LOGO In the Name of GOD. LOGO مصرف پلاکت و فرآورده های پلاسمائی...
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Transcript of LOGO In the Name of GOD. LOGO مصرف پلاکت و فرآورده های پلاسمائی...
LOGO
و پلاکت مصرفپلاسمائی های فرآورده
خرداد 1393شیراز
آذرکیوان آزیتا دکتر
هماتولوژی تخصص فوق کودکان؛ انکولوژیمتخصص
Blood Products
حجم با کامل سی 450خون سیخونی های فرآورده و شده سانتریفیوژ
شوند می مشتق آن از
گلبول قرمز
متراکم
پالکت
پالسما
Platelets
Platelets:Storage Controlled room temperature (20 – 24 oC).
Platelets must be stored on a special agitator rack to prevent themaggregating.
Shelf life 5 days from date of donation.Each bag of platelets has an expiry date – expires at midnight ofthe date shown.
Volume (mls):PooledApheresis
Locally defined nominal volume rangeMean volume 310mlsMean volume 220mlsNB Neonatal packs available – mean volume 55mls
Compatibility testingrequirement
Preferably ABO identical with the recipient / patient.Rhesus negative females under the age of 45 years should begiven Rh D negative platelets.
NB Platelets must never be refrigerated as this causes them to irreversibly aggregate.Platelets must be kept away from direct heat or sunlight as temperatures above therecommended range may cause rapid proliferation of bacteria.
8
Platelet
Random donor Platelets
Whole blood 1 unit
Platelet Concentrate 1 unit
> 5.5 x 1010 platelets in 50-70 ml of plasma
3 days
Single donor platelets
1 Donor
Platelet concentrate
> 3 x 1011 platelets in
~ 300 ml of plasma3 Days
Platelet Threshold For plt Tx
Platelet count 100’000/μl in pt who need
Surgery or unstable condition
Platelet count 50’000/μl in pts who need
invasive lab. Procedure
Platelet count 50’000/μl in pts With Active
bleeding
Platelet Dysfunction with manifested bleeding
Platelet Tranfusion In The Domain of bleeding disorders : Platelet Transfusion needs just in the field of
Congenital platelet Dysfunction They need chronic platelet tx, BUT there is the
risk of p.refractoriness So it is better to tx p. just on bleeding threatening life ,
If there is possible use from alternative drugs such as antifibrinolytic drugs
It is better to have some HLA matched donor platelets
Platelet RefractorinessDefinition Failure to achieve the expected platelet increment after 2 successive platelet transfusions Corrected count Increment (CCI)
(post tx plt ct- pre tx plt ct) = BSA X
No of plts transfused (1011)
1hr Increment is <7500 or <4500 at 24 hrs
DefinitionPlatelet refractoriness: Inappropriately low increment in
platelet count following a transfusion.Formula to determine platelet response:
1 hour Increment < 5,000-7,500. Corrected Count Increment (CCI):
• Expected > 7500 at 10-60 minutes or >4500 at 18-24 hours.
Less than predicted platelet increment on 2 occasions:• Fresh platelets: < 72 hours. • ABO compatible.
Low Post-transfusion Platelet Increment
1 hour post (platelet recovery) poor platelet alloantibodies platelet autoantibodies hepatosplenomegaly
24 hour post (platelet survival) poor infection , bleeding DIC , fever
Platelet Refractoriness
Non ImmuneSepsis, drugs, DIC, poor quality non-
viable platelets, splenomegaly
ImmuneAlloimmunisation to HLA Class I antigenHLA Bw4/ Bw6ABO incompatibilityPlatelet specific antibody
Plasma Processing
Whole Blood Collection:180-300 cc of plasma can be obtained after
the procssing of one unit of whole blood depending on the volume & RBC content of the unit collected
Single donor Plasmapheresis:500-800cc of plasma depending of donor’s
wt
Fresh Frozen PlasmaFFP Contains
II, V, VII, VIII, XI, X, XIProtein C, Protein S, ATIII and various other
componentsFresh frozen plasma contains a normal
concentration of fibrinogen and the labile coagulation factors VIII and V.
Indications for FFP Transfusion
Usually If the pt is known case of hemophilia
Donot need to FFP
Sever Factor Deficiency With Bleeding No Factor
available
Sever Protein C deficienc
FFP is not completely Safe
Cryo precipitate
Volume of 15 ml , frozen
Contain VWF , FVIII , FXIII, Fibrinogen
Usually use in :
Hypofibrinogenemia , of dysfib,
FXIII deficiency
VWD
1 unit for every 5 kg
Treatment of Hemophilia
Fresh Frozen PlasmaCryoprecipitate
Concentrates of FactorPlasma-derivedBiotechnology
Vials of of 250 to 3000 unités
1 FFP (200 ml) = 200 units of F8
1 ml FFP = 1 unit of F8
Plasma derivatives
are produced on an
industrial scale
from plasma pools
consisting of
thousands of
donations
Major Plasma Derived Products
Immunoglobulin, albumin and coagulation factors are the most important therapeutic plasma derived proteins that is obtained during plasma fractionation
Other Proteins…
Proteins associated with vitamin KThrombinAntithrombin IIIFactor XIFibrinogenFactor XIIAlpha-1-antitripsinC1-InhibitorImmunoglobulin M
Company name
Virus Removal Plasma fractionation Filtration methods Various chromatographic methodsPathogen Inactivation Pasteurization Solvent / Detergent (S/D) treatment High salt, alcohol or acid treatment Vapour heat treatment
Pathogen Reduction
Specific Inf Removal Tx : Nanofiltration
Bacteria µm
0.2 µm Filtration
Virus nm
Nanofiltration
Protein Å
Ultrafiltration
Virus inactivation methods
Dry Heating Wet Heating Pasteurization Low/High pH Gamma Radiation UV Radiation Nanofiltration Solvent/Detergent Beta Propiolacton Caprylate
Photochemical inactivation
Chemical inactivation
Gene introduced into plasmid Plasmid then transfected into cells New DNA integrated into DNA of cells Cells producing large amounts of rFactor selected and cultivated by fermentation Factor protein secreted into media cells grown in, and harvested
plasma-Derived products
– Country of plasma origin– Donor selection– Viral screening by antibody– Antigen and nucleic acid amplification testing– Viral screening and inactivation in pooled plasma
– Establishing safety of the cell line– Eliminating exogenous human or animal proteins– Viral removal and inactivation ,steps designed to reduce the risk of viral contamination
Recombinant products
Minimizing infection risk
Recombinant Factor• Infectious safety• Good supply• More costly• Greater inhibitor risk???Plasma-derived Factor• As safe as recombinant• Less inhibitor risk???• Superior inhibitor eradication• Cheaper
Recombinant VS Plasma derived
Second generationAnimal- and human-derived proteins in cell culture• No albumin in final product
First generation• Animal- and human-derived proteins in cell culture• Human albumin in final product
Third generation• No animal- and human-derived proteins in cell culture, processing or final product