This post is about my over 10 years of experience with automated component processing using Terumo equipment, first Atreus and then Reveos at HMC Qatar. The Reveos system is still in use at that institution. There is also a previous post about Mirasol riboflavin-based pathogen inactivation.
We were the first place in the world to combine the automated component production Atreus with the Mirasol pathogen inactivation. Their synergism was very important in the rapid throughput of component production for Qatar.
Terumo has two programs, 2C (C for components) to yield plasma and RBCs and 3C for yielding RBCs, plasma, and platelets. The 2C program is faster but no platelets are separated.
We used the Atreus since 2010 and later replaced it with the Reveos in 2016. Both systems use a special blood bag set that collects the whole blood in European CPD. The kit is carefully placed in the machine. Atreus machines accepted one blood bag set, the Reveos can accept up to 4 sets. In both cases, the whole blood is processed to yield packed RBCs, leukoreduced plasma (<1E6 residual WBCs), platelets, and a special WBC bag (i.e. the residual buffy coat, which is not for clinical use.
The Atreus took about 10 minutes to process the one bag set whereas the Reveos processes 4 bag sets in slightly more than 20 minutes. Thus, the throughput from the Reveos is twice that of Atreus.
We had 4 Atreus and later 4 Reveos machines and these were handled by up to 4 technologists, depending on the number of the units. While the machines were running, the staff were filtering the RBCs and platelet pools, pooling the platelets, and performing the PAS-Mirasol pathogen inactivation. The workflow was not hectic and staff were not stressed out by the multiple tasks. Normally 1 staff member ran the Reveos or Atreus machines at any one time.
When the processing was complete, the RBC bags were filtered with an integral leukodepletion filter designed to leave a residual of <1E6 WBCs in accordance with the CE Standard. The platelets were combined to give a target yield of >= 2.4E11 absolute number of platelets. Then the pool was leukodepleted by filtration to a residual of <1E6 WBCs.
Both Reveos and Atreus measured the RBC, platelet, and plasma volume yields. Additionally, for platelets a Platelet Yield Index PYI was calculated as a relative measure of the platelet yield. To reach a goal of 2.4E11 platelets, the PYI indices for the individual platelet bags were added so that the total exceeded 240.
When combined with the Mirasol system, the component volumes for the plasma and platelets needed to be within specified ranges. Both systems could easily meet these requirements.
When we switched from Atreus to Reveos, our platelet yields increased. The transition period was only two weeks. When we adopted platelet additive solution PAS at the same time, the Reveos had a special program to make “dry” platelets with less volume so that the PAS could be added and still stay within the acceptable range for pathogen-inactivation.
Throughout these years, Terumo sent us special engineers to handle the Atreus then Reveos, Mirasol, and PAS processing. All staff were trained by Terumo initially before we finalized their competency assessments.
We had excellent local service: we never had downtimes due to equipment failures. During the COVID pandemic, all materials (kits, filters, Mirasol solution, and PAS) have been provided without interruption.
We went live with Medinfo Hematos IIG software for the entire blood donor center and hospital blood banks in 2013. From the first day 30/6/13 we had bidirectional interfaces first to the Atreus and later to the Reveos—the world’s first. Likewise, the Mirasol and PAS processing were fully integrated with Medinfo when they were activated.
The residual buffy coat was not used for patient care. However, it has proven invaluable as a quality control material for the stem cell laboratory. In addition, many researchers have used it to establish cell lines for investigational use.
Proper handling the collected whole blood units is critical to success:
- Maintain the temperature below 25C.
- Carefully stack the whole blood units in the blood containers—do not play “ring toss” and just throw them into the container.
In summary, I am very pleased with using this system for over 10 years. In a few weeks, the production laboratory was fully GMP compliant using a diverse group of staff with varying technical backgrounds.
The following are some pictures of the Reveos and its prepared blood components.