CSP.005 Reduced Volume Platelets

PATHOLOGY AND LABORATORY MEDICINE DIVISION OF TRANSFUSION MEDICINE STANDARD WORK INSTRUCTION MANUAL

Reduced Volume Platelets

Approved By: Dr. Antonio Giulivi Document No: CSP.004 Date Issued: 2004/04/05 Category: Component Selection and Preparation Date Revised: 2009/12/31 Page 1 of 4

1.0 Principle

Platelets maybe volume reduced in order to decrease the total volume of the component transfused or partially remove plasma.

2.0 Scope and Related Policies

2.1 In most cases small children cannot tolerate large volumes of platelets but may need relatively large numbers of platelets. Reducing the final volume is a practical solution as platelets can then be given by ‘IV push’ in a very short time.

2.2 When ABO incompatible platelets are used reducing the volume can mitigate the impact of incompatible ABO isoaggutinins. For neonates, it is desirable to avoid administration of plasma that is incompatible with the infant’s red cells; if platelets containing compatible are not available, the plasma can be reduced.

2.3 Volume reduction of buffy coat platelets should only be attempted if appropriate product validation has been done at the hospital site.

2.4 All blood products shall be inspected for abnormal appearance before use and the visual inspection must be documented. If an obvious abnormality is detected, the unit must not issued the blood supplier shall be consulted regarding the final disposition of the product. Any such consultation must be documented.9.1

2.5 An issue voucher and/or compatibility label/tag shall be completed for all platelets issued.

3.0 Specimen

Platelet component:

 Buffy Coat

Ontario Regional Blood Coordinating Network CSP.004 Standard Work Instruction Manual Page 1 of 4 Reduced Volume Platelets

 Apheresis

 Random donor

4.0 Materials

Equipment: Balance scale Refrigerated blood component centrifuge Heat Sealer Plasma extractor

Supplies: Transfer set Plastic over wrap Balance supplies Heat sealer clamps

5.0 Quality Control – N/A

6.0 Procedure

6.1 Turn on the centrifuge and allow the temperature to reach 22 – 24° C.

6.2 Place the platelet component and transfer set in a plastic over wrap bag and place in the centrifuge.

6.3 Balance the buckets and centrifuge at acceptable speed and time. See Procedural Note 8.1.

6.4 Without disturbing the contents, transfer the bag from the centrifuge to the plasma extractor.

6.5 The final volume is 10 mL for each unit of platelets in the pool or 60 mL for apheresis platelets, e.g., a 3 unit pool would have a final volume of 30 mL, or as requested by the Physician. Final volume of reduced platelets may be lower for neonates.

6.6 When the scale indicates approximately 10 mL more that the desired volume clamp off the line.

6.7 Remove the platelet bag from the scale and heat seal (or manual clamp) the tubing. Make 3 seals just above the pooling bag, approximately 0.5 inch apart. See Procedural Note 8.3 if using a heat sealer.

Ontario Regional Blood Coordinating Network CSP.004 Standard Work Instruction Manual Page 2 of 4 Reduced Volume Platelets 6.8 Label the segment with a label containing the serial numbers of the units in the pool (or a pool number if one was used). Retain the pooled platelet segment for 7 days. See Procedural Note 8.5.

6.9 Record the expiry date and time on the unit (4 hours from initial time of entry).

6.10 Leave the platelet bag undisturbed at 20-24° C (without agitation) for 60 minutes.9.2 Place the label face down.

6.10.1 A 60 minute resting period prior to mixing is required for platelets to allow them to regain their functionality, especially when platelets are fresh (<24-48 hours old).

6.10.2 Platelets can be resuspended sooner in case of emergency.

6.11 Resuspend platelets by gentle hand manipulation to allow for uniform suspension.

7.0 Reporting

7.1 Prepare a compatibility/component label containing at least the following information. See Procedural Note 8.2.

 Recipient family and given names

 Recipient identification number

 Recipient ABO and Rh group

 Product name (e.g., volume reduced platelets pooled or platelets apheresis)

 ABO group of the pooled platelets

 Number of units in the pool

 Unit numbers in the pool or pool number. See Procedural Note 8.1, if indicated

 Weight or total volume of product

 Expiry date and time

8.0 Procedural Notes

Ontario Regional Blood Coordinating Network CSP.004 Standard Work Instruction Manual Page 3 of 4 Reduced Volume Platelets 8.1 Unit number must include the unit identification number, the check digit and the source code of the original unit(s). If pool numbers are used, there must be a log or computer system capable of tracking the original unit numbers indefinitely.

8.2 When labelling units, the following criteria should be met:

 Whenever possible, place the label onto the label on the transfer bag

 Only labels with approved adhesive must be used on blood bags

 Do not use scotch tape, masking tape or other adhesives that are not approved

 Do not use felt pen on bag labels; use pen only

8.3 The manufacturer’s directions should be followed when using a heat sealer device.

8.4 Platelets are the component that is most likely to be contaminated with bacteria. See RT.012 – Investigation of Transfusion Complications.

8.5 Centrifugation speed and time should be developed for each piece of equipment.

9.0 References

9.1 Standards for Hospital Transfusion Services, Version 2 – September 2007, Ottawa, ON: Canadian Society for Transfusion Medicine, 2007: 5.7.3.1.

9.2 Roback JD, ed. American Association of Blood Banks Technical Manual, 16th ed. Bethesda, MD: American Association of Blood Banks, 2008: 960-961.

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