches from the first operating mode to the second operating mode. - D. Concurrent Collection Mode
- In a second or concurrent collection mode (FIG. 5), the
controller 18 conditions tosystem 10 to operate in a sustained draw cycle, to process whole blood and concurrently collect the targeted volume of RBC, along with associated additional volumes of PC and PPP. During the concurrent collection mode, thecontroller 18 does not switch operation of thesystem 10 to a return cycle. There is only one sustained draw cycle during the concurrent collection mode, and no components are returned to the donor. - During the sustained draw cycle of concurrent collection mode, the
controller 18 avoids the collection of a large surplus volume of whole blood in thedraw reservoir 66. In the illustrated embodiment, thecontroller 18 achieves this objective by maintaining a smaller flow rate differential between the whole blood inlet pump P1 and the whole blood processing pump P2, compared to the differential maintained during the draw cycle of non-concurrent collection mode. For example, in the illustrated embodiment, the whole blood inlet pump P1 is operated at a minimal differential of, e.g., only 1 mL/min, above the whole blood processing pump P2. - To further assure that only a slight buffer volume of whole blood is maintained in the
draw reservoir 66 during the sustained draw cycle of concurrent collection mode, theweight scale 70 toggles the whole blood inlet pump P1 and anticoagulant pump P3 off whenever the sensed volume of blood in thedraw reservoir 66 exceeds a specified minimum buffer amount , e.g., 5 g. - During the sustained draw cycle of concurrent collection mode, red blood cells are directed into a collection container C4, via the valve V4, which is opened for this purpose (return valve V3 is closed, so no RBC collect in the return reservoir 68). A
weigh scale 108 monitors the weight of the collection container C4. - An associated volume of PC collects in the
second stage 32 of thechamber 16, while the associated volume of PPP collects in the collection container C3 (through the operation of the PPP pump P7 and valve V5, which is opened). Valve V3 is closed , so no PPP collects in thereturn reservoir 68. - The
controller 18 continuously derives Vbrem during the sustained draw cycle of concurrent collection mode. When Vbrem becomes zero, thecontroller 18 terminates the concurrent collection mode. - E. Blood Volume Trimming Function
- In the illustrated embodiment (see FIG. 6), at the end of the concurrent collection mode, the
controller 18 assesses the volumes of RBC and PPP that have been collected, usingweigh scales - If the volume of RBC collected exceeds RBCGoal, the
controller 18 commands thesystem 10 to enter a return cycle to return the excess RBC volume to the donor from the collection container C4, through the branch path 43 (valve V6 being opened), and into the return path 42 (valve V2 being closed), by operation of the in-line return pump P6. - Likewise, if the volume of PPP collected exceeds PPPGoal the
controller 18 commands thesystem 10 to enter a return cycle to return the excess PPP volume to the donor from the collection container C3, through the branch path 45 (valve V7 being opened and valve V5 being closed), and into thereturn path 42, by operation of the in-line return pump P6. - At the end of the blood volume trimming function, the
controller 18 commands a saline reinfusion operation to return residual blood in thesystem 10 to the donor, along with a prescribed fluid replacement volume. - F. Post Collection Processing
- 1. PPP
- The retention of PPP can serve multiple purposes, both during and after the component separation process.
- The retention of PPP serves a therapeutic purpose during processing. PPP contains most of the anticoagulant that is metered into WB during the component separation process. By retaining a portion of PPP instead of returning it all to the donor, the overall volume of anticoagulant received by the donor during processing is reduced. This reduction is particularly significant when large blood volumes are processed. The retention of PPP during processing also keeps the donor's circulating platelet count higher and more uniform during processing.
- The
system 10 can also derive processing benefits from the retained PPP. For example, thesystem 10 can, in an alternative recirculation mode, recirculate a portion of the retained PPP, instead of PRP, for mixing with WB entering thefirst compartment 24. Or, should WB flow be temporarily halted during processing, thesystem 10 can draw upon the retained volume of PPP as an anticoagulated “keep-open” fluid to keep fluid lines patent. In addition, at the end of the separation process, thesystem 10 can draw upon the retained volume of PPP as a “rinse-back” fluid, to resuspend and purge RBC from thefirst stage compartment 24 for return to the donor through thereturn branch 42. - 2. PC
- After the separation process, the
system 10 also operates in a resuspension mode to draw upon a portion of the retained PPP to resuspend PC in thesecond stage 24 for transfer and storage in the collection container(s) C5. Resuspension and transfer of PC to the collection containers C5 can be accomplished manually or on line. - Preferable, the container(s) C5 intended to store the PC are made of materials that, when compared to DEHP-plasticized polyvinyl chloride materials, have greater gas permeability that is beneficial for platelet storage. For example, polyolefin material (as disclosed in Gajewski et al U.S. Pat. No. 4,140,162), or a polyvinyl chloride material plasticized with tri-2-ethylhexyl trimellitate (TEHTM) can be used.
- G. RBC
- In the illustrated embodiment (see FIG. 7), a disposable collection set76 is provided to process the RBC volume collected for storage.
- The
set 76 includes atransfer path 78. Thetransfer path 78 has a sealedfree end 80 designed to be connected in a sterile fashion to a sealedtube segment 82 on the RBC collection container C4 (see FIG. 7). Known sterile connection mechanisms (not shown) like that shown in Spencer U.S. Pat. No. 4,412,835 can be used for connecting thetransfer path 78 to thetube segment 82. These mechanisms form a molten seal between tubing ends, which, once cooled, forms a sterile weld. - A
first bag 84 communicates with thetransfer path 78 through a length ofsample tubing 86. Thefirst bag 84 contains a red blood cell additive solution S, e.g., SAG-M or ADSOL® Solution (Baxter Healthcare Corporation). Following coupling of the collection set 76 to the RBC collection container C4, a conventional in-linefrangible cannula 106 in thesample tubing 86 is opened, and the red blood cell additive solution S is transferred from thefirst bag 84 into the collection container C4 for mixing with the collected RBC volume. The mixture of additive solution and RBC can then be transferred back into thefirst bag 84. - Residual air in the
first bag 84 can be vented into an in-lineair venting chamber 88, which communicates with thetransfer path 78. At the same time, an aliquot of the collected RBC volume present in thefirst bag 84 can be expressed into thesample tubing 86. - The
tubing 86 preferably carries anidentification code 90 which is identical to acode 90 printed on or otherwise applied to thefirst bag 84. Thetubing 86 is then closed with a conventional snap-apart seal, and thefirst bag 84 is detached from the collection set 76 for storing the RBC volume. Thetubing 86 can be further sealed in segments, using conventional tube sealers, to isolate multiple samples of the RBC for analysis and cross-matching. - The
set 76 also includes asecond bag 92, which communicates with thetransfer path 78 downstream of thefirst bag 84 through abranch path 94. Thebranch path 94 includes an in-line filter 96. The in-line filter 96 carries afiltration medium 98 that selectively removes leukocytes from red blood cells. The filter can comprise, e.g., a R-3000 Red Blood Cell Filter (Asahi Medical) - The mixture of red blood cells and additive solution can be transferred from the collection bag C4 to the
second bag 92 through the in-line filter 96, by-passing thefirst bag 84. In this way, theset 76 provides red blood cells essentially free of leukocytes, suitable for long term storage. - An
air venting path 100 extends from thesecond bag 92 to thetransfer path 78, bypassing the in-line filter 96. By opening a conventional break-awaycannula 106 in thepath 100, residual air in thesecond bag 92 can be vented through thepath 100 into the in-lineair venting chamber 88. A one-way valve 104 in thepath 100 allows air and liquid flow in thepath 100 away from thebag 92, but not in the opposite direction. - At the same time, an aliquot of the collected RBC present in the
second bag 92 can be expressed into the ventingpath 100. The ventingpath 100 carries anidentification code 102 which is identical to acode 102 printed on or otherwise applied to thesecond bag 92. The ventingpath 100 andbranch path 94 can be closed with a conventional snap-apart seal, to allow detachment of thesecond bag 92 from thetransfer path 78. Thepath 100 can also be sealed in segments, to provide multiple samples of the RBC for analysis and cross-matching. - The collection set76 provides the flexibility to provide a red blood cell product suitable for long term storage, which is either non-leukocyte reduced or leukocyte reduced before storage.
- In addition to the information that the utility functions F1 to F4 provide before, during, and after a selected blood processing procedure, the
controller 18 can also include utility functions F5 and F6, which provide additional information before, during, or after the procedure, estimating the effect of the selected procedure upon the donor's blood volume and hematocrit. More particularly, additional utility function F5 provides an estimation of the donor's net fluid volume deficit as a result of the procedure, which will be called the Post-Intravascular Volume Deficit or Post-IVD. The additional utility function F6 provides an estimation of the hematocrit of the donor's blood after the procedure, which will be called the Post-Hematocrit. The utility functions F5 and F6 can be performed after any selected blood processing procedure, e.g., after a procedure that collects platelets without collecting red blood cells, or after a procedure that collects both platelets and red blood cells. - Post-IVD or Post-Hematocrit can be derived by the utility functions F5 or F6 at the beginning of the selected procedure based upon the operating parameters existing at that time. Post-IVD or Post-Hematocrit can be updated by the utility functions F5 or F6 at any time during the selected procedure as operating parameters change or are changed by the operator.
- The
controller 18 desirably displays the values of the Post-Intravascular Volume Deficit, or other expressions thereof, and the Post-Hematocrit on theinterface 58. The information can also be presented in printed form, e.g., for paper record filing, or in data form for offloading, e.g., to a centralized donor database. - Access to this information before, during, or after the selected procedure aids the operator in assessing the effect of the procedure on the donor's blood volume. This information allows a blood center to assess the effect of a given procedure upon the donor, so that a blood center can optimize its collection of blood products from a donor, without compromising donor safety or regulatory requirements.
- A. Utility Function F5: Deriving Post-Intravascular Volume Deficit
- The Post-Intravascular Volume Deficit (Post-IVD) is defined as the total maximum blood volume that the intended procedure will remove from the donor, minus replacement volume of fluids (TotVolReplaced) provided to the donor over the course of the procedure. Stated differently, the Post-Intravascular Volume Deficit (Post-IVD) is an assessment of the donor's net fluid volume deficit resulting from the procedure.
- To derive the Post-Intravascular Volume Deficit Post-IVD), the utility function F5 derives the donor's total blood volume (DonVol) at the start of the procedure. DonVol is based upon the donor's gender, height, and weight. DonVol can be derived empirically, e.g., according to Equation (13) in the Summary below.
- The utility function F5 also derives the total volume of blood products to be removed from the donor during the procedure. This comprises the sum of the desired PC yield to be collected (YldGoal), the desired RBC volume to be collected(RBCGoal), and the desired PPP volume to be collected (PPPGoal). Of course, depending upon objectives of the particular selected procedure, one or more of these blood volumes may be zero, if that blood product is not targeted for collection by the procedure. These targeted values are inputted by the operator at the beginning of a given procedure, and can be modified by the operator during the course of the procedure.
- The utility function F5 also desirably accounts for other blood losses the donor will experience, due to, e.g., the residual red blood cell volume of the blood processing system, any cycle volume (for single needle systems), or any other blood volumes (Res-Vol) that will not be returned to the donor at the end of the procedure. In this respect, the utility function F5 conducts a “worst case” blood loss scenario, one that goes beyond accounting for only the volume of blood products collected, and one that also accounts for blood loss from other sources, to assess an actual total blood volume loss from all sources.
- The sum of the blood product volumes and Res-Vol comprise the total blood volume loss that the donor will experience as a result of the procedure (TotVolRemoved), expressed as follows:
- TotVolRemoved=(YldGoal)+(RBCGoal)+(PPPGoal)+(Res-Vol)
- The utility function F5 also derives the total volume of replacement fluid (TotVolReplaced) that will be returned to the donor during the procedure. This includes the volume of saline given to the donor at the beginning of the procedure due to saline prime, plus the estimated volume of anticoagulant ACD to be used during the procedure. The sum of these volumes comprise the total replacement fluid volume for the procedure (TotVolReplaced).
- To derive Post-Intravascular Volume Deficit (Post-IVD), the utility function F5 subtracts TotVolReplaced from TotVolRemoved, expressed as follows:
- Post-IVD=TotVolRemoved−TotVolReplaced
- Numeric information pertaining to Post-IVD is desirably expressed to the operator in one or more different formats, which relay the information in the context of, e.g., a blood center policy or a regulatory requirement. For example, Post Procedure Net Fluid Deficit Information can express Post-IVD as the percentage of the donor's total blood volume prior to the procedure (DonVol), that is:
- Post Procedure Net Fluid Deficit Information (%)=Post-IVD/DonVol.
- As another example, Post Procedure Net Fluid Deficit Information can express Post-IVD as a fraction of the donor's weight (Wgt) (in kg), that is:
- Post Procedure Net Fluid Deficit Information (mL/kg)=Post-IVD/Wgt.
- The
controller 18 can include programming that compares Post-IVD or Post Procedure Net Fluid Deficit Information to prescribe standards. Thecontroller 18 can produce a cautionary output based upon the comparison, if the derived value is not consistent with the prescribed standards. - B. Utility Function F6: Deriving Post-Hematocrit
- The Post-Hematocrit is defined as an estimation of the donor's total red blood cell volume remaining after the intended procedure divided by an estimation of the donor's total blood fluid volume remaining after the intended procedure.
- In deriving Post-Hematocrit, the utility function F6 relies upon three estimated quantities: (i) the donor's red blood cell volume existing prior to the procedure (Pre-RBC-Vol), which is a function of the donor's blood hematocrit measured prior to the procedure (Pre-Hct); (ii) the donor's red blood cell volume remaining after the procedure (Post-RBC-Vol), which is a function of the desired RBC volume to be collected (RBCGoal) and system residual red blood cell volume (Res-Vol) (also used by utility function F5 above); and (iii) the donor's total blood volume after the procedure (Post-Tot-Vol), which is a function of donor's total blood volume existing prior to the procedure (DonVol) and the Post-Intravascular Volume Deficit (Post-IVD), as derived by utility function F5.
- More particularly, to estimate Pre-RBC-Vol, an actual measurement of the donor's blood hematocrit (Pre-Hct) before the procedure is preferably relied upon. The value of Pre-Hct is inputted to the
controller 18 for processing by the utility function F6. Alternatively, an accurate estimation of the donor's blood hematocrit before the procedure can be used as Pre-Hct. To derive Pre-RBC-Vol, the utility function F6 multiplies the donor's total blood volume (DonVol) prior to procedure (derived in the same manner as utility function F5) by the donor's blood hematocrit prior to the procedure (Pre-Hct), expressed as follows: - Pre-RBC-Vol=DonVol×Pre-Hct
- To estimate Post-RBC-Vol, the utility function F6 subtracts the sum of the desired RBC volume to be collected (RBCGoal) and the system residual blood volume (Res-Vol) (also used by utility function F5 above) from the donor's pre-procedure red blood cell volume (Pre-RBC-Vol), expressed as follows:
- Post-RBC-Vol=Pre-RBC-Vol−(RBCGoal+Res-Vol)
- To determine Post-Tot-Vol, the utility function F6 subtracts from the donor's total blood volume existing prior to the procedure (DonVol), the Post-Intravascular Volume Deficit (Post-IVD), as derived by utility function F5, expressed as follows:
- Post-Tot-Vol=DonVol−Post-IVD
- To derive Post-Hematocrit, the utility function F6 divides the estimation of the donor's red blood cell volume existing after the procedure (Post-RBC-Vol) by the estimation of the donor's total blood volume existing after the procedure (Post-Tot-Vol), expressed as follows:
- Post-Hematocrit=Post-RBC-Vol/Post-Tot-Vol
- Information pertaining to Post-Hematocrit is desirably processed for display to the operator, along with the information pertaining to Post-IVD. Such information can also be presented in printed form or downloaded in electronic form for data storage and manipulation.
- The
controller 18 can include programming that compares Post-Hematocrit to prescribe standards. Thecontroller 18 can produce a cautionary output based upon the comparison, if the derived value is not consistent with the prescribed standards. - A. Deriving Platelet Yield
- The utility function F1 makes continuous calculations of the platelet separation efficiency (ηplt) of the
system 10. The utility function F1 treats the platelet separation efficiency ηptl as being the same as the ratio of plasma volume separated from the donor's whole blood relative to the total plasma volume available in the whole blood. The utility function F1 thereby assumes that every platelet in the plasma volume separated from the donor's whole blood will be harvested. - The donor's hematocrit changes due to anticoagulant dilution and plasma depletion effects during processing, so the separation efficiency ηplt does not remain at a constant value, but changes throughout the procedure. The utility function F1 contends with these process-dependent changes by monitoring yields incrementally. These yields, called incremental cleared volumes (ΔClrVol), are calculated by multiplying the current separation efficiency ηplt by the current incremental volume of donor whole blood, diluted with anticoagulant, being processed, as follows:
- ΔClrVol=ACDil×ηplt×ΔVOLproc Eq (1)
- where:
- ΔVolproc is the incremental whole blood volume being processed, and
-
- where:
- AC is the selected ratio of whole blood volume to anticoagulant volume (for example 10:1 or “10”). AC may comprise a fixed value during the processing period. Alternatively, AC may be varied in a staged fashion according to prescribed criteria during the processing period.
- For example, AC can be set at the outset of processing at a lesser ratio for a set initial period of time, and then increased in steps after subsequent time periods; for example, AC can be set at 6:1 for the first minute of processing, then raised to 8:1 for the next 2.5 to 3 minutes; and finally raised to the processing level of 10:1.
- The introduction of anticoagulant can also staged by monitoring the inlet pressure of PRP entering the
second processing stage 32. For example, AC can be set at 6:1 until the initial pressure (e.g. at 500 mmHg) falls to a set threshold level (e.g., 200 mmHg to 300 mmHg). AC can then be raised in steps up to the processing level of 10:1, while monitoring the pressure to assure it remains at the desired level. - The utility function F1 also makes continuous estimates of the donor's current circulating platelet count (PltCirc), expressed in terms of 1000 platelets per microliter (μl) of plasma volume (or k/μl). Like ηplt, PltCirc will change during processing due to the effects of dilution and depletion. The utility function F1 incrementally monitors the platelet yield in increments, too, by multiplying each incremental cleared plasma volume ΔClrVol (based upon an instantaneous calculation of ηplt) by an instantaneous estimation of the circulating platelet count PltCir. The product is an incremental platelet yield (Δyld), typically expressed as en platelets, where en=0.5×10n platelets (e11=0.5×1011 platelets).
-
- where:
-
- where:
- Pltcurrent is the current (instantaneous) estimate of the circulating platelet count of the donor.
- ΔYld is divided by 100,000 in Eq (4) to balance units.
- The following provides further details in the derivation of the above-described processing variables by the utility function F1.
- 1. Deriving Overall Separation Efficiency ηplt
- The overall system efficiency ηplt is the product of the individual efficiencies of the parts of the system, as expressed as follows:
- ηplt=η1stSep×η2ndSep×ηAnc Eq (5)
- where:
- η1stSep is the efficiency of the separation of PRP from WB in the first separation stage.
- η2ndSep is the efficiency of separation PC from PRP in the second separation stage.
- ηAnc is the product of the efficiencies of other ancillary processing steps in the system.
- a. First Stage Separation Efficiency η1stsep
-
- where:
- Qb is the measured whole blood flow rate (in ml/min).
- Qp is the measured PRP flow rate (in ml/min).
- Hb is the apparent hematocrit of the anticoagulated whole blood entering the first stage separation compartment. Hb is a value derived by the utility based upon sensed flow conditions and theoretical considerations. The utility function F1 therefore requires no on-line hematocrit sensor to measure actual WB hematocrit.
-
- where:
-
- where:
- qb is inlet blood flow rate (cm3/sec), which is a known quantity which, when converted to ml/min, corresponds with Qb in Eq (6).
- qp is measured PRP flow rate (in cm3/sec), which is a known quantity which, when converted to ml/min corresponds with Qp in Eq (6).
- β is a shear rate dependent term, and Sγis the red blood cell sedimentation coefficient (sec). Based upon empirical data, Eq (8) assumes that β/Sγ=15.8×106 sec1 −.
- A is the area of the separation chamber (cm2), which is a known dimension.
- g is the centrifugal acceleration (cm/sec2), which is the radius of the first separation chamber (a known dimension) multiplied by the rate of rotation squared Ω2 (rad/sec2) (another known quantity).
-
-
- set forth in Brown, The Physics of Continuous Flow Centrifugal Cell Separation, “Artificial Organs”1989; 13(1):4-20)). Eq (8) solves Eq (10) for Hrbc.
- b. The Second Stage Separation Efficiency η2ndSep
- The utility function F1 also derives η2ndsep continuously over the course of a procedure based upon an algorithm, derived from computer modeling, that calculates what fraction of log-normally distributed platelets will be collected in the
second separation stage 32 as a function of their size (mean platelet volume, or MPV), the flow rate (Qp), area (A) of theseparation stage 32, and centrifugal acceleration (g, which is the spin radius of the second stage multiplied by the rate of rotation squared Ω2). - The algorithm can be expressed in terms of a function, which expressed η2ndSep in terms of a single dimensionless parameter gASp/Qp,
- where:
- Sp=1.8×10−9 MPV2/3 (sec), and
- MPV is the mean platelet volume (femtoliters, fl, or cubic microns), which can be measured by conventional techniques from a sample of the donor's blood collected before processing. There can be variations in MPV due to use of different counters. The utility function therefore may include a look up table to standardize MPV for use by the function according to the type of counter used. Alternatively, MPV can be estimated based upon a function derived from statistical evaluation of clinical platelet precount PltPRE data, which the utility function can use. The inventor believes, based upon his evaluation of such clinical data, that the MPV function can be expressed as:
- MPV (f1)≈11.5−0.009Plt PRE (k/μl)
- c. Ancillary Separation Efficiencies ηAnc
- ηAnc takes into account the efficiency (in terms of platelet loss) of other portions of the processing system. ηAnc takes into account the efficiency of transporting platelets (in PRP) from the first stage chamber to the second stage chamber; the efficiency of transporting platelets (also in PRP) through the leukocyte removal filter; the efficiency of resuspension and transferral of platelets (in PC) from the second stage chamber after processing; and the efficiency of reprocessing previously processed blood in either a single needle or a double needle configuration.
- The efficiencies of these ancillary process steps can be assessed based upon clinical data or estimated based upon computer modeling. Based upon these considerations, a predicted value for ηAnc can be assigned, which Eq (5) treats as constant over the course of a given procedure.
- 2. Deriving Donor Platelet Count (PltCirc)
- The utility function F1 relies upon a kinetic model to predict the donor's current circulating platelet count PltCirc during processing. The model estimates the donor's blood volume, and then estimates the effects of dilution and depletion during processing, to derive PltCirc, according to the following relationships:
- Plt Circ=[(Dilution)×Plt Pre]−(Depletion) Eq (11)
- where:
- PltPre is the donor's circulating platelet count before processing begins (k/μl), which can be measured by conventional techniques from a sample of whole blood taken from the donor before processing. There can be variations in Pltpre due to use of different counters (see, e.g., Peoples et al., “A Multi-Site Study of Variables Affecting Platelet Counting for Blood Component Quality Control,” Transfusion (Special Abstract Supplement, 47th Annual Meeting), v. 34, No. 10S, October 1994 Supplement). The utility function therefore may include a look up table to standardize all platelet counts (such as, PltPre and Pltpost, described later) for use by the function according to the type of counter used.
- Dilution is a factor that reduces the donor's preprocessing circulating platelet count PltPre due to increases in the donor's apparent circulating blood volume caused by the priming volume of the system and the delivery of anticoagulant. Dilution also takes into account the continuous removal of fluid from the vascular space by the kidneys during the procedure.
- Depletion is a factor that takes into account the depletion of the donor's available circulating platelet pool by processing. Depletion also takes into account the counter mobilization of the spleen in restoring platelets into the circulating blood volume during processing.
- a. Estimating Dilution
-
- where:
- Prime is the priming volume of the system (ml).
- ACD is the volume of anticoagulant used (current or end-point, depending upon the time the derivation is made)(ml).
- PPP is the volume of PPP collected (current or goal) (ml).
- DonVol (ml) is the donor's blood volume based upon models that take into account the donor's height, weight, and sex. These models are further simplified using empirical data to plot blood volume against donor weight linearized through regression to the following, more streamlined expression:
- DonVol=1024+51Wgt(r 2=0.87) Eq (13)
- where:
- Wgt is the donor's weight (kg).
- b. Estimating Depletion
-
- where:
- Yld is the current instantaneous or goal platelet yield (k/μl). In Eq (14), Yld is multiplied by 100,000 to balance units.
- Eq (14) does not take into account splenic mobilization of replacement platelets, which is called the splenic mobilization factor (or Spleen). Spleen indicates that donors with low platelets counts nevertheless have a large platelet reserve held in the spleen. During processing, as circulating platelets are withdrawn from the donor's blood, the spleen releases platelets it holds in reserve into the blood, thereby partially offsetting the drop in circulating platelets. The inventor has discovered that, even though platelet precounts vary over a wide range among donors, the total available platelet volume remains remarkably constant among donors. An average apparent donor volume is 3.10±0.25 ml of platelets per liter of blood. The coefficient of variation is 8.1%, only slightly higher than the coefficient of variation in hematocrit seen in normal donors.
- The mobilization factor Spleen is derived from comparing actual measured depletion to Depl (Eq (14)), which is plotted and linearized as a function of PltPre. Spleen (which is restricted to a lower limit of 1) is set forth as follows:
- Spleen=[2.25−0.004Plt Pre]≧1 Eq (15)
-
- 3. Real Time Procedure Modifications
- The operator will not always have a current platelet pre-count Pltpre for every donor at the beginning of the procedure. The utility function F1 allows the system to launch under default parameters, or values from a previous procedure. The utility function F1 allows the actual platelet pre-count PltPre, to be entered by the operator later during the procedure. The utility function F1 recalculates platelet yields determined under one set of conditions to reflect the newly entered values. The utility function F1 uses the current yield to calculate an effective cleared volume and then uses that volume to calculate the new current yield, preserving the platelet pre-count dependent nature of splenic mobilization.
-
- where:
- ClrVol is the cleared plasma volume.
- DonVol is the donor's circulating blood volume, calculated according to Eq (13).
- YldCurrent is the current platelet yield calculated according to Eq (3) based upon current processing conditions.
- Prime is the blood-side priming volume (ml).
- ACD is the volume of anticoagulant used (ml).
- PPP is the volume of platelet-poor plasma collected (ml).
- PreOld is the donor's platelet count before processing entered before processing begun (k/μl).
- SpleenOld is the splenic mobilization factor calculated using Eq (16) based upon PreOld.
-
- where:
- PreNew is the revised donor platelet pre-count entered during processing (k/μl).
- YldNew is the new platelet yield that takes into account the revised donor platelet pre-count PreNew.
- ClrVol is the cleared plasma volume, calculated according to Eq (17).
- DonVol is the donor's circulating blood volume, calculated according to Eq (13), same as in Eq (17).
- Prime is the blood-side priming volume (ml), same as in Eq (17).
- ACD is the volume of anticoagulant used (ml), same as in Eq (17).
- PPP is the volume of platelet-poor plasma collected (ml), same as in Eq (17).
- SpleenNew is the splenic mobilization factor calculated using Eq (15) based upon PreNew
- 4. Remaining Procedure Time
-
- where:
- Vbrem is the remaining volume to be processed, calculated using Eq (19) based upon current processing conditions.
- Qb is the whole blood flow rate, which is either set by the user or otherwise derived by the
controller 18. - 5. Plasma Collection
- The utility function F2 adds the various plasma collection requirements to derive the plasma collection volume (PPPGoal) (in ml) as follows:
- PPP Goal =PPP PC +PPP Source +PPP Reinfuse +PPP Waste +PPP CollCham Eq (20)
- where:
- PPPPC is the platelet-poor plasma volume selected for the PC product, which can have a typical default value of 250 ml, or be otherwise calculated by the
controller 18 based upon current processing conditions. - PPPsource is the platelet-poor plasma volume selected for collection as source plasma.
- PPPWaste is the platelet-poor plasma volume selected to be held in reserve for various processing purposes (Default=30 ml).
- PPPCollCham is the volume of the plasma collection chamber (Default=40 ml).
- PPPReinfuse is the platelet-poor plasma volume that will be reinfusion during processing.
- 6. Plasma Collection Rate
-
- where:
- PPPGoal is the desired platelet-poor plasma collection volume (ml).
- PPPCurrent is the current volume of platelet-poor plasma collected (ml).
- trem is the time remaining in collection, calculated using Eq (19) based upon current processing conditions.
- 7. Total Anticipated AC Usage
-
- where:
- ACDCurrent is the current volume of anticoagulant used (ml).
- AC is the selected anticoagulant ratio,
- Qb is the whole blood flow rate, which is either set by the user or otherwise calculated by the
controller 18 based upon current processing conditions. - trem is the time remaining in collection, calculated using Eq (19) based upon current processing conditions.
- Various features of the inventions are set forth in the following claims.
Claims (1)
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US10/827,951 US20040199098A1 (en) | 1999-10-16 | 2004-04-20 | Blood collection systems and methods that derive estimated effects upon the donor's blood volume and hematocrit |
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US41974299A | 1999-10-16 | 1999-10-16 | |
US09/789,183 US6730054B2 (en) | 1999-10-16 | 2001-02-20 | Blood collection systems and methods that derive estimated effects upon the donor's blood volume and hematocrit |
US10/827,951 US20040199098A1 (en) | 1999-10-16 | 2004-04-20 | Blood collection systems and methods that derive estimated effects upon the donor's blood volume and hematocrit |
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US10/827,951 Abandoned US20040199098A1 (en) | 1999-10-16 | 2004-04-20 | Blood collection systems and methods that derive estimated effects upon the donor's blood volume and hematocrit |
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Also Published As
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WO2002066110A1 (en) | 2002-08-29 |
EP1361909A1 (en) | 2003-11-19 |
US20020062100A1 (en) | 2002-05-23 |
US6730054B2 (en) | 2004-05-04 |
EP1361909B1 (en) | 2013-11-06 |
CA2437094A1 (en) | 2002-08-29 |
EP1361909A4 (en) | 2010-11-10 |
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