Neocytopheresis: New Approach of transfusion in Thalassemia major

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Neocytes: These are new red cells which come afresh from bone marrow. They have a longer life span and lesser weight as compared to older cells (gerocytes) in the circulation. The young red cells survive longer after transfusion and hence, there are longer intervals between transfusions (one transfusion in three months instead of once a month).

Thalassemia major patients are required to maintain hemoglobin level above 10-12 g/dL to ensure active life and adequate growth. Hence, requiring repeated blood transfusions, which in turn leads to multiple complications like iron overload, a risk of developing alloantibodies, transmission of transfusion transmitted infections (TTIs) and finally multiple organ dysfunctions due to hemosiderosis and hemochromatosis. Current perspective and recent practice are the use of blood units enriched with neocytes, which reduces the frequency of transfusions and thereby diminishes the risk of iron overload, alloimmunization, and transmission of TTIs.

 Neocytes harvesting: The Neocytes being lighter in weight can be separated and collected, selectively, by a method of apheresis from a blood donor.

Apheresis procedure (Neocytopheresis) is to isolate young red cells by centrifugation using continuous flow cell separator. Donor’s blood is anticoagulated and the young red cell harvesting is carried out over 3-4 hours. The red cells along with large numbers of white cells and platelets are collected in the procedure, but cryopreservation and subsequent washing remove 99% of these undesired cells. After completion of this process, a product yielding 70% of the total hemoglobin content of a standard frozen/deglycerolized red cell unit is produced. The neocyte enrichment is evaluated by reticulocyte count, MCV and Pyruvate kinase enzyme (an age-dependent enzyme).However, this procedure is expensive and requires a lot of expertise, but despite the high cost of this blood product, the efficacy of neocytopheresis is showing promising results by reducing blood consumption.

Neocytopheresis is a new age procedure for treatment of chronic anemias especially thalassemia major patients.

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Last modified: 12/02/2018

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