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Warm up to clumping prevention practices
It’s time to grab your favorite hot beverage and dig into the latest edition of Access Point — a publication exclusively for those who regularly work with the Spectra Optia® Apheresis System from Terumo Blood and Cell Technologies. In this issue, we focus on clumping, a top collection challenge.
Fast fact: When we reviewed hundreds of collection procedures, clumping was the main cause of reduced efficiency in 25% of procedures. This issue’s insights will support your efforts to improve those odds.
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The invisible dilemma: Clumping in the inlet line trap
Clumping in any exchange procedure can lead to many issues if not addressed. If it occurs in the connector of an exchange set, clumping is fairly simple to identify because you see a change in the interface, where plasma and red cells meet during an exchange.
The interface inside the connector should appear like the edge of a knife, with layers clearly separated. If, instead, you see an unstable interface — sometimes described as “ocean waves in the connector” — that is the most common indication of clumping.
Clumping in the inlet line trap, on the other hand, is difficult to see and may not even be visible. Instead, it may be indicated by inlet alarms, the need for repeated inlet flushing, or the appearance of “stringy stuff” in the inlet line or port.
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Spot it: How to identify clumping in collection procedures
When clumping occurs during a collection procedure on Spectra Optia, it can look like there are hills or peaks at the connector interface, instead of a straight, defined separation of cellular layers. You might see platelet aggregates exiting the centrifuge through the collect line. The color in the collect line may be unstable and go from light to dark and back again, without any changes being made to the collection preference.
Keep reading to see what clumping can look like in the connector during a collection procedure, as well as what you might see when looking at the automated interface management (AIM) system.
For more on how to manage and resolve clumping, see the Dear Access Point and Resource Spotlight content below.
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Dear Access Point,
What happens if clumping does not resolve? Can a clot be reversed?
— Jennifer in Tallahassee, FL
Dear Jennifer,
If you cannot resolve clumping, you may need to leave the inlet:AC ratio at 8:1 to 10:1 for the entire procedure. This will slow down your procedure. However, if a clot forms, it is not reversable, and you may need to discontinue the procedure altogether. Inadequate anticoagulation can lead to clot formation. If the low-level reservoir sensor becomes obstructed by a clot, it may allow air to be drawn into the return line. If the filter becomes completely occluded, the reservoir cannot be emptied, and you must discontinue the run.
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If you have a specific question about the Spectra Optia system, let us know. We will feature a reader question in each Access Point edition. Be sure to tell us your first name, hometown, and state or province. Questions not featured will be answered directly via email.
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Four ways to manage clumping
- Decrease the inlet:AC ratio to 8:1 until the clump disappears. This may take at least 100 mL of inlet volume processed.
- Once 100 mL of inlet volume has been processed, reassess to see if clumping has been resolved. If so, consider increasing the inlet:AC ratio to 10:1 and process 500 mL to 1000 mL of inlet volume.
- For subsequent changes of the inlet:AC ratio, process 500 mL to 1000 mL of inlet volume between changes.
- If the clump persists, keep the inlet:AC ratio at 10:1 to minimize the impact on procedure efficiency.
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ACD-A stands for anticoagulant citrate dextrose solution, solution A. Each component carries out a specific role to help prevent coagulation. The anticoagulant (AC) is an acid that lowers the pH of whole blood, helping prevent platelet aggregation and keeping platelets in suspension. The citrate binds ionized calcium in the extracorporeal circuit. And the dextrose assists in nourishing cells during cellular collection procedures. It is important to note that ACD-A is an extracorporeal anticoagulant — it does not anticoagulate the patient.
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Living with sickle cell disease
As a chronic sickle cell type SS patient, Rona Wiggins had been using simple transfusion for years, but still had pain crises. To get past them, she says, “I tried everything … diaphragmatic breathing … meditation … reflexology. I’ve tried denial.”
Yet she would still have joint pain, fatigue, and jaundice. But when Wiggins discovered automated red blood cell exchange (RBCX), everything changed.
“It improved my quality of life almost instantaneously,” she says. More than 20 years later, with automated RBCX and apheresis nurses well trained on Spectra Optia, Wiggins feels she is living her best life. “This is currently what’s keeping me healthy, and I am definitely living well with sickle cell.”
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Upcoming Successions Programs
Red Blood Cell Exchange
January 31, 2024 | Johns Hopkins University
Cell Collections
February 1, 2024 | Johns Hopkins University
If you are interested in attending either workshop, please send us an email. Hurry, space is limited.
Are you interested in hosting a future Successions workshop?
Contact your local Terumo Blood and Cell Technologies representative or send us an email.
Live From Lakewood
Learn more about our live and interactive sessions from our headquarters in Lakewood, Colorado. If you would like a specific topic covered in one of these webinars, please send us an email.
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You’re on the front lines of care, and we’re here to assist.
Contact us online or via 877.339.4228.
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Sources:
Terumo Blood and Cell Technologies. Continuous Mononuclear Cell Collection (Version 12 CMNC) Procedure Training. 2023. Part number TS-OPTI-00124.
Terumo Blood and Cell Technologies. Therapeutic Plasma Exchange (TPE). Spectra Optia Apheresis System. Training Presentation. 2023. Part number TS-OPTI-01918.
Terumo Blood and Cell Technologies. Anticoagulant Management on the Spectra Optia® Apheresis System. Successions Training. 2021. Part number TS-OPTI-01182.
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