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In the Name of GOD

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و پلاکت مصرفپلاسمائی های فرآورده

خرداد 1393شیراز

آذرکیوان آزیتا دکتر

هماتولوژی تخصص فوق کودکان؛ انکولوژیمتخصص

Whole Blood

Blood Products

حجم با کامل سی 450خون سیخونی های فرآورده و شده سانتریفیوژ

شوند می مشتق آن از

گلبول قرمز

متراکم

پالکت

پالسما

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Platelets

Platelets

Platelets:Storage Controlled room temperature (20 – 24 oC).

Platelets must be stored on a special agitator rack to prevent themaggregating.

Shelf life 5 days from date of donation.Each bag of platelets has an expiry date – expires at midnight ofthe date shown.

Volume (mls):PooledApheresis

Locally defined nominal volume rangeMean volume 310mlsMean volume 220mlsNB Neonatal packs available – mean volume 55mls

Compatibility testingrequirement

Preferably ABO identical with the recipient / patient.Rhesus negative females under the age of 45 years should begiven Rh D negative platelets.

NB Platelets must never be refrigerated as this causes them to irreversibly aggregate.Platelets must be kept away from direct heat or sunlight as temperatures above therecommended range may cause rapid proliferation of bacteria.

Platelet Incubator

Stored in room

tempreture with

constant agitation

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Platelet

Random donor Platelets

Whole blood 1 unit

Platelet Concentrate 1 unit

> 5.5 x 1010 platelets in 50-70 ml of plasma

3 days

Single donor platelets

1 Donor

Platelet concentrate

> 3 x 1011 platelets in

~ 300 ml of plasma3 Days

Platelet Pheresis

Single Donor PlateletSingle Donor Platelet

Volume ~ 300 ml

Platelet Threshold For plt Tx

Platelet count 100’000/μl in pt who need

Surgery or unstable condition

Platelet count 50’000/μl in pts who need

invasive lab. Procedure

Platelet count 50’000/μl in pts With Active

bleeding

Platelet Dysfunction with manifested bleeding

Platelet Tranfusion In The Domain of bleeding disorders : Platelet Transfusion needs just in the field of

Congenital platelet Dysfunction They need chronic platelet tx, BUT there is the

risk of p.refractoriness So it is better to tx p. just on bleeding threatening life ,

If there is possible use from alternative drugs such as antifibrinolytic drugs

It is better to have some HLA matched donor platelets

Platelet RefractorinessDefinition Failure to achieve the expected platelet increment after 2 successive platelet transfusions Corrected count Increment (CCI)

(post tx plt ct- pre tx plt ct) = BSA X

No of plts transfused (1011)

1hr Increment is <7500 or <4500 at 24 hrs

DefinitionPlatelet refractoriness: Inappropriately low increment in

platelet count following a transfusion.Formula to determine platelet response:

1 hour Increment < 5,000-7,500. Corrected Count Increment (CCI):

• Expected > 7500 at 10-60 minutes or >4500 at 18-24 hours.

Less than predicted platelet increment on 2 occasions:• Fresh platelets: < 72 hours. • ABO compatible.

Low Post-transfusion Platelet Increment

1 hour post (platelet recovery) poor platelet alloantibodies platelet autoantibodies hepatosplenomegaly

24 hour post (platelet survival) poor infection , bleeding DIC , fever

Platelet Refractoriness

Non ImmuneSepsis, drugs, DIC, poor quality non-

viable platelets, splenomegaly

ImmuneAlloimmunisation to HLA Class I antigenHLA Bw4/ Bw6ABO incompatibilityPlatelet specific antibody

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Plasma Products

Fresh Frozen Plasma

Plasma Processing

Whole Blood Collection:180-300 cc of plasma can be obtained after

the procssing of one unit of whole blood depending on the volume & RBC content of the unit collected

Single donor Plasmapheresis:500-800cc of plasma depending of donor’s

wt

Fresh Frozen PlasmaFFP Contains

II, V, VII, VIII, XI, X, XIProtein C, Protein S, ATIII and various other

componentsFresh frozen plasma contains a normal

concentration of fibrinogen and the labile coagulation factors VIII and V.

Indications for FFP Transfusion

Usually If the pt is known case of hemophilia

Donot need to FFP

Sever Factor Deficiency With Bleeding No Factor

available

Sever Protein C deficienc

FFP is not completely Safe

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Cryo precipitate

Volume of 15 ml , frozen

Contain VWF , FVIII , FXIII, Fibrinogen

Usually use in :

Hypofibrinogenemia , of dysfib,

FXIII deficiency

VWD

1 unit for every 5 kg

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Cryoprecipitate (Cryo)

Cryoprecipitate Pooling Cryo

Treatment of Hemophilia

Fresh Frozen PlasmaCryoprecipitate

Concentrates of FactorPlasma-derivedBiotechnology

Vials of of 250 to 3000 unités

1 FFP (200 ml) = 200 units of F8

1 ml FFP = 1 unit of F8

Plasma Derived Fractionation

Plasma derivatives

are produced on an

industrial scale

from plasma pools

consisting of

thousands of

donations

Major Plasma Derived Products

Immunoglobulin, albumin and coagulation factors are the most important therapeutic plasma derived proteins that is obtained during plasma fractionation

Other Proteins…

Proteins associated with vitamin KThrombinAntithrombin IIIFactor XIFibrinogenFactor XIIAlpha-1-antitripsinC1-InhibitorImmunoglobulin M

Immigration and Demographics

Immigration:1) Human2) Plasma

Need To Pathogen Clearance

3 walls protecting from transmission of pathogens

donor criteria testing inactivation, removal

Recognise that any system has gaps

Swiss cheese model of safety

TTVI

TTVI

Blood Safety Strategies

Testing vs. Inactivation

Pathogen Reduction

Removal MethodInactivation Method

Company name

Virus Removal   Plasma fractionation Filtration methods   Various chromatographic methodsPathogen Inactivation   Pasteurization   Solvent / Detergent (S/D) treatment   High salt, alcohol or acid treatment   Vapour heat treatment

Pathogen Reduction

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Removal of Viruses by Fractionation and Purification Processes

Processes

Product

Waste

Specific Inf Removal Tx : Nanofiltration

Bacteria µm

0.2 µm Filtration

Virus nm

Nanofiltration

Protein Å

Ultrafiltration

Virus inactivation methods

Dry Heating Wet Heating Pasteurization Low/High pH Gamma Radiation UV Radiation Nanofiltration Solvent/Detergent Beta Propiolacton Caprylate

Photochemical inactivation

Chemical inactivation

Gene introduced into plasmid Plasmid then transfected into cells New DNA integrated into DNA of cells Cells producing large amounts of rFactor selected and cultivated by fermentation Factor protein secreted into media cells grown in, and harvested

plasma-Derived products

– Country of plasma origin– Donor selection– Viral screening by antibody– Antigen and nucleic acid amplification testing– Viral screening and inactivation in pooled plasma

– Establishing safety of the cell line– Eliminating exogenous human or animal proteins– Viral removal and inactivation ,steps designed to reduce the risk of viral contamination

Recombinant products

Minimizing infection risk

Recombinant Factor• Infectious safety• Good supply• More costly• Greater inhibitor risk???Plasma-derived Factor• As safe as recombinant• Less inhibitor risk???• Superior inhibitor eradication• Cheaper

Recombinant VS Plasma derived

Second generationAnimal- and human-derived proteins in cell culture• No albumin in final product

First generation• Animal- and human-derived proteins in cell culture• Human albumin in final product

Third generation• No animal- and human-derived proteins in cell culture, processing or final product

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