Letter to the Editor Pre-Apheresis Donor Platelet Count: An Important Platelet Yield Predictor Karan Saluja, Beenu Thakral, Ratti Ram Sharma, and Neelam Marwaha * Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India To the Editor: We read with interest the article by Chaudhary et al. [1] evaluating the need for quality systems and standard operating procedures (SOP) in automated plateletphere- sis for a developing country like India. We would like to suggest certain modifications in the flowchart proposed by the authors with the aim to obtain a high-quality com- ponent with maximum platelet yield and simultaneously ensuring donor safety. According to AABB standards [2], 90% of SDP must contain platelets 3 3 10 11 /unit while the Council of Europe [3] recommends 2 3 10 11 /unit. The authors sug- gest that the European guidelines may be more suitable for India as only 41.2% of their SDP obtained on Baxter CS 3000plus met AABB standards whereas 96% met Euro- pean guidelines. We do not agree with the authors that the minimum quality requirements of apheresis platelets be reduced. Out of 350 procedures performed at our centre on Baxter CS 3000plus, we found a yield from 3.04–8.8 3 10 11 /unit (3 3 10 11 /unit) in 318 units (90.85%) with the donor pre-procedure platelet count varying between 1.8– 4.7 3 10 9 /L. Our observation from northern India is similar to another study from western India [4]. Moreover, in 9.15% of procedures where the yield was <3 3 10 11 /unit, the donor platelet count was 1.5–1.8 3 10 9 /L and in 100% the yield was >2.5 3 10 11 /unit. The authors have not cor- related a low platelet yield with the pre-apheresis donor platelet count as the platelet yield is dependent upon the pre-procedure platelet count of the donor, blood volume processed, and efficiency of platelet removal by the cell separator [4]. A statistically higher blood volume was pro- cessed using Baxter CS 3000plus as compared to Haemo- netics MCS 3p. The reasons for this difference on platelet yield were not discussed by the authors. We found a resid- ual WBC level of <5 3 10 5 /unit in 128 units (85.3%) out of 150 units tested using Neubauer’s haemocytometer. For an efficient quality management system, the authors have suggested an SOP, an operational flow chart for plateletpheresis and recommend it to be easily fol- lowed by other centers in India. We do agree with the authors that as compared to repeat regular plateletpheresis donors in developed countries, due to economic con- straints in India, SDP are usually collected from first time replacement donors. Besides Hb, platelet count, ABO and Rh(D) typing, and screening for transfusion-transmitted infections (TTI), the Indian Drugs and Cosmetics Act [5] also mandates inclusion of TLC and DLC on plateletphe- resis donors for any subclinical infection. Thus, these tests may be included in the SOP suggested by the authors. In addition, the authors have suggested doing a repeat TTI screening on the final apheresis component. How- ever, donors are selected only if pre-procedure TTI status is non-reactive. Thus, repeating such a test on the compo- nent would add to the cost without any additional benefit and delay the release of on-demand prepared SDP when there may also be a shortage of RDP in the inventory. In light of these considerations, we believe that the authors’ conclusion of lowering the minimum platelet yield/unit is not justified on the basis of a limited number of procedures. The pre-apheresis donor platelet count, an important predictor for good platelet yield, needs to be investigated in the future. REFERENCES 1. Chaudhary R, Das SS, Agarwal P, Shukla JS. Quality systems in automated plateletpheresis in hospital-based blood transfusion service in north India. J Clin Apheresis 2005;20:81–85. 2. Brecher ME, editor. Technical manual, 15th ed. Bethesda, MD: American Association of Blood Banks (AABB); 2005. 202 p. 3. Guide to the preparation, use and quality assurance of blood components. Strasbourg: Council of Europe Publishing. 1996. 4. Patel AP, Kaur A, Patel V, Patel N, Shah D, Kanvinde S, Praja- pati S, Patel H, Rathod D, Adesara R, Rani S. Comparative study of plateletpheresis using Baxter CS 3000 plus and Haemo- netics MCS 3p. J Clin Apheresis 2004;19:137–141. 5. Drugs and Cosmetics Act 1940, 16th ed. Lucknow, India: East- ern Book Company; 2003. p 297. *Correspondence to: Prof. Neelam Marwaha M.D., F.A.M.S., Pro- fessor and Head, Department of Transfusion Medicine, PGIMER, Chandigarh, 160012 India. E-mail: neelam2918@yahoo.com Received 15 February 2006; Accepted 11 April 2006 Published online 17 July 2006 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jca.20100 V V C 2006 Wiley-Liss, Inc. Journal of Clinical Apheresis 21:274 (2006)