Microsoft Word - article 3_3 - MB Research article Distribution of Mega-Platelet Units (Platelet Apheresis) During Four Years at Blood Bank and Transfusion Center LUMHS Hyderabad Faheem Ahmed Memon, Khalid Yousaf, Abdul Rehman and Ali Raza Department of Pathology LUMHS Jamshoro/Diagnostic and Research Laboratory LUMHS Hyderabad. Received: 7 May 2019 Revised: 24 July 2019 Accepted for publication 9 August 2019 Correspondence: Faheem Ahmed Memon, Department of Pathology LUMHS Jamshoro/Diagnostic and Research Laboratory LUMHS Hyderabad. E-mail: drfamemon@hotmail.com This article may be sighted as: Memon FA, Yousaf K, Rehman A, Raza A. Distribution of Mega-Platelet Units (Platelet Apheresis) During Four Years at Blood Bank and Transfusion Center LUMHS Hyderabad. LMRJ. 2019; 1(3): 55-57. Doi: 10.38106/LMRJ. 2019.1.3-3 Abstract The transfusion of constituents drawn from human blood strengthens up-to date medicine. But, transfusion is not devoid of hazards. Platelet transfusions are rising more speedily than the transfusion of other parts. Single-donor apheresis clusters are spent favorably commonly known as single donor platelet procedure; blood is obtained from a donor in anticoagulant solution. Benefit of solo provider platelets upon shared donor platelets are of decreased hazard of bacterial infection. To determine the distribution of platelet concentrates from healthy donors to various units of LUH Hyderabad. This cross sectional and descriptive study was done at Blood bank and transfusion center, Diagnostic and research (D&R) Laboratory LUMHS Hyderabad from March 2012 to February 2016. Platelet apheresis was processed in 691 healthy males; age between 21 to 45 years. Apheresis was done by cell separators (Fresenius Hemo Care GmbH, Germany and Trima accel United States). And were distributed in different units of Liaquat University Hospital, Hyderabad, i.e. Oncology 176(25.47%), Medicine 169 (24.45%), Surgery 126 (18.23%), Gynecology and Obstetrics 115 (16.64%), Intensive Care Unit (ICU) 61 (8.82%), Casualty 44 (6.36%). Reviewing of blood component’s demand is an effective workout to decrease the figure of inapplicable transfusions, given the threats of transfusions despite progresses in preparing them harmless. KEYWORDS: Platelet apheresis, Transfusion, Distribution, Units. Introduction The transfusion of constituents drawn from human blood strengthens up-to date medicine, But, transfusion is not devoid of hazards1. Platelet transfusions are rising more speedily than the transfusion of other parts. Single-donor apheresis clusters are spent favorably2, commonly known as single donor platelet procedure; blood is obtained from a donor in anticoagulant solution. Platelets suspended in plasma are retained as end product and the remaining constituents i.e. red blood cells and plasma are returned to the donor. A single unit of platelet collection manufactured from a unit of entire blood contains, on the average, 7.5 x 1010 platelets and must rise the platelet tally by 5 to 10 x 109/L (5,000 - 10,000/mL) in a 70 kg beneficiary. Apheresis platelet assembles normally contain 3 - 6 x 1011 platelets, subject on compendium preparation. Therefore, 6-times more platelets can be collected at one time through the apheresis than through whole blood donation. Benefit of solo provider platelets upon shared donor platelets are of decreased hazard of bacterial infection3. Today 50% to 80% of patients with leukemia are given platelet apheresis. Indications For Platelet Transfusion: Leukemia, Aplastic Anemia, AIDS, Hyper-spleenism, Sepsis, Bone Marrow Transplant, Radioactivity treatment, Organ Transplant, Cardio-pulmonary by pass and Dengue Fever. Purpose/Objectives: To determine the distribution of platelet concentrates from healthy donors to various units of LUMHS Hyderabad. Material and Methods: This cross sectional and descriptive study was done at Blood Bank and Transfusion Center Diagnostic & Research Laboratory, LUMHS Hyderabad, Samples were collected from 691 fit and fine first time voluntary and alternate platelet apheresis donors age between 21 to 45 years from March 2012 To February 2016, Details of platelet apheresis were described to each donor who gave due consent earlier the process. Donors were selected based on the criteria: weight more than 50 kg, as a minimum 3 months from last whole blood donation or 3 days from previous platelet apheresis, hemoglobin above 12.5 gm/dl, platelet count above 200 x 103/cmm, absence of any illness, no any intake of © 2019 LMRJ Liaquat Medical Research Journal, 2019, 1, 3 55 non-steroidal anti-inflammatory drugs for last 7 days, Not taken Aspirin for last 72 Hours, negative viral profile i-e HIV, HBV, HCV, Syphilis and Malaria, ABO identical donor for the patient and adequate venous accesses and with Request Receiving Protocol as: Patient Name, Ward/Bed # and Arrange One Mega Unit. Donor-cell separator choice was depend on the availability of a specific separator at the time of the procedure. Procedure was performed on following cells separators platelet apheresis machines: 1. Fresenius separator (COM.TEC), DN (Fresenius Hemo Care GmbH, Bad Homburg V.D.H, Germany) 2. Trima accel Automated Blood collection System Result A total of 691 donors were there and platelet apheresis were used in the following departments4 of attached Liaquat University Hospital Hyderabad. No Department No Of Plateletpheresi s Percentag e 01 Medicine 169 24.45% 02 Oncology 176 25.47% 03 Surgery 126 18.23% 04 Gynaecology and Obstetrics 115 16.64% 05 Emergency Room 44 6.36% 06 Intensive Care Unit (ICU) 61 8.82% Total 691 100% Distribution 61 Medicine LMRJ the unnecessary use of donor blood in clinical practice. This study revealed that platelet apheresis for obtaining platelet concentrates can be used in many clinical situations. Transfusing patients with thrombocytopenia to sophisticated platelet counts has several prospective benefits; as one of the probable advantage is to diminish the frequency of hemorrhagic situations. Attention should also be given to the long-lasting sustainability of Platelet manufacturing systems, especially given the extraordinary per unit costs, a consideration of the blood service’s need to regain an increasing percentage of charge8. One important benefit of platelet apheresis is that no further supervision is required for the outcome to be labeled as ‘leukoreduced’. Leukocytes must be <5 × 106 per concentrate corresponding to USA standards and <1 × 106 per concentrate according to European standards9. One of the negative point is that Platelet concentrates have the shortest expiry time of all routine blood components; and they are also associated with risk of bacterial growth particularly beyond the shelf life of 5-day. As demand for platelet transfusions is continuing increasing, donor availability poses a major challenge for blood banks. For that ideal managing of platelet supply, a close relationship between clinicians, blood banks and transfusion specialists is compulsory10. Comparative Studies A study conducted by Trivo et al7 in INDONESIA used 204 Platelet apheresis from 2009-2013 in oncology department in another study by John P. Pitman et al8 in NAMABIA used 771 Platelet apheresis from 2006-2011 in oncology department. A local study conducted at ISLAMABAD by Samina Tufail Amanat et al3 used 200 Platelet apheresis from 2010-2014 in Dengue fever while a study in trauma center of INDIA by Arulselvi S et al4 used 950 Platelet apheresis in only one year. 126 Discussion 169 176 Oncology Surgery Gynae & Obs ER ICU Limitations There is no stock available due to high cost and shelf life, Non availability of volunteer’s donors, dependent only patient’s donor don’t know the actual requirement of platelets in wards. Conclusion The platelet apheresis procedure is considered relatively safe. However, several complications may occur. It forms an important adjuvant to blood bank inventory. It is also useful Platelet apheresis is practiced all over the world. Platelet manufacture must comprise widespread guidance of clinicians (on proper component use) as it is an invasive procedure, but it requires a greater dedication to the donor because of the prolonged duration of the procedure as compared to whole blood collection. The primary goal of platelet transfusion is to ensure that it is done safely and used appropriately for specific clinical condition, thereby avoiding in wide variety of clinical situations; the need of platelet concentrates obtained from single donors by apheresis is growing5. Transfusing patients with thrombocytopenia to sophisticated platelet counts has several prospective benefits; as one of the probable advantage is to diminish the frequency of hemorrhagic conditions. Results of this study we praise that apheresis donors should be observed for post-donation haematological issues. Donors © 2019 LMRJ Liaquat Medical Research Journal, 2019, 1, 3 56 LMRJ with noteworthy decrements should be reviewed successively to exclude or, if necessary, treat properly. The generation of high-dose apheresis concentrates has financial associations for transfusion services and blood centers. Thus, in end, sensible execution of guidelines for the use of various blood products may help decrease unsuitable use of blood constituents and guarantee their availability to larger number of needy patients as well. Knowledge and teaching amongst all those considering patients would go a long way in bringing the percentage of appropriate transfusion to nearly 100%. Auditing of blood order is a productive practice to minimize the number of inappropriate transfusions, given the risks of transfusions despite advances in making them safe6. Acknowledgment Donors, Patients and Technical Staff of Diagnostic & Research laboratory, LUMHS. References 1. William N Schofield, George L Rubin and Mark G Dean Appro- priateness of platelet, fresh frozen plasma and cryoprecipitate trans- fusion in New South Wales public hospitals MJA Vol 178 3 February 2003 2. Lawrence T. Goodnough, David J. Kuter, Jeffrey McCullough, Sherrill J. Slichter, John DiPersio, John Romo, Randolph Peterson, Kenneth J. Smith, Thomas Raife, Dianne Tomita, and Susan Armstrong Prophylactic platelet transfusions from healthy aphere- sis platelet donors undergoing treatment with thrombopoietin Blood, 1 September 2001 Z Volume 98, Number 5 3. Samina Tufail Amanat1, Huma Abdul Shakoor1, Masooma Raza1, Nadeem Khan2 and Abdul Rauf2 Clinical Indications and Adverse Reactions of Platelet Apheresis Journal of the College of Physicians and Surgeons Pakistan 2015, Vol. 25 (6): 403-406 4. Arulselvi S, Rangarajan K, Sunita S, Misra M C Blood transfusion practices at a level one trauma centre: a one-year retrospective review Singapore Med J 2010; 51(9): 736 5. Stefano Fontanaa Peter Kellerb Behrouz Mansouri Taleghanib Platelet Recruitment during Multiple Donor Platelet Apheresis Differs between Cell Separators Transfusion Medicine and Hemotherapy 2011; 38:195–198 6. Minal Wade · Ratna Sharma · Mamta Manglani Rational use of blood components – an audit Indian J Hematology Blood Transfusion 25(2):66–69 Indian Society of Hematology and Trans- fusion Medicine 2009 7. Trivo et al J Clin Apher 2015 Jun;30(3):139-40. doi: 10.1002/j- ca.21350. Epub 2014 Aug 12 8. John P. Pitman1,7, Sridhar V. Basavaraju1, Ray W. Shiraishi1, Robert Wilkinson2, Bjorn von Finckenstein2, David W. Lowrance4, Anthony A. Marfin1, Maarten Postma6,7, Mary Mataranyika3, and Cees Th. Smit Sibinga5 Namibia’s transition from whole blood–derived pooled platelets to single-donor apheresis platelet collections Author manuscript Transfusion. Author manuscript; available in PMC 2015 October 15. 9. Fevzi Altuntasa Ismail Sarib Ismail Kocyigita Leylagul Kaynara Sibel Hacioglub Ahmet Ozturkc Mehmet Oztekina Musa Solmaza Bulent Esera Mustafa Cetina Ali Unala Comparison of Plateletpheresis on the Fenwal Amicus and Fresenius Com.Tec Cell Separators Transfus Med Hemother 2008;35:368–373 10. Andreas Holbroa, Laura Infantia, Jörg Sigleb, Andreas Busera Platelet transfusion: basic aspects Swiss Med Wkly. 2013;143:w13885 © 2019 LMRJ Liaquat Medical Research Journal, 2019, 1, 3 57