transfusion medicine

1. PLATELETPHERESIS
DR VIJAYSRI
JUNIOR RESIDENT
DEPARTMENT OF IMMUNOHEMATOLOGY & TRANSFUSION MEDICINE
WENLOCK DISTRICT HOSPITAL

2. THROMBOCYTAPHRESIS
ERYTHROCYTOPHRESIS
LEUKOCYTAPHERESIS

3. THROMBOCYTAPHRESIS

4. DEFINITION
• Plateletpheresis referred to a procedure in which a portion of
the donor's platelet and some plasma is removed with the
return of the donor's red blood cells (RBCs), white blood cells
(WBCs), and remaining plasma. The product is also known as
single donor platelet (SDP).

5. CATEGORIES
COMPONENT COLLECTION THERAPEUTIC APHERESIS

6. GENERAL CRITERIA
• Donor screening similar to whole blood collection.( Weight - above 60kg)
• Written informed consent
• Repeat donor
• Venous access- vein examination
• TTI screening - history & testing
• Investigation - hemoglobin, calcium, blood grouping & typing
• Medical examination.
DGHS GUIDELINES

7. SELECTION CRITERIA FOR PLATELETPHERESIS
1. Donor weight should be more than 60 Kg.
2. The interval between procedures should be at least 48 hours. A donor should not undergo the procedure more
than 2 times a week or 24 times a year. After the whole blood donation plateletpheresis, the donor should be
accepted only after 28 days of interval.
3. Platelets may be collected from donors who do not meet the requirement if the component is of particular value
to the patient - HLA matched donors.
4. Donors who have taken aspirin-containing medication within 3 days / 72 hours are deferred.
5. A complete haematological profile, including platelet count, should be done before all plateletpheresis
procedures, and platelet count and haemoglobin must be more than 150,000/μl and > 12.5 g/dl before starting
the procedure.
6. If extra plasma is collected and if the procedure is performed more than once in every 4 weeks, the procedure
should not be done if the total serum protein is less than 6.0 g/dl or if there has been an unexplained weight
loss.
7. Double unit apheresis can be taken in donors whose platelet count is more than 250,000/ul and weight more
than 60kg and those who are not first-time apheresis donors.
AABB GUIDELINES

8. PRINCIPLE
PARTS OF CENTRIFUGED BLOOD

9. THERAPEUTIC INDICATION
• For therapeutic procedure, the American Society for Apheresis (ASFA) delineates
plateletpheresis based on the acuity of the clinical presentation
◦ Symptomatic thrombocytosis: ASFA category II
◦ Prophylactic or secondary thrombocystosis: ASFA category III
DONOR
THROMBOCYTOPENIA DUE TO LEUKEMIA , APLASTIC ANEMIA , BONE MARROW TRANSPLANT
PLATELET DYSFUNCTION
NEWBORN&POST PARTUM BLEED
TRAUMA - SURGICAL CASES
AS A PART OF MASSIVE TRANSFUSION PROTOCOL

10. VASCULAR ACCESS
• Therapeutic procedure - central or peripheral
• Donor - peripheral preferred.
APHERESIS MACHINE
INTERMITENT FLOW CENTIFUGATION CONTINOUS FLOW CENTRIFUGATION

11. INTERMITENT FLOW CENTIFUGATION CONTINOUS FLOW CENTRIFUGATION

12. CHARACTERISTICS OF TUBING USED IN APHERESIS PROCEDURE
Heparin should be avoided as an anticoagulant because of its tendency to cause platelet clumping within the
apheresis circuit.

13. Platelet
Platelet

14. WHAT HAPPENS POST DONATION ?
•The typical platelet donor experiences a 20% to 29% drop in platelet count (Szymanski et al.,
1973; Heyns et al., 1985), with that among females typically being greater (Rogers et al.,
1995; Dettke et al., 1998).
•Glowitz & Slichter, 1980-In donors undergoing alternate-day collections, platelet count and
apheresis yields have been shown to return to baseline levels by day 10 of collection
PLATELET MOBILISATION FROM SPLEEN OCCURS
IMMEDIETLY MAINTAINING THE COUNT
MALE RETURN TO BASELINE PLT COUNT 4 DAYS
FEMALE INCREASE IN THROMBOPOIETIN
GREATER RECOVERY TIME THAN MALE/calcium level is low normally.

15. ROLE OF ACD IN APHERESIS PROCEDURE
SYMPTOMS OF HYPOCALCEMIA
CIRCUMORAL PARASTHESIA
NAUSEA
VOMITING
DIARRHOEA
TETANY
QT PROLONGATION IN ECG

16. COMPLICATIONS
• Citrate toxicity- mild -perioral tingling and paresthesias, chills, nausea, twitching, and
tremors. severe-carpopedal spasm, seizures, tetany, and cardiac arrhythmias.
• Vascular complications- sepsis,hematoma,phlebitis
• Vasovagal reaction- counselling & hydration.
• Hypovolemia
• Allergic reaction .
• Air embolism
• Depletion of clotting factors
• Transfusion transmitted infections

17. PLATELET PRODUCT REQUIREMENT
•Standards for Blood Banks and Transfusion Services require that the mini- mum
number of platelets in an apheresis product should be 3.0 × 1011 in 90% of units tested
(Standards Committee of the AABB, 2018).
•The U.S. Food and Drug Administration (FDA) requires a minimum of 3.0 × 1011 in 75%
of units tested (Code of Federal Regulations [CFR], 2014).
•The result of these requirements, however, is that an apheresis platelet product
contains at least as many platelets as a pool of platelets from six whole- blood
donations.

18. ADVANTAGES OF SDP
• Routinely, the number of platelets in an
apheresis product is equivalent to 6–8
random platelet concentrates.
• SDP has unique advantages
leukoreduced product, can be human
leukocyte antigen matched, and
platelet-antigen-compatible phenotypes.
• collect large numbers of platelets from
-fewer donor exposures for the patient.

19. ADVANTAGES OF SDP
The potential advantages of SDP that were considered included the following:
• Reduction of infectious complications- SEPTIC PLT TRANSFUSION REACTION DUE
TO BACTERIAL CONTAMINATION IN STORED PLT.
• Reduction of transfusion reactions;
• Ease of leukodepletion- CMV TRANSMISSION
• Reduction in transfusion frequency;
• Prevention of alloimmunization;
• Enhancement of platelet quality;
• Elimination of the need to pool WBDP in transfusion service. (Whole blood derived
platelet)
• SHELF LIFE -5 DAYS

20. RATIONALE
•The goal of therapeutic plateletpheresis in patients with acute thrombotic or
hemorrhagic disorders is reduction of the platelet count to a normal or near-normal
level (typically 400,000/μL); such a procedure can be expected to reduce the platelet
count by 30% to 60% .
• VOLUME : The current ASFA guidelines5
recommend processing anywhere from 1.5 to
2 total blood volumes (TBV), with the anticoagulant-to-blood ratio ranging from 1:8 to
1:12.

21. THERAPEUTIC
INDICATIONS
Thrombocytosis,
It is defined as a platelet count
exceeding 450,000 to
500,000/μL, may be caused by a
reactive process (second- ary
thrombocytosis) or by an
underlying clonal marrow
disorder (primary )

22. • Therapeutic plateletpheresis of patients can rapidly reduce an elevated platelet count
to help mitigate either thrombotic or hemorrhagic complications. Such short-term
reduction can provide symptomatic relief and a therapeutic bridge to the delayed
effects of cytoreductive therapy.

23. LEUKOCYTAPHERESIS

24. •STANDARD CRITERIA for granulocyte transfusion IS NOT ESTABLISHED:
•It is typically agreed on as the minimum necessary to proceed (Schiffer, 1990).
•These include:
1. A proven (by clinical testing) bacterial or fungal infection
2. No response to a trial of appropriate antibiotics/antifungals
3. Absolute neutropenia (<500 cells/μL)
4. A reasonable expectation of patient marrow recovery
Since their first infusion in 1964, GRANULOCYTE TRANSFUSION - adjunct to
antibiotic therapy in neutropenic patients with bacterial and/or fungal infections that are
otherwise refractory to treatment.

25. DONOR LEUKOCYTAPHERESIS
•leukocytapheresis donors must fulfill all of the
requirements applicable to whole-blood donation.
•150,000/μL platelet count requirement .
•ABO type of both recipient and donor should match.
•cytomegalovirus (CMV) status of the donor and
recipient .
• In alloimmunized patients, it is critical that HLA-
• crossmatch-compatible donors be selected.

26. GRANULOCYTE DONOR STIMULATION
1.administer steroids to donors 10 to 12 hours before collection -ORAL PREDNISOLONE
OR DEXAMETHASONE
? WHY - The effects of steroids appear to result from mobilization of granulocytes from
marrow stores as well as delayed granulocyte apoptosis .
2.granulocyte colony stimulating factor (G-CSF) -
Administration of 5 μg/kg of G-CSF every other day resulted in granulocyte
collections four to five times those seen in unstimulated donors and greater than those
seen with prednisone stimulation (Jendiroba et al., 1998).
The optimum timing for granulocyte collection -12 hours after administration of G-CSF

27. GRANULOCYTE PRODUCT
REQUIREMENT
The current adult collection dose requires that 75% of granulocyte components
collected have a minimum of 1.0 × 1010 granulocytes-(Standards Committee of the AABB,
2018).
granulocytes are stored at room temperature (20°C–24°C) without agitation and have an
expiration date of 24 hours (Standards Committee of the AABB, 2018)
EARLY TRANSFUSION SUGGESTED - APOPTOSIS OCCURS RAPIDLY IN
STORAGE PERIOD .

28. GRANULOCYTE COLLECTION PROCEDURE
• Red blood cells and granulocytes have similar densities and sedimentation rates,
resulting in poor separation during centrifugation .
• hydroxyethyl starch (HES )-The mechanism of action of HES is the induction of
rouleaux formation among red blood cells.

29. GRANULOCYTE DONOR
CONCERN
• granulocytes, platelets and significant numbers of red blood cells are present in the
leukocytapheresis product.
• The donor’s hematocrit typically drops by 7% following a granulocyte collection
(Hester et al., 1995).- loss of red blood cells& dilutional effects of volume expansion
caused by the HES.
• Platelet count typically drops by 22% after each procedure

30. SIDE EFFECTS OF PROCEDURE
• PROLONGED PLATELET RECOVERY.
• G-CSF SIDE EFFECTS-Nausea, vomiting ,headache,splenic rupture, anaphylaxis,
acute iritis, marginal keratitis, gouty arthritis, autoimmune thyroiditis, rheumatoid
arthritis exacerbaTion, thrombosis, erythema multiforme, acute lung injury, and
capillary leak syndrome .
• CORTICOSTERIODS side effects

31. HYPERLEUKOCYTOSIS
WBC count exceeding 50,000 to 100,000/μL,
may occur in acute or chronic leukemias of either myeloid or lymphocytic lineage.
WBC ARE MORE RIGID THAN WBC
MICROVASCULATURE OCCLUSIVE COMPLICATION
HYPERLEUKOSTASIS
ISCHEMIA
TUMOUR LYSIS SYNDROME
CHEMOTHERAPY RELEASE INTRACELLULAR TUMOUR CONTENTS
DIC
MULTI-ORGAN DAMAGE
THERAPEUTIC ASPECT :::

32. The use of an erythrocyte sedimenting agent such as hydroxyethyl starch (HES) to
enhance separation of immature and mature myeloid cells from red cells .

33. (APL- ACUTE PROMYELOCYTIC ANEMIA)
IN CHILDREN LESS THAN 10 ML , MANUAL BLOOD EXCHANGE IS PREFERABLE

34. CLINICAL APPLICATION OF Therapeutic Leukapheresis
The role of leukapheresis is to reduce the leukocyte concentration in the peripheral blood.
1. AML patients with HL-then leukapheresis offers the potential to decrease morbidity and
mortality by removing large quantities of these activated cells- CUTRTAILS THE RELEASE
OF INFLAMMATORY CYTOKINES & PROLIFERATION
2.Leukapheresis may also have an adjunctive role in chronic disorders characterized by
leukocytosis such as CML, CMML, and CLL - chemotherapy is contraindicated.
3.use of leukapheresis to avoid the teratogenic effects of chemotherapy in early pregnancy
when complicated by myeloproliferative disorders .

35. SELECTIVE LEUKOCYTE APHERESIS
This procedures the removal of more specific pathologic subsets
of leukocytes that may be relevant to the pathogenesis of clinical
disease, with the goal of modulating or suppressing the disease
process using specialized columns or filters to remove leukocytes
from whole blood
DEFINITION

36. TYPES
1. 2-stage filter composed of nonwoven polyester
fabric that removes leukocytes through filtration and
adhesion.
2.The efficiency of removal is related to the small
diameter (0.8 to 2.8 microns) of the inner filter fibers.
3.Remove about 99% of granulocytes and
monocytes and 40% to 60% of lymphocytes from
processed blood.35,36
4.USED IN Active ulcerative colitis and rheumatoid
arthritis
1.filter component consists of a column (335-mL
capacity) filled with 220 g of cellulose acetate
beads (2 mm in diameter) and immersed in 130
mL of isotonic saline.37
2.selectively adsorbs approximately 65% of
granulocytes and 55% of monocytes without
significantly adsorbing lymphocytes.38
3.treatment of Crohn disease, ulcerative colitis
(UC), rheumatoid arthritis, systemic lupus
erythematosus, and ocular Behçet disease, and in
Japan for ulcerative colitis.
leukocyte adsorptive apheresis system granulocyte/monocyte adsorptive apheresis system

37. CONCLUSION
• Clinical signs and symptoms arising from HL or thrombocytosis are variable and
unpredictable.
• Without specific laboratory assays to identify patients at risk for complications,
guidelines for therapeutic apheresis procedures to lower peripheral blood
concentrations of platelets and leukocytes may have to continue to rely on diagnosis,
clinical findings, and peripheral blood counts alone.

38. • CLAUDIA S COHN,MEGHAN DALANEY, AABB TEXTBOOK OF APHERESIS PRINCIPLES AND
PRACTICE - 20EDITION,PAGE NO-705-720
• MACKROO.R.N, PRINCIPLES &PRACTICE OF TRANSFUSION MEDICINE , SECOND EDITION,
CHAPTER 7
• TOBY L SIMON,JEFFERY MACCULOUGH, EDWARD ,ROSSI OF PRINCIPLES OF TRANSFUSION
MEDICINE-5TH EDITION
• NBEMS WEBINAR
• MAGRET DIGUARDO , ELEH BOBR,HENRYS CLINICAL DIAGNOSIS & MANAGMENT BY LABORATORY
METHODS , 24TH EDITION, CHAPTER-38,ELSEIVER
REFERENCES
Thank you

39. ERYTHROCYTOPHRESIS

40. RED CELL APHERESIS
This term particularly applies to the removal of red cells using
automated blood-processing instruments that are capable of
selectively removing erythrocytes while returning the plasma,
buffy coat cells, and additional isotonic saline to the patient
DEFINITION

41. DONOR SELECTION
• The FDA and the AABB do not define a minimum hemoglobin/hematocrit for double
red cell donation.
• The AABB limits the total volume of red blood cells removed, such that the donor’s
hematocrit and hemoglobin are not <30% and <10 g/ dL, respectively, after volume
replacement (

42. Erythrocytopheresis Product Requirements
• The Standards for Blood Banks and Transfusion Services - mean hemoglobin >60 g
or a packed red cell volume of 180 mL.
• 95% of the units sampled must have >50 g of hemoglobin or 150 mL packed red cell
volume (Standards Commit- tee of the AABB, 2018).
• If the red blood cell units are leukocyte reduced, then the mean hemoglobin must be
>51 g or 153 mL packed red cell volume. Here, at least 95% of tested units must have
>42.5 g of hemoglobin or 128 mL packed red blood cell volume (Standards
Committee of the AABB, 2018).

43. SICKLE CELL DISEASE
ASFA- CATEGORY I
-ability to rapidly reduce the burden of parasitemia
-reduce the level of toxic mediators such as cytokines.
- IMPROVED SURVIVAL OF RED CELLS
- malaria with parasitemia >10%.
-babesiosis with >5% parasitemia
MALARIA
ASFA CATEGORY-II
BABESIA
ASFA CATEGORY-II
INDICATIONS
POLYCYTHEMIA VERA
ASFA- CATEGORY I
-rapidly decrease hematocrit for extended intervals relative to simple phlebotomy
-acute thrombotic or microvascular complications
HEREDITARY
HEMOCHROMATOSIS
ASFA CATEGORY-I
-more rapid decline and normalization of ferritin;
--erythrocytapheresis procedure every two weeks and weekly whole blood phlebotomy
are equiv alent