ddr.susheela innah professor &hod dept of transfusion medicine jubilee mission medical college,...
TRANSCRIPT
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DDr.Susheela InnahProfessor &HoD
Dept of Transfusion MedicineJubilee Mission Medical College, Thrissur
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In 1910 Duke first noted that platelets from whole blood reduce the bleeding time
In 1950s platelets were collected and transfused, but only for diagnostic purposes.
In 1960s plastic blood bags became available which enabled platelets to be separated from whole blood collections by centrifugation.
History
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In the 1970s Drs. Scott Murphy and Frank Gardner discovered that platelet function was best preserved if the platelets were stored at room temperature with agitation. This resulted in the introduction of prophylactic platelet transfusions for patients with leukaemia.
In the 1980s new methods for platelet transfusion were introduced using cytapheresis technique
In the 1990s cytapheresis methods was refined by collecting leucocyte reduced platelet products.
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Platelets are obtained by three different methods:
Platelet concentrates from whole blood by hard spin (Random donor platelets) - RDP
Buffy coat removed platelet concentrate – BCR-P
Apheresis Platelets (Single Donor Platelets) - SDP
Platelet Products Available for Transfusion
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Preparation of platelet concentrate
RBCs PRP
Plasma
Platelet
concentrate
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The hard-spinning of the platelets on to the bottom of the bag in the PRP method, requiring re-suspension of the plts, may induce a collection injury that could potentially compromise the long-term storage of PRP platelets compared with BC platelets. However, there is currently no direct evidence to substantiate this hypothesis
Transfusion 1989;29:605-609 Blood 2003;102:93a.
Blood 2006;108:282a-283a.
RDP
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Buffy coat removed cells prepared by centrifugation and separation by automated Component separator
Buffy Coat Removed Platelets
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PPPBC
BCR-RBC
WB
Preparation of leuco-reduced components using top and bottom bags with optipress
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Optipress with PPP and RBC
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PPPBC
BCR-RBC
PPPBCR-RBC
BCBC
Buffy coat
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Buffy Coat is hung
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BC-PC
BCRBCR BC-PC
Leuco-reduced platelets
BC
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BC
BC
BC
BCBCP
BC
Sterile connecting device for preparing pooled platelets
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Single-donor apheresis platelet concentrates may be collected by a variety of apheresis systems, using different protocols. Platelet yields may vary, and each procedure or protocol must be fully validated, documented and specifications set.
Single Donor Platelets
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Single Donor Plasma
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Random donorplatelets
Buffy coatplatelets
Cytapheresisplatelets
Preparation Prepared fromcentrifugation of whole bloodderived plateletrich plasma
Prepared fromcentrifugation of whole blood derived buffy coats
Prepared byapheresis from a single donor
Donor number
Multiple Multiple One
Volume 45-50 ml 45-50 ml 200-300 ml
Platelets 5.5 x 1010 6 x 1010 3 x 1011
Properties of platelet concentrates
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Random donorplatelets
Buffy coatplatelets
Cytapheresisplatelets
Leucocytes 7-9 x 1010 1 x 107 < 1 x 106
Red Cells < 1 ml rare < 1 ml
pH 7.35 7.16 7.30
Bacterial contamination
2.5% 0.12%
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Random donorplatelets
Buffy coatplatelets
Cytapheresisplatelets
IL-1 (Day 1) 0 6 pg/ml 0
IL-6 (Day 1) 140 pg/mL 73 pg/mL <15 pg/mL
IL-8 (Day 1) 100 pg/mL 489 pg/mL
170 pg/mL
TGFa(Day 1)
11,050 pg/mL 2,900 pg/mL 2,670 pg/mL
AUSTRALASIAN SOCIETY OF BLOOD TRANSFUSION Topics in Transfusion MedicineFebruary 2001 Vol 8 No 1
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RDP BCR -P SDP
CostRs 2400 -3000For 6 units
Rs 3000 – 4000For 6 units
Rs 9000 to 14000 for 1 unit
Side-effects of Transfusion
Same Same Same
Post-transfusion increments, haemostatic effectiveness
Same Same Same
Donor Exposure Multiple Multiple Single
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RDP BCR -P SDPAlloimmunization
Develops only in minority of patients on chemotherapy
Lesser than RDP
Less chances
Inventory Management
Sufficient stock can be managed on a daily basis
Sufficient stock can be managed on a daily basis
Difficult to obtain during emergencyand holidays
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Thus administering random donor platelets followed by single donor platelets if alloimmunization develops, is justified by both economic and scientific reasoning.
Conclusion
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