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

2. 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

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. + + 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

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

16. 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

17. 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

18. 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

19. 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

20. THANKS
Salwa Hindawi