Why Special Blood Products? Salwa Hindawi MSc, FRCPath, CTM Director of Blood Transfusion Services kAUH, Jeddah Saudi Arabia ESPHO Cairo 2008 Salwa Hindawi

Introduction Despite general measures to ensure transfusion safety, there still an added risk to infants and children with underlying hematological, oncologic and immunologic disorders. Transfusion reaction may be caused by both infectious or non infectious processes. Special products are blood components collected, processed, and selected specifically to minimize these complications. Salwa Hindawi

Transfusion Transmitted CMV Infection CMV is transmitted by leucocytes. The use of CMV-seronegative blood components has been shown to reduce the incidence of CMV infection to 1-3%. Salwa Hindawi

Indication for the use of CMV-seronegative blood components Patients with congenital immunodeficiency disorders AIDS (human immunodeficiency virus infection) patients Hematopoietic progenitor cell transplant recipients Organ allograft transplant recipients Premature infants during infancy Cancer patients undergoing intense chemotherapy Recipients of intrauterine transfusions Salwa Hindawi

Leucocyte Reuced Blood Components Leucocytes in the blood components can lead to many complications Universal Leucodepletion verses specific indications. Salwa Hindawi

Transfusion Complications Caused by WBCs: Nonhemolytic transfusion reactions (commonly called “febrile nonhemolytic transfusion reactions”) Alloimmunization to HLA Class I antigens Cytomegalovirus infections Immune modulation Graft-vs-host disease Salwa Hindawi

Gamma-Irradiated Blood Components WHY? To Prevent Graft verses Host Disease mediated by T lymphocytes in units of Packed RBCs, Platelets, and Granulocytes. Blood components that contain viable lymphocytes may be irradiated to prevent proliferation of T lymphocytes, which is the immediate cause of GVHD. The standard dose of gamma irradiation is 2500 cGy , maximum allowable dose is 5000cGy. Salwa Hindawi

Patients Who Should Receive Gamma-Irradiated Blood Components Patients with congenital immunodeficiency disorders of cellular immunity. Intrauterine transfusion and neonatal exchange transfusion recipients. Hematopoietic progenitor cell transplant recipients. Recipients of blood components from 1st & 2nd degree relatives. Salwa Hindawi

Patients receiving HLA-matched cellular blood components. Patients with hematologic malignancies and Cancer patients undergoing intense chemotherapy or Hodgkin’s disease receiving fludarabine. Salwa Hindawi

Components negative for Sickle Hemoglobin Sickle cell trait: Hb A = 60% Hb S = 40% Hypoxia and acidosis can lead to sickle crisis. Can donate blood. Salwa Hindawi

AABB Recommendations Define patients populations who should receive red blood cells known to lack hemoglobin S. 1- infants with small blood volume or massive transfusion in neonates. 2- Sickle cell patients Salwa Hindawi

Pathogen Inactivation (PI) The risk of: Bacterial contamination Emerging pathogens are still a major concerns which lead to the need for better techniques. PI for platelet concentrates have been in routine use since 2002 and for plasma in 2006 (INTERCEPT blood system). A noval PI approach to blood safety (the Mirasol PRT System). Salwa Hindawi

PI Techniques Nucleic acid targeted pathogen inactivation technologies offer the potential to protect from infectious and non infectious processes through prevention of cell replication and transcription. To accurately assess the true value of a pathogen reduction system it is essential to weigh its cost against the saving it offers in terms of quality of life and reduced cost to society. Salwa Hindawi

+ + MIRASOL PRT system for platelets and plasma – Concept Platelet or plasma product Riboflavin (Vitamin B2) UV Light Reduction of viruses, bacteria, parasites Inactivation of residual white cells Salwa Hindawi

The MIRASOL PRT process: 1 2 3 Transfer platelet product to MIRASOL Illumination bag Add 35 mL Riboflavin Solution (500 uM) Illuminate product for 6-10 min.* * Illumination time depends on product volume Salwa Hindawi

strategies to reduce donor exposure or RBC transfusions: delayed clamping of the umbilical cord; restricting blood sampling using recombinant human erythropoietin to stimulate erythropoiesis using iron supplementation or vitamins to minimize the severity of anemia Salwa Hindawi

using appropriately collected and stored multipack RBC units using appropriately screened and handled RBCs from regular or designated donors; and collecting and transfusing umbilical cord blood (autologous blood transfusion). Salwa Hindawi

Conclusions The use of special products is a must for specific patients in pediatric age group to ensure safety. The use of PI procedures are recommended to ensure better safety. Training for the staff, policies, and guidelines in pediatric age group are important issues to be considered. Salwa Hindawi

References Pediatric Transfusion, A Physician’s handbook 2nd Edition, 2006. Prenatal and childhood transfusion, Practical Transfusion Medicine 2001. A novel Approach to blood safety, Gambro BCT 2007. Impact of Pathogen activation on platelets utilization during 3 years of routine use, AABB October 2007. Pathogen Inactivation making decisions about new technologies preliminary reports of a consensus conference, Vox Sanguinis 2007. Salwa Hindawi

THANKS Salwa Hindawi