DDr.Susheela InnahProfessor &HoD

Dept of Transfusion MedicineJubilee Mission Medical College, Thrissur

In 1910 Duke first noted that platelets from whole blood reduce the bleeding time

In 1950s platelets were collected and transfused, but only for diagnostic purposes.

In 1960s plastic blood bags became available which enabled platelets to be separated from whole blood collections by centrifugation.

History

In the 1970s Drs. Scott Murphy and Frank Gardner discovered that platelet function was best preserved if the platelets were stored at room temperature with agitation. This resulted in the introduction of prophylactic platelet transfusions for patients with leukaemia.

In the 1980s new methods for platelet transfusion were introduced using cytapheresis technique

In the 1990s cytapheresis methods was refined by collecting leucocyte reduced platelet products.

Platelets are obtained by three different methods:

Platelet concentrates from whole blood by hard spin (Random donor platelets) - RDP

Buffy coat removed platelet concentrate – BCR-P

Apheresis Platelets (Single Donor Platelets) - SDP

Platelet Products Available for Transfusion

Preparation of platelet concentrate

RBCs PRP

Plasma

Plateletconcentrate

The hard-spinning of the platelets on to the bottom of the bag in the PRP method, requiring re-suspension of the plts, may induce a collection injury that could potentially compromise the long-term storage of PRP platelets compared with BC platelets. However, there is currently no direct evidence to substantiate this hypothesis

Transfusion 1989;29:605-609 Blood 2003;102:93a. Blood 2006;108:282a-283a.

RDP

Buffy coat removed cells prepared by centrifugation and separation by automated Component separator

Buffy Coat Removed Platelets

PPPBC

BCR-RBC

WB

Preparation of leuco-reduced components using top and bottom bags with optipress

Optipress with PPP and RBC

PPPBC

BCR-RBC

PPPBCR-RBC

BCBC

Buffy coat

Buffy Coat is hung

BC-PC

BCRBCR BC-PC

Leuco-reduced platelets

BC

BC

BC

BC

BCBCP

BC

Sterile connecting device for preparing pooled platelets

Single-donor apheresis platelet concentrates may be collected by a variety of apheresis systems, using different protocols. Platelet yields may vary, and each procedure or protocol must be fully validated, documented and specifications set.

Single Donor Platelets

Single Donor Plasma

Random donorplatelets

Buffy coatplatelets

Cytapheresisplatelets

Preparation Prepared fromcentrifugation of whole bloodderived plateletrich plasma

Prepared fromcentrifugation of whole blood derived buffy coats

Prepared byapheresis from a single donor

Donor number

Multiple Multiple One

Volume 45-50 ml 45-50 ml 200-300 ml

Platelets 5.5 x 1010 6 x 1010 3 x 1011

Properties of platelet concentrates

Random donorplatelets

Buffy coatplatelets

Cytapheresisplatelets

Leucocytes 7-9 x 1010 1 x 107 < 1 x 106

Red Cells < 1 ml rare < 1 ml

pH 7.35 7.16 7.30

Bacterial contamination

2.5% 0.12%

Random donorplatelets

Buffy coatplatelets

Cytapheresisplatelets

IL-1 (Day 1) 0 6 pg/ml 0

IL-6 (Day 1) 140 pg/mL 73 pg/mL <15 pg/mL

IL-8 (Day 1) 100 pg/mL 489 pg/mL

170 pg/mL

TGFa(Day 1)

11,050 pg/mL 2,900 pg/mL 2,670 pg/mL

AUSTRALASIAN SOCIETY OF BLOOD TRANSFUSION Topics in Transfusion MedicineFebruary 2001 Vol 8 No 1

RDP BCR -P SDP

CostRs 2400 -3000For 6 units

Rs 3000 – 4000For 6 units

Rs 9000 to 14000 for 1 unit

Side-effects of Transfusion

Same Same Same

Post-transfusion increments, haemostatic effectiveness

Same Same Same

Donor Exposure Multiple Multiple Single

RDP BCR -P SDPAlloimmunization

Develops only in minority of patients on chemotherapy

Lesser than RDP

Less chances

Inventory Management

Sufficient stock can be managed on a daily basis

Sufficient stock can be managed on a daily basis

Difficult to obtain during emergencyand holidays

Thus administering random donor platelets followed by single donor platelets if alloimmunization develops, is justified by both economic and scientific reasoning.

Conclusion

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