Focus of the month

ReaDigest Transfusion Medicine–

Platelets

Vo l u m e 1 , I s s u e 5 F e b2 0 1 0

Season’s greetings
At ReaMetrix, A brief overview of ‘Platelet Transfusion’
Our unique capability to
Platelets are small circulating cells platelets – obtained from whole Diagnostics have a critical role to
address local markets
that are fragments of megakaryo- blood donations or Apheresis plate- play in platelet transfusion. The key
with indigenous resources
gives us a strong cytes present in the bone marrow. lets– obtained from a single donor, clinical decisions that depend on
competitive edge over They are mainly involved in the after separating out the non-platelet evidence from specific, sensitive
western companies. The primary hemostasis (to stop bleed- components of blood. diagnostic assays include:
health care market is in ing and maintain blood in liquid
need of sea change to
Platelets processed from random A. DECISION ON WHEN TO
state). Platelets circulate for
address barren pipelines donors have higher risk of signifi- TRANSFUSE PLATELETS
about 8-12 days after their re-
and orphaned diseases. In cant leukocyte contamination. These
lease into the blood. An adequate B. DECISION ON WHICH BAG
particular, tremendous are known to cause febrile transfu-
number of platelets is necessary TO TRANSFUSE, ESPECIALLY
business opportunities to sion reactions, adverse immunomodu-
address healthcare to maintain normal hemostasis. The IN CASE OF RANDOM DO-
latory effects, HLA alloimmunization
problems in the developing normal platelet count ranges from NOR PLATELETS
and transfer of some transfusion-
world remain untapped by 150,000 to 450,000/µL of blood.
associated viruses like cytomegalovi- Flow cytometry diagnostic assays
the Western research and
p h a rm a c e u t i c a l Quantitative changes in platelet rus (CMV). Even with the available provide highly specific and sensitive
community. counts such as Thrombocyto- pre-storage filtration techniques for information in support of the above
sis’ (platelet count >450000) and WBC removal, the problem of cyto- two clinical decisions.
‘Thrombocytopenia’ (platelet count kines and WBC fragments during
Single Donor Apheresis
To learn more about us <50,000) can be detected with a storage before transfusion still per-
Contact us routine screening test. sists. Apheresis or ‘Single Donor
platelets’ are known for a harvest
ReaMetrix India Pvt. Ltd, Low platelet counts could be a
with reduced number of WBCs and
50 B, 2nd Phase, TVS genetic disorder or due to a dis-
Cross, Peenya Industrial hence this minimizes the total donor
ease. The condition can also be
A r e a , P e e n y a exposure of patients.
seen during a specific treatment
Bangalore- 560 058
or surgery. Burn victims, organ In the developing nation context,
India.
transplant patients, marrow trans- random donor platelet (pooled plate-
Phone: +91 80 2837 8693 Pooled Platelets
plant patients, those undergoing let) is sometimes preferred, due to
Fax : +91 80 4117 2451 chemotherapy, and those who have the underlying cost factor, as
undergone heart surgery often Apheresis platelets is expensive.
require not only blood transfusions
but platelet transfusions as well.
Platelet component for transfusion
can be either Random donor

PTO to find Do you know?

Brain Gym 2 • Generally two liters of blood is needed for a single unit of platelet for transfusion and one unit has
about 3x1011 platelets
Platelet and residual 3
leukocyte enumeration • Apheresis is a medical technology that separates out a specific constituent from blood through an
by flow cytometry
apparatus and returns the reminder to the donor
Bacterial contamina- 3 • The newer use of platelet concentrate is ‘Gelatinous platelet glue’. It can be formed by the action of
tion in platelets– new thrombin and Calcium chloride in platelet rich plasma (PRP). This could be used for controlling unsutur-
tools on horizon
able bleeding sites or re-open heart surgery. To know more please read ’current concepts in platelet
transfusion’ - a review by Dipika Mohanty (Asian Journal of Transfusion Science, 2009, Vol. 3)

• PRP contains and releases (through degranulation) at least seven different growth factors that stimu-
To know the answers for
late bone and soft tissue healing
‘Brain Gym’, log onto

readigest.reametrix.com
1
 Brain Gym
Match-up the blood factors given in the black-box below to the right clue

(Take hints from the picture and arrow)

The Stuart factor

The Sandoz factor

The Unsteady factor

The Jingle bells factor

The Laki factor

Factor X Factor XIII Factor V Factor IV Factor IX

2 We welcome your feedback, write to us at readigest@reametrix.com

 Platelet and Residual Leukocyte Enumeration by Flow Cytometry
Platelet enumeration is essential in the
periodic check of patients suffering
from diseases like dengue fever and
thrombocytopenia. Conventionally, plate-
let enumeration is done using hematology
analyzers.
But in recent years, the use of flow cy-
tometry employing monoclonal antibody
has gained advantage over the conven-
tional method of platelet enumeration.
The factors that have triggered the
need for a flow based reagent for plate-
let enumeration are the unreliable, im-
precise counts from some hematology
analyzers. However, the high cost of
antibody conjugates and the short shelf
life of the liquid reagents, have affected
the widespread use of flow cytometric
methods for platelet enumeration.
ReaMetrix has innovated on an afford-
able, specific, CD41/CD61 antibody cock-
tail based assay reagent for enumeration
of platelets, in a novel dried-down, room
temperature stable format.
Precise and reliable measurement of
platelet counts around the stipulated
threshold levels to start transfusion
(10,000 cells/µl and in some cases 20,000
cells/µL) is crucial for indicating prophy-
lactic platelet transfusion in thrombocy-
topenic patients.
AABB (American Association of Blood
Banks) stipulates that PC's must be leuko-
reduced to contain:
No more than 5x108 (<1600 WBCs/µL) to
prevent febrile reactions
No more than 5x106 WBCs (<16 WBCs/µL)
to minimize the transfer of microorgan-
isms and
No more than 1x106 (<3 WBCs/µL) to be
considered virtually leukocyte free.
At Reametrix we provide, ReaPan
Thrombo and ReaPan Leuko which are
robust, accurate and precise diagnostic
solutions for platelet enumeration and
leukocyte enumeration in platelet concen-
trates, respectively.
The product overview is presented in the
table alongside. For further queries/
information please contact us.
Once the decision to transfuse platelets is
taken, it is also imperative to measure the
residual leukocyte load (rWBC) in the plate-
let concentrates (PC) that will be used in
transfusion. This process called
‘Leukoreduction’ becomes important as
platelet transfusion induced infections in
immunocompromised patients is a major
cause of post-transfusion mortality. The
situation includes febrile reactions, bacte-
rial sepsis, transmission of toxoplasmosis
etc.

Bacterial Contamination in Platelets : New Tools on the Horizon

All blood products are under the threat of
bacterial related transmission of infections.
The risk of high morbidity and mortality
associated with such contamination is espe-
cially true with platelets.
There is a major risk leading to fatalities as
the platelets are generally stored at 20-24 °
C (room temperature) which favors bacterial
growth. Bacterial contamination of platelets
is estimated to occur at an incidence of
1:1000 to 1:3000 of which 1:15000 of the
reactions are severe and 1:60000 lead to
mortality.
The current gold standard for testing is the
cell culture technique. This method involves
using-up of large volume of platelet sample
and long-wait to obtain results. The other
currently available methods for bacterial
detection are BacT/ALERT® (Bio-Mérieux,
Nürtingen, Germany)- this utilizes the CO2
production in culture bottles for bacterial
detection. BDS (Pall Biomedical)- uses the
O2 consumption method for bacterial
growth in samples. Verax PGD (Verax Bio-
medical) is a rapid detection test for leu-
koreduced apheresis platelet. Scansys-
tem™ is another rapid detection method
that is available. However, many of the
rapid tests, that do not culture the sam-
ples, do not have a sensitivity better than
1000 CFU/mL.
The molecular detection methods using
microbial DNA and RNA have also been
described in literature but the their mar-
ket-applicability in platelet concentrate is
yet to be demonstrated.
The other approach for contamination-
free platelet concentrate is ‘pathogen
inactivation’ method. The two available
methods are The ‘INTERCEPT blood sys-
tem’ (cerus corporation) and ‘Mirasol
PRT’ (Navigant Biotechnologies Ltd) which
uses psoralen and riboflavin compounds
respectively for inactivation of nucleated
cells. Platelets do not have nuclei and are
not affected by these compounds.
Generally the bacterial inactivation/
detection is done at blood banks and
transfusion centers do not have any ap-
proved tests for assessing the quality of a
particular platelet bag before transfusion.
The status of a platelet bag with respect
to bacterial numbers would not be robust
given that there is 24-72hr between test-
ing at blood bank and then use of platelet
in transfusion centers.
The need of the hour is a simple bacterial
load measurement tool that can be used at
the transfusion center, to stratify plate-
let bags.

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