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Unintentional Platelet Removal by Plasmapheresis
Journal of Clinical Apheresis 16:55–60 (2001) Unintentional Platelet Removal by Plasmapheresis Jedidiah J. Perdue,1 Linda K. Chandler,2 Sara K. Vesely,1 Deanna S. Duvall,2 Ronald O. Gilcher,2 James W. Smith,2 and James N. George1* 1Hematology-Oncology Section, Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 2Oklahoma Blood Institute, Oklahoma City, Oklahoma Therapeutic plasmapheresis may remove platelets as well as plasma. Unintentional platelet loss, if not recognized, may lead to inappropriate patient assessment and treatment. A patient with thrombotic thrombocytopenic purpura- hemolytic uremic syndrome (TTP-HUS) is reported in whom persistent thrombocytopenia was interpreted as continuing active disease; thrombocytopenia resolved only after plasma exchange treatments were stopped. This observation prompted a systematic study of platelet loss with plasmapheresis. Data are reported on platelet loss during 432 apheresis procedures in 71 patients with six disease categories using three different instruments. Com- paring the first procedure recorded for each patient, there was a significant difference among instrument types ,than with the COBE Spectra (1.6% (21 ס P<0.001); platelet loss was greater with the Fresenius AS 104 (17.5%, N) .With all procedures, platelet loss ranged from 0 to 71% .(24 ס or the Haemonetics LN9000 (2.6%, N (26 ס N Among disease categories, platelet loss was greater in patients with dysproteinemias who were treated for hyper- viscosity symptoms. Absolute platelet loss with the first recorded apheresis procedure, in the 34 patients who had a normal platelet count before the procedure, was also greater with the AS 104 (2.23 × 1011 platelets) than with the Spectra (0.29 × 1011 platelets) or the LN9000 (0.37 × 1011 platelets). -
Platelet-Rich Plasmapheresis: a Meta-Analysis of Clinical Outcomes and Costs
THE jOURNAL OF EXTRA-CORPOREAL TECHNOLOGY Original Article Platelet-Rich Plasmapheresis: A Meta-Analysis of Clinical Outcomes and Costs Chris Brown Mahoney , PhD Industrial Relations Center, Carlson School of Management, University of Minnesota, Minneapolis, MN Keywords: platelet-rich plasmapheresis, sequestration, cardiopulmonary bypass, outcomes, economics, meta-analysis Presented at the American Society of Extra-Corporeal Technology 35th International Conference, April 3-6, 1997, Phoenix, Arizona ABSTRACT Platelet-rich plasmapheresis (PRP) just prior to cardiopulmonary bypass (CPB) surgery is used to improve post CPB hemostasis and to minimize the risks associated with exposure to allogeneic blood and its components. Meta-analysis examines evidence ofPRP's impact on clinical outcomes by integrating the results across published research studies. Data on clinical outcomes was collected from 20 pub lished studies. These outcomes, DRG payment rates, and current national average costs were used to examine the impact of PRP on costs. This study provides evidence that the use of PRP results in improved clinical outcomes when compared to the identical control groups not receiving PRP. These improved clinical out comes result in subsequent lower costs per patient in the PRP groups. All clinical outcomes analyzed were improved: blood product usage, length of stay, intensive care stay, time to extu bation, incidence of cardiovascular accident, and incidence of reoperation. The most striking differences occur in use of all blood products, particularly packed red blood cells. This study provides an example of how initial expenditure on technology used during CPB results in overall cost savings. Estimated cost savings range from $2,505.00 to $4,209.00. -
Management of Refractory Autoimmune Hemolytic Anemia Via Allogeneic Stem Cell Transplantation
Bone Marrow Transplantation (2016) 51, 1504–1506 © 2016 Macmillan Publishers Limited, part of Springer Nature. All rights reserved 0268-3369/16 www.nature.com/bmt LETTER TO THE EDITOR Management of refractory autoimmune hemolytic anemia via allogeneic stem cell transplantation Bone Marrow Transplantation (2016) 51, 1504–1506; doi:10.1038/ urine output and nausea. Physical examination was otherwise bmt.2016.152; published online 6 June 2016 normal. Her laboratory evaluation was notable for a hematocrit of 17%, reticulocyte count of 6.8%, haptoglobin below assay limits and an Waldenström’s macroglobulinemia (WM) represents a subset LDH (lactate dehydrogenase) that was not reportable due to of lymphoplasmacytic lymphomas in which clonally related hemolysis (Table 1). Creatinine was 1.1 mg/dL, total bilirubin was lymphoplasmacytic cells secrete a monoclonal IgM Ab.1 6.7 mg/dL with a direct bilirubin of 0.3 mg/dL and lactate was Overproduced IgMs can act as cold agglutinins in WM. Upon 5 mmol/L. Over 4 h, her hematocrit decreased to 6% and her exposure to cooler temperatures in the periphery, they cause creatinine rose to 1.6 mg/dL. Given concern for acute hemolytic anemia via binding to the erythrocyte Ii-antigen group and anemia due to cold agglutinins, she was warmed and received classical complement cascade initiation.2 Treatment of seven units of warmed, packed RBC, broad-spectrum antibiotics, cold-agglutinin-mediated autoimmune hemolytic anemia (AIHA) high-dose steroids and underwent emergent plasmapheresis. She in WM typically targets the pathogenic B-cell clone1–4 or the also underwent hemodialysis for presumed pigment nephropathy. -
Patient Information Leaflet – Plasma Exchange Procedure
Therapeutic Apheresis Services Patient Information Leaflet – Plasma Exchange Procedure Introduction Antibodies, which normally help to protect you from infection, can begin to attack your own This leaflet has been written to give patients healthy cells, or an over production of proteins can information about plasma exchange (sometimes cause your blood to become thicker and slow down called plasmapheresis). If you would like any more the blood flow throughout your body. A plasma information or have any questions, please ask the exchange can help improve your symptoms, doctors and nurses involved in your treatment at although this may not happen immediately. the NHS Blood and Transplant (NHSBT) Therapeutic Apheresis Services Unit. Although plasma exchange may help with symptoms, it will not normally cure your condition When you have considered the information given as it does not switch off the production of the in this leaflet, and after we have discussed the harmful antibodies or proteins. It is likely that procedure and its possible risks with you, we will this procedure will form only one part of your ask you to sign a consent form to indicate that you treatment. are happy for the procedure to go ahead. Before any further procedures we will again check that you are happy to proceed. How do we perform Plasma Exchange? What is a plasma exchange? Plasma exchange is performed using a machine Blood is made up of red cells, white cells and called a Blood Cell Separator which can separate platelets which are carried around in fluid called blood into its various parts. The machine separates plasma. -
FACTS ABOUT DONATING Blood WHY SHOULD I DONATE BLOOD? HOW MUCH BLOOD DO I HAVE? Blood Donors Save Lives
FACTS ABOUT DONATING BLOOD WHY SHOULD I DONATE BLOOD? HOW MUCH BLOOD DO I HAVE? Blood donors save lives. Volunteer blood donors provide An adult has about 10–11 pints. 100 percent of our community’s blood supply. Almost all of us will need blood products. HOW MUCH BLOOD WILL I donate? Whole blood donors give 500 milliliters, about one pint. WHO CAN DONATE BLOOD? Generally, you are eligible to donate if you are 16 years of WHAT HAPPENS TO BLOOD AFTER I donate? age or older, weigh at least 110 pounds and are in good Your blood is tested, separated into components, then health. Donors under 18 must have written permission distributed to local hospitals and trauma centers for from a parent or guardian prior to donation. patient transfusions. DOES IT HURT TO GIVE BLOOD? WHAT ARE THE MAIN BLOOD COMPONENTS? The sensation you feel is similar to a slight pinch on the Frequently transfused components include red blood arm. The process of drawing blood should take less than cells, which replace blood loss in patients during surgery ten minutes. or trauma; platelets, which are often used to control or prevent bleeding in surgery and trauma patients; and HOW DO I PREPARE FOR A BLOOD DONATION? plasma, which helps stop bleeding and can be used to We recommend that donors be well rested, eat a healthy treat severe burns. Both red blood cells and platelets meal, drink plenty of fluids and avoid caffeine and are often used to support patients undergoing cancer alcohol prior to donating. treatments. WHAT CAN I EXPECT WHEN I DONATE? WHEN CAN I DONATE AGAIN? At every donation, you will fill out a short health history You can donate whole blood every eight weeks, platelets questionaire. -
Summary of Blood Donor Deferral Following COVID-19 Vaccine And
Updated 04 14 2021 Updated Information from FDA on Donation of CCP, Blood Components and HCT/Ps, Including Information on COVID-19 Vaccines, Treatment with CCP or Monoclonals 1) HCT/P DONOR ELIGIBILITY: For the agency’s current thinking on HCT/P donation during the pandemic, including donor eligibility following vaccination to prevent COVID-19, refer to FDA’s January 4th Safety and Availability communication, Updated Information for Human Cell, Tissue, or Cellular or Tissue-based Product (HCT/P) Establishments Regarding the COVID-19 Pandemic. 2) CCP and ROUTINE BLOOD DONOR ELIGIBILITY: 2-1. Blood donor eligibility following COVID-19 vaccine Blood donor deferral following COVID-19 vaccines is not required. Consider the following information on FDA’s web page Updated Information for Blood Establishments Regarding the COVID-19 Pandemic and Blood Donation last updated 01/19/21” – see the full document on page 2 below. The blood establishment’s responsible physician must evaluate prospective donors and determine eligibility (21 CFR 630.5). The donor must be in good health and meet all donor eligibility criteria on the day of donation (21 CFR 630.10). The responsible physician may wish to consider the following: o individuals who received a nonreplicating, inactivated, or mRNA-based COVID-19 vaccine can donate blood without a waiting period, o individuals who received a live-attenuated viral COVID-19 vaccine, refrain from donating blood for a short waiting period (e.g., 14 days) after receipt of the vaccine, o individuals who are uncertain about which COVID-19 vaccine was administered, refrain from donating for a short waiting period (e.g., 14 days) if it is possible that the individual received a live-attenuated viral vaccine. -
Cord Blood Stem Cell Transplantation
LEUKEMIA LYMPHOMA MYELOMA FACTS Cord Blood Stem Cell Transplantation No. 2 in a series providing the latest information on blood cancers Highlights • Umbilical cord blood, like bone marrow and peripheral blood, is a rich source of stem cells for transplantation. There may be advantages for certain patients to have cord blood stem cell transplants instead of transplants with marrow or peripheral blood stem cells (PBSCs). • Stem cell transplants (peripheral blood, marrow or cord blood) may use the patient’s own stem cells (called “autologous transplants”) or use donor stem cells. Donor cells may come from either a related or unrelated matched donor (called an “allogeneic transplant”). Most transplant physicians would not want to use a baby’s own cord blood (“autologous transplant”) to treat his or her leukemia. This is because donor stem cells might better fight the leukemia than the child’s own stem cells. • Cord blood for transplantation is collected from the umbilical cord and placenta after a baby is delivered. Donated cord blood that meets requirements is frozen and stored at a cord blood bank for future use. • The American Academy of Pediatrics’s (AAP) policy statement (Pediatrics; 2007;119:165-170.) addresses public and private banking options available to parents. Among several recommendations, the report encourages parents to donate to public cord blood banks and discourages parents from using private cord blood banks for personal or family cord blood storage unless they have an older child with a condition that could benefit from transplantation. • The Stem Cell Therapeutic and Research Act of 2005 put several programs in place, including creation of the National Cord Blood Inventory (NCBI) for patients in need of transplantation. -
When Is Blood Donation Safe? T Lise Sofie H
Transfusion and Apheresis Science 58 (2019) 113–116 Contents lists available at ScienceDirect Transfusion and Apheresis Science journal homepage: www.elsevier.com/locate/transci Review ☆ Donor health assessment – When is blood donation safe? T Lise Sofie H. Nissen-Meyera, Jerard Seghatchianb a Oslo Blood Centre, Department of Immunology and Transfusion Medicine, Oslo University Hospital, Oslo, Norway b International Consultancy in Blood Components Quality/Safety Improvement and DDR Strategies, London, United Kingdom ARTICLE INFO ABSTRACT Keywords: Blood donation is a highly regulated practice in the world, ensuring the safety and efficacy of collected blood and its Blood donation components whether used as irreplaceable parts of modern transfusion medicine, as a therapeutic modality or addi- Donor health assessment tional support to other clinical therapies. In Norway blood donation is regulated by governmental regulations Health and disease (“Blodforskriften”) and further instructed by national guidelines, “Veileder for transfusjonstjenesten” [1], providing an Transfusion aid for assessment of donor health. This concise review touches upon: definitions of donor health and disease; some Blood components important pitfalls; and the handling of some common and less common pathophysiological conditions; with an example from the Blood center of Oslo University Hospital, Norway’s largest blood center. I also comment on some medications used by a number of blood donors, although wounds, ulcers and surgery are not included. Considering the panorama of conditions blood donors can suffer from, blood donation can never be completely safe for everybody, as zero riskdoes not exist, but it is our task through donor evaluation to identify and reduce risk as much as possible. 1. -
Recommendations for Collecting Red Blood Cells by Automated Apheresis Methods
Guidance for Industry Recommendations for Collecting Red Blood Cells by Automated Apheresis Methods Additional copies of this guidance document are available from: Office of Communication, Training and Manufacturers Assistance (HFM-40) 1401 Rockville Pike, Rockville, MD 20852-1448 (Tel) 1-800-835-4709 or 301-827-1800 (Internet) http://www.fda.gov/cber/guidelines.htm U.S. Department of Health and Human Services Food and Drug Administration Center for Biologics Evaluation and Research (CBER) January 2001 Technical Correction February 2001 TABLE OF CONTENTS Note: Page numbering may vary for documents distributed electronically. I. INTRODUCTION ............................................................................................................. 1 II. BACKGROUND................................................................................................................ 1 III. CHANGES FROM THE DRAFT GUIDANCE .............................................................. 2 IV. RECOMMENDED DONOR SELECTION CRITERIA FOR THE AUTOMATED RED BLOOD CELL COLLECTION PROTOCOLS ..................................................... 3 V. RECOMMENDED RED BLOOD CELL PRODUCT QUALITY CONTROL............ 5 VI. REGISTRATION AND LICENSING PROCEDURES FOR THE MANUFACTURE OF RED BLOOD CELLS COLLECTED BY AUTOMATED METHODS.................. 7 VII. ADDITIONAL REQUIREMENTS.................................................................................. 9 i GUIDANCE FOR INDUSTRY Recommendations for Collecting Red Blood Cells by Automated Apheresis Methods This -
Points to Consider in the Preparation and Transfusion of COVID-19 Convalescent Plasma
Points to consider in the preparation and transfusion of COVID-19 convalescent plasma Jay Epstein1 & Thierry Burnouf2 On behalf of the ISBT Working Party on Global Blood Safety 1 US Food and Drug Administration, Silver Spring, MD, USA 2 College of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan Important notices: • Because the safety and efficacy of convalescent COVID-19 plasma as a treatment for COVID- 19 are unproven at this time, clinical use of this product should be managed as an experimental therapy consistent with ethical and legal safeguards (informed consent of donors and patients, institutional approval, special labeling as an investigational product, compliance with applicable regulatory requirements). • Ideally, COVID-19 plasma should be used in the context of an organized research study designed to determine its safety and efficacy in comparison with standard of care or other therapeutic interventions. Even if used empirically it is vital to ensure monitoring of patient outcomes including clinical and laboratory indicators of safety and efficacy to maximize the knowledge that might be gained. • Collection and retention of blood specimens from both donors and recipients (pre- and post- treatment) should be performed to permit retrospective determination of the characteristics of an effective product and dosage regimen, and the characteristics of patients most likely to benefit. • General information on the rationale and approach to use of convalescent plasma in virus epidemics can be found in the “WHO Blood Regulators Network (2017) Position Paper on Use of Convalescent Plasma, Serum or Immune Globulin Concentrates as an Element in Response to an Emerging Virus.” (1) Intentional collection of convalescent plasma should be performed only by apheresis in order to avoid unnecessary red cell loss in the donor and to optimize the volume of plasma that can be generated for investigational use. -
Directed Blood Donor Program FAQ
Directed Blood Donor Program FAQ How Do I Contact the Blood Donor Center? To make an appointment or for any questions, e-mail us or call (323) 361-2441. How Do I Participate? 1. Discuss the possibility of blood transfusion and all the transfusion options with the patient’s physician. 2. Have surgery or transfusion therapy scheduled at Children's Hospital Los Angeles. 3. If the patient’s blood type is not known, have his or her physician order a blood test. 4. Register the patient with the hospital in order to obtain a Medical Record Number. 5. Give an accurate, complete Directed Donor Request Form to the Blood Donor Center. 6. Have potential donors call the Blood Donor Center to make appointments to donate blood. Donors must provide the patient's full name and date of birth. 7. Notify the Blood Donor Center if the date of the surgery or transfusion therapy is changed. 8. Monitor the inventory of Directed Donor units. 9. Recruit additional donors as required. How Should I Prepare? Drink extra fluids the day prior to donating and the day of your donation. Eat a healthy meal before donating. Do not fast. Bring I.D. with you (drivers license or I.D. card). Who May Donate? To donate, donors must: Be 17 years of age or older (no upper age limit) Be at least 110 pounds Have no history of hepatitis, heart disease, or certain types of cancer Have no cold, sore throat, or other type of infection Not have engaged in any activity considered "at risk" for exposure to HIV (AIDS) and hepatitis Not be taking "significant" medications Not have donated blood in the past eight weeks Have a valid identification card (ID) Our staff of qualified blood donation professionals will provide potential donors with advice concerning specific medications or other questions of eligibility. -
Utility of Double Filtration Plasmapheresis in Acute Antibody
doi: 10.5262/tndt.2011.1003.17 Olgu Sunumu/Case Report Utility of Double Filtration Plasmapheresis in Acute Antibody Mediated Renal Allograft Rejection: Report of Three Cases Akut Antikor Aracılı Renal Allograt Rejeksiyonunda Çift Filtrasyon Plazmaferez: Üç Vaka Bildirimi ABSTRACT Yalçın SOLAK1 Hüseyin ATALAY1 Plasmapheresis is an extracorporeal procedure, which is often employed to rapidly lower circulating 2 titers of autoantibodies, immune complexes or toxins. There are two types of plasmapheresis namely, İlker POLAT 1 regular plasmapheresis (RPP) by centrifugation and membrane fi ltration, and double fi ltration Melih ANIL 1 plasmapheresis (DFPP) which is a special form of membrane fi ltration in which two membranes called Kültigin TÜRKMEN 1 as plasma separator and plasma fractionator are employed to fi lter macromolecules more selectively. Zeynep BIYIK 1 DFPP have several advantages over RP. Despite widespread utilization of DFPP in the setting of ABO Mehdi YEKSAN blood group incompatible kidney transplantation, there is no report regarding DFPP in patients with antibody mediated acute renal allograft rejection who are good candidates for benefi cial effects of DFPP. Here we report three renal transplant recipients in whom DFPP was applied as a component of anti-rejection treatment regimen. 1 Selcuk University Faculty of Medicine, KEYWORDS: Kidney, Transplantation, Rejection, Plasmapheresis Department of Nephrology, Konya, Turkey 2 Selcuk University Faculty of Medicine, ÖZ Department of Internal Medicine, Konya, Turkey Plazmaferez, dolaşımdaki antikor, immün kompleks ve toksin düzeylerini hızla düşürmek için kullanılan bir ekstrakorporeal yöntemdir.İki tip plazmaferez bulunmaktadır: Santrifüj ve membran fi ltrasyonu ile yapılan regüler plazmaferez (RP) ve büyük moleküllerin daha selektif olarak fi ltre edildiği, plazma ayırıcısı ve plazma fraksiyoneri olarak adlandırılan iki membranın kullanıldığı özel bir fi ltrasyon şekli olan çift fi ltrasyon plazmaferezdir (ÇFP).ÇFP’nin RP’ye göre bazı avantajları vardır.