presence of medication taken by blood donors in plasma for transfusion

Presence of medication taken by blood donors in plasma for transfusion

A. van Tilborgh, J. Wiersum, M. SchipperusD. TouwF. Hudig

3-6-2013 ISBT Regional Congress Amsterdam

http://www.hagaziekenhuis.nl/








• 70-year-old female patient, von Willebrand disease type II, with known allergies (plasters, barium contrast, fruit, penicillin?)

• Fractured collar bone

21/1 14.00 hrs start platelet transfusion, BP 160/71

21/1 14.10 hrs bronchospasm, glottis edema, urticaria, hypotension

• Tavegil and hydrocortisone: quick recovery (BP 180/90)

• No IgA deficiency

TRIP report: Anaphylactic reaction,imputability probable, severity grade 2


Case historie

TR severity grade 2 or higher 2008-2012

serious anaphylactic TR

serious TR


• Every year TRIP receives several reports like this one.• The category of anaphylactic reaction, defined as allergic reactions with systemic features such as airway obstruction, fall in blood pressure, vomiting or diarrhoea, accounts for the largest number of serious transfusion reactions.

• In most cases no cause is found for these reactions.

anaphylactic TR 2008-2012

RBCsplateletsplasmacombinationother (drain blood)Distributed blood components

Could some of these reactions be due to

medication taken by the donor?


• TRIP data show that anaphylactic reactions occur relatively frequently during or after transfusion of plasma or platelet concentrates. Most platelet units are also rich in plasma.

• Data from blood services show that approximately 10% or more of plasma donors use medication which is permitted under donation guidelines.


Thawed FFP rejected for transfusion sample 5 ml

This exploratory study investigated the presence of drugs or drug metabolites in donor plasma after quarantine, storage and thawing.

Only samples for which the blood supply organisation confirmed that the donor had consented to research use were included.





I-Tox screening

The samples were analysed for approximately 800 drugs or drug metabolites


3-6-2013 ISBT Regional Congress Amsterdam87 samples have been processed

All detectable substances that were recognised as drug or drugmetabolite were considered a positive screening result


87 samples

negative

positive 1 substance

postive 2 or 3 substances



73 (84%)

11 (13%)

3 (3%)87 samples

negative

positive 1 substance

postive 2 or 3 substances





What did we find?

The most prescribed drugs in The Netherlands in 2009/2010

• Metoprolol• Omeprazol (also OTC)• Acetylsalicylic acid (also OTC)

We expected that frequently prescribed drugs or over the counter drugs were most likely to be found in some of the donor plasma units.




Type of drug Name Freq Publication / FTK# Lareb$

Antidepressant(SSRI)

ParoxetineCitalopram

11 (C1*)

Antipsychotic PipamperonQuetiapine

1 (C1*)

1 (C1*)

Antihypertensive(ARB)

ValsartanTelmisartan

23 (C2*)

Ca channel blocker

Amlodipine 1 (C2*)

ß-blocker Metoprolol 1 (C2*)

Antidiabetic Glicazide 1

# Publication Yes – No / mentioned in FTK = Farmacotherapeutisch Kompas$ Lareb = Netherlands Pharmacovigilance center, number of reports in database

Anaphylactic reactions?

* C. = combination of medication





Type of drug Name Freq Publication / FTK# Lareb$

Antidepressant(SSRI)


11 (C1)

N /very rare(<0.01%)

Y / ? 96


1 (C1)

1 (C1)

N / ?N /sometimes (<1%)

-2



23 (C2)

N / ?N /rare (<0,1%)

31

Ca channel blocker

Amlodipine 1 (C2) N /very rare(<0.01%) 3

ß-blocker Metoprolol 1 (C2) N / - 9Antidiabetic Glicazide 1 N / - -

* C. = combination of medication# Publication Yes – No / mentioned in FTK = Farmacotherapeutisch Kompas$ Lareb = Netherlands Pharmacovigilance center, number of reports in database






Type of drug Name Freq Publication/FTK LarebAntidepressant(SSRI)


11 (C1)

- / very rare(<0.01%)

Y / ? 96


1 (C1)

1 (C1)

- / ?- / sometimes (<1%)

-2



23 (C2)

- /- / rare (<0,1%)

31

Ca channel blocker

Amlodipine 1 (C2) - / very rare(<0.01%) 3

ß-blocker Metoprolol 1 (C2) - / - 9Antidiabetic Glicazide 1 - / - -PPI (OTC) Omeprazol 1 Y / rare (<0,1%) 16NSAID (OTC) Naproxen 4 Y / rare (<0,1%) 50






Type of drug Name Freq Publication/FTK LarebAntidepressant(SSRI)


11 (C1)

- / very rare(<0.01%)

Y / ? 96


1 (C1)

1 (C1)

- / ?- / sometimes (<1%)

-2



23 (C2)

- /- / rare (<0,1%)

31

Ca channel blocker

Amlodipine 1 (C2) - / very rare(<0.01%) 3

ß-blocker Metoprolol 1 (C2) - / - 9Antidiabetic Glicazide 1 - / - -PPI (OTC) Omeprazol 1 Y / rare (<0,1%) 16NSAID (OTC) Naproxen 4 (C3) Y / rare (<0,1%) 50Anabolic steroid Metenolon 1 (C3) - -Preservative Methylparaben 1 Y -

http://www.lareb.nl/LarebCorporateWebsite/media/publicaties/Anafylactische-reacties-op-NSAID-s.pdf

Non-allergic anaphylaxis







Conclusions

• It is possible to detect medication in donor plasma after freezing, quarantine, storage and thawing

• It cannot be excluded that medication taken by the donor in plasma for transfusion could cause an anaphylactic reaction in the recipient






Any questions?

[email protected]

Acknowledgements to:Annet van Zijl, KCHL Haga ZiekenhuisVeronica Rodriguez, Apotheek Haagse ZiekenhuizenSanquin blood supply organisationEugène van Puijenbroek, Lareb

presence of medication taken by blood donors in plasma for transfusion

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