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PLATELET PLATELET PLATELET PLATELET TRANSFUSION IN TRANSFUSION IN TRANSFUSION IN TRANSFUSION IN CASES OF DENGUE CASES OF DENGUE CASES OF DENGUE CASES OF DENGUE FEVERFEVERFEVERFEVER
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DR.K.HITESH DR.K.HITESH DR.K.HITESH DR.K.HITESH KUMARKUMARKUMARKUMAR1st yr PG,M.D (T.M)DEPARTMENT OF TRANFUSION MEDICINE
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INDICATIONS FOR INDICATIONS FOR INDICATIONS FOR INDICATIONS FOR PLATELET TRANSFUSIONPLATELET TRANSFUSIONPLATELET TRANSFUSIONPLATELET TRANSFUSION�Thrombocytopenia•<10,000/cu.mm in uncomplicated patients•<20,000/cu.mm if febrile or septic eg: Dengue Fever •<50,000/cu.mm if bleeding/undergoing major surgery.•<100,000/cu.mm for neurosurgery /ophthalmologic procedures
�Thrombocytopathy• Congenital defects.• Drugs etc.
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4
�Platelets can be transfused either by
SINGLE DONOR PLATELETSSINGLE DONOR PLATELETSSINGLE DONOR PLATELETSSINGLE DONOR PLATELETS orororor RANDOM DONOR PLATELETRANDOM DONOR PLATELETRANDOM DONOR PLATELETRANDOM DONOR PLATELET
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PLATELETSPLATELETSPLATELETSPLATELETS�Single donor plateletsSingle donor plateletsSingle donor plateletsSingle donor platelets
•Also referred to as “Jumbo platelets”•250 ml•Expected increment of 30,000- 50,000/μl/dose (unit)
� Advantages:
• Less infectious risk• Less risk of HLA alloimmunization
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�Random donor plateletsRandom donor plateletsRandom donor plateletsRandom donor platelets
•Whole blood derived platelets•50 ml•Dose
�10-15 ml/kg�4-6 units for an average adult
•Must transfuse within 4 hours after pooling•Expected increment of 5000-10,000/μl/unit
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DONOR SELECTION DONOR SELECTION DONOR SELECTION DONOR SELECTION CRITERIACRITERIACRITERIACRITERIA� Weight >50kg� Age -18 to 60 yrs� Atleast 72hrs from last plateletpheresis or 3
months from last blood donation.� Hb >12.5 gm%� Platelet count >1.5×1010/μl� Absence of any illness.� No H/0 consumption of NSAIDs for last 7days� Screening tests for HIV, HBsAg, HCV, Syphilis &
Malaria.
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PLATELETS- BLOOD PLATELETS- BLOOD PLATELETS- BLOOD PLATELETS- BLOOD GROUP??GROUP??GROUP??GROUP??� Express ABO antigens
•Will get best increment with ABO compatible platelets
� DO NOT express Rh antigens•Can give regardless of Rh type •However, platelet bag may contain a small amount of RBCs
�Rh-negative woman of child-bearing Rh-negative woman of child-bearing Rh-negative woman of child-bearing Rh-negative woman of child-bearing age should receive Rh negative age should receive Rh negative age should receive Rh negative age should receive Rh negative plateletsplateletsplateletsplatelets
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APHERESISAPHERESISAPHERESISAPHERESIS
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APHERESISAPHERESISAPHERESISAPHERESIS
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PLATELETPHERESISPLATELETPHERESISPLATELETPHERESISPLATELETPHERESIS
�It is by 2 methods:
INTERMITTENT FLOW CENTRIFUGATIONINTERMITTENT FLOW CENTRIFUGATIONINTERMITTENT FLOW CENTRIFUGATIONINTERMITTENT FLOW CENTRIFUGATION
� Haemonetics MCS - HAEMONETIC� Haemonetic MCS+ � PCS/PCS2 - CORPORATION � Autopheresis C - BAXTER(FENWAL)
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HAEMONETIC MCS+HAEMONETIC MCS+HAEMONETIC MCS+HAEMONETIC MCS+
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CONTINOUS FLOW CONTINOUS FLOW CONTINOUS FLOW CONTINOUS FLOW CENTRIFUGATIONCENTRIFUGATIONCENTRIFUGATIONCENTRIFUGATION
� CS-3000 plus
� CS-3000+AMS
� Amicus - Baxter (Fenwal)
�Spectra - Gambro (Cobe)
� AS-104 - FRESENIUS AS-104AS-104AS-104AS-104
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DONOR COUCHDONOR COUCHDONOR COUCHDONOR COUCH
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Apheresis Apheresis Apheresis Apheresis Platelets/SDPPlatelets/SDPPlatelets/SDPPlatelets/SDP
�It takes 6-8 cycles for complete apheresis procedure
�Time taken is 90 – 120 min
�One SDP unit is equivalent to 5-6 RDP’s.
� Stored at 20-240 C (RT) with agitation for 5 days
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�Dosage of platelet concentrate in children
Body wt. Dosage Volume Platelets
Upto 15kg 1 dose 30-50ml 60×109/μl
15-30kg 2 doses 60-100ml 120×109/μl
>30kg 4 doses 180-400ml 240×109 /μl
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MONITORING OF EFFECT OF MONITORING OF EFFECT OF MONITORING OF EFFECT OF MONITORING OF EFFECT OF PLATELET TRANSFUSION PLATELET TRANSFUSION PLATELET TRANSFUSION PLATELET TRANSFUSION
� Bleeding time� Platelet count after 1hr & 24hrs� aPTT� PT� Fibrinogen levels
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PLATELET DOSE PLATELET DOSE PLATELET DOSE PLATELET DOSE RESPONSERESPONSERESPONSERESPONSE�Cessation Of Clinical Bleeding�CORRECTED COUNT INCREMENT(CCI)
�CCI at 1hr = BSA= ( body surface area in m2 )
�Expected CCI at 1hr >7500 per μl
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= Platelet increment
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EXPECTED PLATELET EXPECTED PLATELET EXPECTED PLATELET EXPECTED PLATELET INCREMENTINCREMENTINCREMENTINCREMENT
If RDP transfused,� in adult(70kg) is 5-10×109 /μl� in children is 20×109 /μl� in infant is 75-100×109 /μl
If SDP transfused� in adult is 30-60×109 /μl
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Failure of expected platelet Failure of expected platelet Failure of expected platelet Failure of expected platelet incrementincrementincrementincrement� Anti-HLA or platelet-antigen antibodies
(after 10-60 minutes)� After 24 hours
– Fever– Infection– Drugs (Amphotericin)– Bleeding– Hepatospleenomegaly– Disseminated intravascular coagulation
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THANK THANK THANK THANK YOUYOUYOUYOU