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

Bacterial Contamination in Platelets : New Tools on the Horizon


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

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