Index

Clinical Guidelines for the Use of Blood Products in SA, 5th Edition Page 2

A Comparison Between Pooled and Single Donor Platelets Page 2

Revised Cross-match Laboratory Request Form Page 5

Your Questions Answered Page 5

Events Diary Page 6

Dear Life Blood Reader

Welcome to the 22nd Edition of Life Blood.

The World Health Organisation EVD (Ebola Virus Disease) updates have not indicated spread to sub-Saharan Africa. In light of this, WPBTS is continuing to rely on its deferral policy for donors who travel to malaria areas as this encompasses donations from individuals who have grown up in or travelled to an Ebola prevalent area. The National Guidelines for Issuing Blood to Viral Haemorrhagic Fever and Ebola Cases can be found in the previous edition of Life Blood.

The 5th Edition of the Clinical Guidelines for the Use of Blood Products in South Africa has been released for distribution to hospital clinical staff. Its aim is to provide useful basic information about blood products available to clinicians in South Africa and brief guidelines for their optimum use.

Other news featured in this edition is a comparison of platelet products, how to refer patients for therapeutic phlebotomy, the revised Cross-match Laboratory Request Form, and notice of the upcoming WPBTS 2015 Educational Seminar, the 33rd SA National Blood Transfusion Congress and the International Plasma Fractionation (IPFA) Workshop which are to be held in March, August and December 2015, respectively.

Feel free to contact us should you have any queries.

Regards

Hayley AlieMarketing Officer

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Issue 22Life Blood

Dr Caroline HiltonTransfusion Medical Specialist

Issue 22Life Blood

Clinical Guidelines for the Use of Blood Products in South Africa, 5th Edition

In January 2015, the 5th Edition of the Clinical Guidelines for the Use of Blood Products in South Africa, was released for distribution to hospital clinical staff. The Guidelines are jointly published by the Western Province Blood Transfusion Service (WPBTS) and the South African National Blood Service (SANBS). Its aim is to provide useful basic information about blood products available to clinicians in South Africa and brief guidelines for their optimum use. I wish to take this opportunity to acknowledge Adcock Ingram Critical Care as the proud sponsors of the booklet and convey our heartfelt thanks and gratitude to them for their support.

Notable changes in the 5th Edition are the inclusion of two new chapters which cover the management of massive blood loss, and HIV/AIDS and blood transfusion. A new section about transfusion-related immunomodulation, has also been added.

It is our aim that one copy of the booklet be kept in every ward using blood products – preferably at the nurse’s station. The PDF version of the Guidelines is available on the WPBTS website.

Please note that a few booklets may have missing and/or duplicated pages. Feel free to contact the WPBTS Marketing Officer should you require a new or replacement copy.

Hayley Alie, WPBTS Marketing Officer Telephone 021 507 6326, Cellphone 083 454 3455, Fax 086 756 7888, E-mail marketing@wpbts.org.za

A Comparison Between Pooled and Single Donor PlateletsClinical Indications for Platelet TransfusionsThe indications for platelet usage are summarised below. Refer to the Clinical Guidelines for the Use of Blood Products in SA, 5th Edition, Chapter 4 for more information.

Platelet transfusions are indicated for the prevention and treatment of bleeding in patients with thrombocytopenia or platelet function defects. The cause of the thrombocytopenia should be established before a decision is made to transfuse platelets since not all causes of thrombocytopenia are responsive to platelet transfusion and may even be contraindicated in some conditions.

• Bone marrow failure: Therapeutic platelet transfusions, prophylactic platelet transfusions, acute leukaemia, haemopoietic stem cell transplantation, chronic stable thrombocytopenia

• Prophylaxis for surgery: Lumbar puncture, epidural anaesthesia, gastroscopy and biopsy, insertion of indwelling lines, transbronchialbiopsy, liver biopsy, laparotomy or similar procedures

• Massive transfusion• Disseminated intravascular coagulation (DIC)• Cardiopulmonary bypass (CPB)• Liver transplantation• Immune thrombocytopenias: Autoimmune thrombocytopenia, neonatal alloimmune thrombocytopenia (NAIT), post transfusion purpura

Platelet transfusions are contraindicated in autoimmune thrombocytopenia, Thrombotic Thrombocytopenic Purpura (TTP) and in Heparin Induced Thrombocytopenia (HIT).

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Collection and Processing Methods

Pooled platelets are obtained from 5 or more individual whole blood donations, which are bled within 12 minutes, from donors who have not taken aspirin or anti-inflammatories within the past 7 days.

After collection, the whole blood is centrifuged and the buffy coat layer, which is rich in platelets and leucocytes, is separated. The individual buffy coats are pooled into one bag and the plasma from one of the donations in the pool is added up to a set volume.

The pool is then centrifuged and the platelets and plasma are removed by separation. Leucocyte reduced pooled platelets are produced on request, by filtering the final pooled platelet product.

Single donor platelets are harvested from individual platelet donations, from donors who have not taken aspirin or anti-inflammatories within the past 7 days, using the Haemonetics MC3P and the Cobe Trima machines, at our Apheresis Platelet Donation Unit. This is situated at our headquarters in Pinelands, Cape Town. The procedure takes about 90 minutes.

The platelets are collected by the donor blood passing through a continuously spinning centrifuge, where the platelets are removed and collected, after which the remaining plasma and red cells are returned to the donor. The process undergoes simultaneous leucodepletion.

Infant and paediatric single donor platelets are produced by splitting the individual donation into smaller volumes according to the platelet count and volume of the original product. These platelets are leucocyte depleted.

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Product Array

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Pooled Platelet Adult Single Donor Apheresis Mega-Platelet

Platelet Count

Volume

≥ 2.4 x 1011

± 300 ml

Platelet Count

Volume

≥ 2.4 x 1011

250 ml ± 50 ml

Leucocyte Reduced Pooled Platelet Paediatric Single Donor Apheresis Mega-Platelet

Platelet Count

Leucocyte Count

Volume

≥ 2.4 x 1011

≤ 5 x 106/unit

250 ± 50 ml

Platelet Count

Volume

≥ 1.5 x 1011

150 ml ± 50 ml

Infant Single Donor Apheresis Mega-Platelet

Platelet Count

Volume

≥ 5.5 x 1010

50 ml ± 10 ml

The Benefits of Single Donor Platelets

• The complete platelet dose is derived from a single donor.• Reduced donor exposure for the patient.• Reduced risk of alloimmunisation to HLA antigens.• Product is integrally leucocyte depleted.• Minimal product intervention.

Ordering Platelets

Pooled platelets are processed daily (weekdays) and stocks are distributed to the Blood Banks, ensuring that they are readily available on request.

Single donor platelets are collected from the donor after the clinician has requested the platelets from the Blood Bank or our Apheresis Platelet Donation Unit. These platelet requests should be ordered by 12h00 on weekdays to ensure that the fully tested platelet product is available the same evening. A limited emergency supply is kept for after-hours usage on weekends and public holidays.

The clinician should clearly indicate whether the platelet product should be HLA-matched, gamma-irradiated, leucocyte reduced, is for designated donation or autologous transfusion.

Price Comparison

Because platelet products have a short expiry i.e. 5 days, and incur high collection/processing costs, the Blood Service must carefully manage the stocks in order to prevent wastage. Single donor platelet products cost 10% more than their comparative product i.e. leucocyte reduced pooled platelets. A separate fee is charged for gamma-irradiation of products and designated/autologous platelet collections and the cost of the platelet search which is performed by the SA Bone Marrow Registry.

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Revised Cross-match Laboratory Request Form

As of October 2014, the revised WPBTS Cross-match Laboratory Request Form has been phased in. It is imperative that the form is completed accurately and that all sections are filled in.

The top five rules for completing the Request Form are as follows.

1. The patient’s particulars must be filled in accurately.2. Every sheet must contain all the patient’s particulars.

When using the patient sticker, please check that there are no other patient stickers on the form.

3. The requesting doctor’s name must be filled in. 4. The phlebotomist’s name and signature, as well as

the date and time that the specimen was taken, must be completed.

5. The hospital name and ward must be provided.

The Cross-match Laboratory Request Form is available from your nearest Blood Bank.

Your Questions Answered

How do I refer patients with elevated iron levels or polycythaemia to donate blood?

This is a reminder to clinicians that all patients who are required to donate blood for medical reasons should be formally enrolled in the WPBTS

therapeutic phlebotomy programme.

It is not appropriate to advise your patient to donate blood without informing WPBTS, as we need to ascertain whether their blood is safe

for use in our general supply. It is not suitable to use blood from patients with elevated iron levels secondary to malignancy, autoimmune disease

or undiagnosed inflammatory conditions. Similarly, the blood from patients with polycythaemia vera or high affinity haemoglobin abnormalities

should not be given to others.

If you would like to refer a patient to our service for venesections for a medical reason, please contact the therapeutic clinic at

phlebotomy@wpbts.org.za or (021) 507 6393/48. You will be required to complete a referral form and supply necessary blood results. If

you suspect your patient has hereditary haemochromatosis, genetic testing should be performed. Blood from haemochromatosis patients

can be used to make blood products, provided that there is no significant liver function enzyme derangement. JAK-2 testing results

should also be supplied if the patient is diagnosed with polycythaemia vera. The causes of secondary iron overload or polycythaemia

must please be stipulated on the referral form in order to expedite enrolment of the patient. The referral will be reviewed by the WPBTS

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Therapeutic Phlebotomy Clinic Particulars

Head OfficeWednesdays (08h00-14h30)Tel: 021 507 6393/48, Fax: 021 531 3335Old Mill Road, Pinelands, 7405, Cape Town

Regional OfficesPaarlThursdays (10h00 – 19h30) Tel: 021 871 1030 263 Main Road, Paarl

WorcesterTuesdays (09h00 – 19h45)Tel: 023 342 245026 Napier Street, Worcester

GeorgeWednesdays (12h00 – 19h00) & Fridays (10h00 – 15h00)Tel: 044 874 2074Medical Centre, Courtenay Street, George

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doctor and if accepted, the patient will be contacted to book their first visit. Please note that people with severe comorbid disease

will not be allowed to donate at our service as there is not adequate medical support for unstable patients, so these people should

be venesected in hospitals or doctor’s rooms. The first blood donation will take place at our therapeutic phlebotomy clinic situated

at our head office (Pinelands) or regional offices (Paarl, Worcester, George). The patient will be charged for the first donation.

If the patient copes well with the donation and there are no problematic co-morbid diseases (eg. insulin dependent diabetes, significant

cardiac disease), they can donate at regular clinics thereafter. Subsequent donations are free of charge provided the patient’s blood can be

used in the general blood supply. If their blood cannot be used due to the underlying condition or use of contraindicated medications (eg.

Warfarin), they will be charged for each donation. Clinicians who refer polycythaemic patients are provided with full blood count results at

every donation in order to guide the patient’s bleeding schedule. It is advised that the ferritin level is checked after every sixth donation for

hyperferritinaemic patients in order to determine how often they should be venesected.

For further information or queries, please contact Dr Caroline Hilton (caroline@wpbts.org.za) or the therapeutic clinic team

(phlebotomy@wpbts.org.za).

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Events Diary You are warmly invited to join us for the following events where we’ll keep you up to date with the latest developments in blood transfusion. Please diarise and register now!

WPBTS 2015 Educational SeminarTheme: Blood TransfusionWhere: WPBTS Auditorium, Old Mill Road, Pinelands, 7405When: Saturday, the 28th of March 2015Time: 08h00 until 13h00Cost: Free of chargeClick here for the invitation flyer

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33rd SA National Blood Transfusion CongressTheme: Conserving Precious Resources – from Donor to Patient Where: Champagne Sports Resort in the DrakensbergWhen: 24th until the 27th of August 2015Please feel free to visit the Congress Website (http://www.sabloodcongress.org/) for more information.

On behalf of the International Plasma Fractionation Association (IPFA), I am pleased to bring to your attention their workshop on “Improving Access to Plasma and Plasma Products in the Southern African Region”, which is to be held on 1-2 December 2015 in Stellenbosch (Cape Town), South Africa. This Workshop reflects IPFA’s priority goal and actions to help increase the global supply of plasma for fractionation and will build on IPFA’s traditions of open and inclusive discussions between all stakeholders who may have an interest in and/or responsibility for meeting the increasing need for plasma derivatives in the Southern African Region.

International Plasma Fractionation Association (IPFA) Workshop Theme: Improving Access to Plasma and Plasma Products in the Southern African RegionWhere: Spier Hotel and Conference Centre, StellenboschWhen: 1st until the 2nd of December 2015Please feel free to visit the IPFA Congress Website (www.ipfa.nl) for more information.Click here for the announcement flyer