Products and Factors for Bleeding Flashcards
What are the two types of platelet donors
‘Random Donor’ Platelets
Apheresis single donor platelets
Compare Random donor vs apheresis single donor platelets
(3)
Random -> single donor units containing at least 45-85 x10^9 per donation. Usually pooled in 4-6 unit bags and issued to the hospitals. Units would have approx 250-300 mls plasma
Apheresis -> contain at least 240 x 10^9 platelets per unit. Suspended in 300mls approximately of male donor plasma.
Both ABO grouped if possible
Why are apheresis donors men
Men tend to not have HLA antibodies
How are apheresis platelets made
Take off 75% of plasma and replace with platelet additive solution
i.e. platelets suspended in 25% male plasma solution
Compare the shape of resting platelets vs activated platelets
Resting platelets are smooth and disc shaped
Activated platelets have an irregular shape with many protruding pseudopodia
What is the platelet swirl test
If platelets have activated e.g. if bacteria present in plasma then they won’t swirl, you will be able to see clumps in pack
How are platelets processed
(4)
Agitated during storage to prevent unacceptable platelet aggregation
All platelet products in Ireland are ‘leucodepleted’ by filtration
All platelet products are irradiated since 2006
CMV antibody tested (donor) for appropriate immunosuppressed patients e.g. neonates, BMT, chemotherapy
Why do we irradiate platelets and not rbc packs
There is no shortening on the life span of platelets when irradiated unlike rbcs
Why do we test for CMV in healthy patients and how do we remove it?
(4)
CMV is always there in your system
CMV hides itself in wbcs
When you irradiate the platelets you remove the wbcs and thus the CMV (pack deemed CMV negative but not deffinite)
We can test for CMV antibodies but this is only done in special cases e.g. for neonates
Who might need a platelet transfusion?
(6)
Bone marrow failure e.g. aplastic anaemia, leukaemia
Chemotherapy
Acute DIC -> platelets consumed in clots
Dilutional thrombocytopoenia -> massive transfusion
Congenital platelet adhesion and aggregation defects
Neonatal alloimmune thrombocytopoenia (NAITP)
What are two congenital platelet adhesion and aggregation defects
Bernard Soulier and Glanzmanns disease
What is NAITP
Neonatal alloimmune thrombocytopoenia
What response is there when a patient receives a platelet transfusion?
(3)
One unit of random donor platelets should raise the count by 5-10 x10^9/L
Anticipate platelet refractoriness (stubborness) - non response - may be due to excessive consumption or antibody mediated destruction
May indicate selection of HLA or HPA matched donor platelets
What platelet count indicates need for transfusion
Platelet count less than 50x10^9/L
What is our commercial factor 8 called
Advate
What is our commercial fibrinogen product called
Haemocomplettan
When might fibrinogen be given
In a mass bleed to stop bleeding
What is our albumin commercial product called
Flexbumin
What is haemophilia
(3)
Inherited bleeding disorders, usually classified as mild, moderate and severe
Either FVIII (Haemophilia A) or FIX (Haemophilia B) deficient
Both X-linked disorders with female carriers and male sufferers
What is Haemophilia B also called
Christmas disease
What lab tests would indicate haemophilia
PT normal
APTT prolonged
Describe the life of a severe haemophiliac before treatment was made available
Usually wheelchair bound by childhood due to bleeds in their joints
Haemorrhaging into tissues and joints fixed their joints in place
How did we used to treat Haemophiliacs
Used to give them full plasma
How do we treat Haemophiliacs now
After the discovery of cryoprecipitate we began using factor 8 transfusions
We used to use human-isolated factors (lyophilised)
We now use recombinant products
