Dokument: Das mittlere Thrombozytenvolumen MPV als Qualitätskontrollparameter für Thrombozyten- und Stammzellaphereseverfahren
| Titel: | Das mittlere Thrombozytenvolumen MPV als Qualitätskontrollparameter für Thrombozyten- und Stammzellaphereseverfahren | |||||||
| Weiterer Titel: | Using the mean platelet volume MPV for the quality assessment of apheresis procedures | |||||||
| URL für Lesezeichen: | https://docserv.uni-duesseldorf.de/servlets/DocumentServlet?id=47934 | |||||||
| URN (NBN): | urn:nbn:de:hbz:061-20181129-082512-2 | |||||||
| Kollektion: | Dissertationen | |||||||
| Sprache: | Deutsch | |||||||
| Dokumententyp: | Wissenschaftliche Abschlussarbeiten » Dissertation | |||||||
| Medientyp: | Text | |||||||
| Autor: | Dr. med Bramhoff, Anja [Autor] | |||||||
| Dateien: |
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| Beitragende: | Prof. Dr. Folker Wenzel [Gutachter] Univ.-Prof. Dr. med. Rainer Haas [Gutachter] | |||||||
| Dewey Dezimal-Klassifikation: | 600 Technik, Medizin, angewandte Wissenschaften » 610 Medizin und Gesundheit | |||||||
| Beschreibungen: | Das Ziel der Arbeit ist es zu überprüfen, ob im Rahmen der Stammzell- bzw. Thrombozytenapherese, maschinell oder funktional bedingt, unterschiedlich große Thrombozyten apheriert werden und nicht, wie bisher angenommen, das ganze Volumenspektrum der Thrombozyten.
Um diese Frage zu beantworten, haben wir bei 29 Stammzellspendern und 10 Thrombozytenspendern die Thrombozytenzahl (PLT) und das mittlere Thrombozytenvolumen (MPV) im peripheren Blut der Spender vor der Apherese (vZS) und nach der Apherese (nZS) sowie im Spenderkonzentrat (Aph) bestimmt [1]. Unsere Arbeit konnte zeigen, dass bei den Stammzellspendern vermehrt großvolumige Thrombozyten apheresiert wurden. Bei der Thrombozytenspende wurden hingegen primär kleinvolumige Thrombozyten separiert [1]. Sowohl bei der Stammzell- als auch bei der Thrombozytenapherese werden die zu separierenden Zellen der Buffy-Coat-Schicht entnommen. Bei der Thrombozytenspende werden die Thrombozyten vornehmlich aus den oberen Schichten separiert. Hier zeigt sich ein kleines mittleres Thrombozytenvolumen. Bei der Stammzellapherese werden die Zellen aus der unteren Buffy-Coat-Schicht apharesiert. Hier zeigt sich ein größeres mittleres Thrombozytenvolumen. Das mittlere Thrombozytenvolumen (MPV) im Apheresat spiegelt somit die Schicht wider, aus der die Zellen separiert wurden [1] [2] [3] [4]. Um den Einfluss der benutzten Gerinnungshemmer auf das gemessene Volumen der Thrombozyten zu untersuchen, erfolgte ferner eine Untersuchungsreihe mit fünf Probanden, bei denen jeweils EDTA, ACD-A (Citrat-Lösung) und Heparin als Gerinnungshemmer verwendet wurden. Hier konnte nachgewiesen werden, dass es im Citrat-Milieu (ACD-A) zu einer mittleren Abnahme der Thrombozytenvolumina um 15 % kam. Es ist daher anzunehmen, dass der Anteil der separierten großvolumigen Thrombozyten in Apheresaten, bei denen ein Citrat-Milieu herrscht, noch größer ist als zunächst gemessen [1]. Um messtechnische Ungenauigkeiten des Zellcounters, z. B. durch Zellüberlappungen, zu untersuchen, welche sich bei unterschiedlichen Zellkonzentrationen ergeben könnten, wurden bei den fünf Probanden desweiteren verschiedene Verdünnungsreihen erstellt und analysiert. Es stellte sich heraus, dass mit zunehmender Verdünnung das gemessene Thrombozytenvolumen leicht abnahm. Dies könnte ein Hinweis auf eine ungenaue Volumenmessung bei erhöhter Thrombozytenzahl aufgrund von Thrombozytenüberlagerungen sein [1]. Insbesondere bei der Thrombozytenspende existieren bisher als Qualitätskontrollparameter die Thrombozytenzahl im Apheresat, das Volumen des Thrombozytenkonzentrats, der Anteil an Restleukozyten und Restthrombozyten, der pH-Wert sowie die Sterilität und visuelle Kontrollen [5,1]. Zusammenfassend kann festgehalten werden, dass unsere Untersuchungsergebnisse einen wichtigen Beitrag dazu leisten, das mittlere Thrombozytenvolumen (MPV) als neuen Qualitätskontrollparameter für das Aphereseverfahren zu etablieren [1].In this study we discuss whether during platelet apheresis or stem cell apheresis different kinds of platelets are collected and not as assumed so far the total spectrum of the platelets in the blood stream. The data of 29 stem cell donors and 10 platelet donors were analysed according to the platelet count, the mean platelet volume before and after apheresis as well as in the cell concentrate [1]. It was shown that the platelets in the cell concentrates differ from the platelets found in the peripheral blood. In platelet concentrates the thrombocytes were smaller than in the peripheral blood of the donors before or after apheresis. However stem cell concentrates contained platelets that were larger than the average platelet found in the peripheral blood of the donors before or after apheresis [1]. It seems that the thrombocyte apheresis procedure is more likely to separate platelets of a lower volume in contrast to that stem cell apheresis procedures collected platelets with a rather higher volume than the average platelet volume in the donor’s blood stream. This could indicate that during platelet apheresis and stem cell apheresis, cells are collected from different layers inside the buffy coat. During platelet apheresis contamination with for example leucocytes or monocytes, which could threaten the acceptors, health needs to be avoided so only the top layer of the buffy coat is separated. Here platelets with a lower volume are found. In contrast to that, in stem cell apheresis it is necessary to collect a great amount of stem cells from the peripheral blood stream of the donor as possible. So the cells are mainly collected from the lower layer of the buffy coat, where the most stem cells and also the platelets with a higher volume are found. The mean platelet volume of the platelets in the cell concentrate can be seen as an indicator of the buffy coat cell layer separated by the apheresis procedure [1] [6] [2] [3] [4]. To analyze the effect of the used of different anticoagulants we examined blood samples of five probands using the anticoagulants heparin, EDTA and Citrat. The analysis shows that in citrate the platelet volume is measured 15 % lower than in EDTA, which could indicate that our measurements of the platelet volume in the stem cell as well as in the platelet concentrates are measured to low [1]. During our study we analysed samples form peripheral blood stream as well as samples form platelet and stem cell concentrates. The samples varied a lot in cell concentration so we also investigated whether the platelet concentration has an impact on the measurement of the platelets volume. We analysed a dilution using blood samples of five probands as well as the same cell counter that has been used measuring the platelets during the apheresis process. The measurement of the platelet volume MPV in not physiological concentration as found in the cell concentrates however differs from the MPV value in the peripheral blood of the donors, which could be due to perhaps overlapping of platelets in high platelet concentration [1] [2] [3] [4]. In this study we could show that by measuring the mean platelet volume in the cell concentrate as well as the peripheral blood of the donor before and after apheresis there is a direct indication on which layer of the buffy coat the cells were collected from [1]. We also know that the layer collected has a great impact of the quality of the separated cell concentrate as well as the quality and efficiency of the apheresis procedure itself. So after all measuring the MPV value during cell apheresis could be used to improve the apheresis procedures for both platelet and stem cell collection and to lower the risk and preserve the donor as well as the recipient from harmful reactions [1]. | |||||||
| Quelle: | Bramhoff A, Giers G, Blessing F, and Wenzel F, "Using the mean platelet volume MPV fpr the quality assesment of apheresis procedures," Clinical Hemorheology and Microcirculation, vol. 64, no. 3, pp. 413-424, 2016.
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| Lizenz: |  Urheberrechtsschutz | |||||||
| Fachbereich / Einrichtung: | Medizinische Fakultät | |||||||
| Dokument erstellt am: | 29.11.2018 | |||||||
| Dateien geändert am: | 29.11.2018 | |||||||
| Promotionsantrag am: | 28.03.2018 | |||||||
| Datum der Promotion: | 08.11.2018 |
