why special blood products?

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Salwa Hindawi Salwa Hindawi MSc, FRCPath, CTM Director of Blood Transfusion Services kAUH, Jeddah Saudi Arabia ESPHO Cairo 2008

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Why Special Blood Products?. Salwa Hindawi MSc, FRCPath, CTM Director of Blood Transfusion Services kAUH, Jeddah Saudi Arabia ESPHO Cairo 2008. Introduction. - PowerPoint PPT Presentation

TRANSCRIPT

Page 1: Why  Special Blood Products?

Salwa Hindawi

Salwa Hindawi MSc, FRCPath, CTM

Director of Blood Transfusion ServiceskAUH, Jeddah

Saudi Arabia

ESPHO Cairo 2008

Page 2: Why  Special Blood Products?

Salwa Hindawi

Despite general measures to ensure transfusion safety, there still an added risk to infants and children with underlying hematological, oncologic and immunologic disorders.

Transfusion reaction may be caused by both infectious or non infectious processes.

Special products are blood components collected, processed, and selected specifically to minimize these complications.

Page 3: Why  Special Blood Products?

Salwa Hindawi

CMV is transmitted by leucocytes.

The use of CMV-seronegative blood components has been shown to reduce the incidence of CMV infection to 1-3%.

Page 4: Why  Special Blood Products?

Salwa Hindawi

Patients with congenital immunodeficiency disorders AIDS (human immunodeficiency virus infection) patients Hematopoietic progenitor cell transplant recipients Organ allograft transplant recipients Premature infants during infancy Cancer patients undergoing intense chemotherapy Recipients of intrauterine transfusions

Page 5: Why  Special Blood Products?

Salwa Hindawi

Leucocytes in the blood components can lead to many complications

Universal Leucodepletion verses specific indications.

Page 6: Why  Special Blood Products?

Salwa Hindawi

Nonhemolytic transfusion reactions (commonly called “febrile nonhemolytic transfusion reactions”)

Alloimmunization to HLA Class I antigens

Cytomegalovirus infections

Immune modulation

Graft-vs-host disease

Page 7: Why  Special Blood Products?

Salwa Hindawi

WHY? To Prevent Graft verses Host Disease mediated by T

lymphocytes in units of Packed RBCs, Platelets, and Granulocytes.

Blood components that contain viable lymphocytes

may be irradiated to prevent proliferation of T lymphocytes, which is the immediate cause of GVHD.

The standard dose of gamma irradiation is 2500 cGy , maximum allowable dose is 5000cGy.

Page 8: Why  Special Blood Products?

Salwa Hindawi

Patients with congenital immunodeficiency disorders of cellular immunity.

Intrauterine transfusion and neonatal exchange transfusion recipients.

Hematopoietic progenitor cell transplant recipients.

Recipients of blood components from 1st & 2nd degree relatives.

Page 9: Why  Special Blood Products?

Salwa Hindawi

Patients receiving HLA-matched cellular blood components.

Patients with hematologic malignancies and Cancer patients

undergoing intense chemotherapy or Hodgkin’s disease receiving fludarabine.

Page 10: Why  Special Blood Products?

Salwa Hindawi

Sickle cell trait:

Hb A = 60%

Hb S = 40%

Hypoxia and acidosis can lead to sickle crisis.

Can donate blood.

Page 11: Why  Special Blood Products?

Salwa Hindawi

Define patients populations who should receive red blood cells known to lack hemoglobin S.

1- infants with small blood volume or massive transfusion in neonates.

2- Sickle cell patients

Page 12: Why  Special Blood Products?

Salwa Hindawi

The risk of:

Bacterial contamination

Emerging pathogens

are still a major concerns which lead to the need for better techniques.

PI for platelet concentrates have been in routine use since 2002 and for plasma in 2006 (INTERCEPT blood system).

A noval PI approach to blood safety (the Mirasol PRT System).

Page 13: Why  Special Blood Products?

Salwa Hindawi

Nucleic acid targeted pathogen inactivation technologies offer the potential to protect from infectious and non infectious processes through prevention of cell replication and transcription.

To accurately assess the true value of a pathogen reduction system it is essential to weigh its cost against the saving it offers in terms of quality of life and reduced cost to society.

Page 14: Why  Special Blood Products?

Salwa Hindawi

Reduction of viruses, bacteria, parasitesInactivation of residual white cells

MIRASOL PRT system for platelets

and plasma – Concept

+Riboflavin

(Vitamin B2)UV Light

Platelet or plasma product

+

Page 15: Why  Special Blood Products?

Salwa Hindawi

The MIRASOL PRT process:

Transfer platelet product to MIRASOL

Illumination bag

1 2

Add 35 mL Riboflavin Solution

(500 uM)

3

Illuminate product for

6-10 min*.

*Illumination time depends on product volume

Page 16: Why  Special Blood Products?

Salwa Hindawi

delayed clamping of the umbilical cord;

restricting blood sampling

using recombinant human erythropoietin to stimulate erythropoiesis

using iron supplementation or vitamins to minimize the severity of anemia

Page 17: Why  Special Blood Products?

Salwa Hindawi

using appropriately collected and stored multipack RBC units

using appropriately screened and handled RBCs from regular or designated donors; and

collecting and transfusing umbilical cord

blood (autologous blood transfusion).

Page 18: Why  Special Blood Products?

Salwa Hindawi

The use of special products is a must for specific patients in pediatric age group to ensure safety.

The use of PI procedures are recommended to ensure better safety.

Training for the staff, policies, and guidelines in pediatric age group are important issues to be considered.

Page 19: Why  Special Blood Products?

Salwa Hindawi

Pediatric Transfusion, A Physician’s handbook 2nd Edition, 2006. Prenatal and childhood transfusion, Practical

Transfusion Medicine 2001. A novel Approach to blood safety, Gambro BCT 2007. Impact of Pathogen activation on platelets utilization

during 3 years of routine use, AABB October 2007. Pathogen Inactivation making decisions about new

technologies preliminary reports of a consensus conference, Vox Sanguinis 2007.

Page 20: Why  Special Blood Products?

Salwa Hindawi