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TRALI RISK REDUCTION AND MALE ONLY PLASMA

TRALI - DEFINITION. TRANSFUSION RELATED ACUTE LUNG INJURYDYSPNEA, HYPOXEMIA, AND INTERSITITIAL INFILATRATES ON CHEST FILM WITH NORMAL PULMONARY WEDGE / CENTRAL VENOUS PRESSURES OCCURRING WITHIN SIX HOURS OF TRANSFUSION. DIFFERENTIAL WITH TRANSFUSION ASSOCIATED CIRCULATORY OVERLOAD. TRALI - IMPORTA

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TRALI RISK REDUCTION AND MALE ONLY PLASMA

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    1. TRALI RISK REDUCTION AND “MALE ONLY” PLASMA HOSPITAL TRANSFUSION SERVICE DIRECTOR

    2. TRALI - DEFINITION TRANSFUSION RELATED ACUTE LUNG INJURY DYSPNEA, HYPOXEMIA, AND INTERSITITIAL INFILATRATES ON CHEST FILM WITH NORMAL PULMONARY WEDGE / CENTRAL VENOUS PRESSURES OCCURRING WITHIN SIX HOURS OF TRANSFUSION. DIFFERENTIAL WITH TRANSFUSION ASSOCIATED CIRCULATORY OVERLOAD

    3. TRALI - IMPORTANCE INCIDENCE – 1:5000 MOST FREQUENT CAUSE OF TRANSFUSION RELATED DEATH REPORTED TO FDA DURING PAST THREE YEARS. COMPONENTS IMPLICATED: FFP>RBC>PLTS

    4. TRALI - ETIOPATHOGENESIS PASSIVE TRANSFER OF HLA CLASS I, CLASS II, GRANULOCYTE SPECIFIC ANTIBODIES (45-60%) TRANSFUSION OF LIPID “PRIMING” COMPOUNDS

    5. REDUCTION OF PASSIVE ANTIBODY TRANSFER RESTRICTED APPROACH: ELIMINATION OF PLASMA FROM PAROUS WOMEN AND TRANSFUSED INDIVIDUALS. REQUIRE COMPLICATED DONOR HISTORY MODIFICATIONS AND COMPUTER ALGORITHMS. BROADER APPROACH: ELIMINATION OF PLASMA DONATED BY WOMEN – “MALE ONLY PLASMA”

    6. DISTRIBUTION OF “MALE ONLY” PLASMA UK MOVED TO ALL MALE PLASMA IN 2003 – ELIMINATED PLASMA ASSOCIATED TRALI IN 2004 ELIMINATION OF FEMALE DONOR PLASMA WILL NOT ADVERSELY IMPACT PATIENT CARE IF PHYSICIANS DECREASE INAPPROPRIATE USE OF PLASMA ACCEPT USE OF 24 hr PLASMA AS EQUIVALENT TO FFP FOR ALMOST ALL CLINICAL INDICATIONS

    7. FFP TRANSFUSION GUIDELINES (Am Soc Anesthesiology 2006) MAY BE INDICATED TO CORRECT SCREENING TESTS > 1.5 X MIDPOINT OF PT OR > 2.0 MIDPOINT OF aPTT REF RANGE WITH BLEEDING CORRECT SINGLE FACTOR DEFICIENCY LEVEL < 30 % WITH BLEEDING OR BEFORE INVASIVE PROCEDURE

    8. “24 HOUR” PLASMA SEPARATED FROM WHOLE BLOOD UNITS WITHIN 24 HOURS OF DONATION RATHER THAN 8 HOURS CRYOPRECIPITATE NOT MANUFACTURED STORED FROZEN AT -18C UNIQUE PRODUCT CODE

    9. “24 HOUR” PLASMA PROCOAGULANT ACTIVITIES OF FACTOR VIII DECREASED 20-30%, PROTEIN S, FACTOR V DECREASED ONLY SLIGHTLY. ALL OTHER PROCOAGULANTS, vWF, AT III, PROTEIN C, PLASMINOGEN LEVELS MAINTAINED. ADAMTS 13 LEVELS MAINTAINED (CLINICAL ISSUES RELATED TO USE SIMILAR TO TRANSFUSION OF THAWED PLASMA)

    10. 24 HOUR PLASMA UTILIZATION IN MOST CLINICAL SCENARIOS REVERSAL OF COUMARIN DRUG EFFECTS: CONTAINS NORMAL LEVELS OF ALL VITAMIN K DEPENDENT COAGULATION FACTORS SEVERE LIVER DISEASE: NORMAL LEVELS OF VIII PRESERVED IN LIVER DISEASE, FACTOR V LEVELS OF ONLY 15-25% ARE HEMOSTATIC. DILUTIONAL COAGULOPATHY: FIBRINOGEN, FACTOR VIII AND vWF LEVELS HIGH (ACUTE PHASE REACTANTS), LOW LEVELS OF V ARE HEMOSTATIC.

    11. 24 HOUR PLASMA UTILIZATION IN MOST CLINICAL SCENARIOS DIC AND PRIMARY FIBRINOLYSIS: DISPROPORTIONATE FALLS IN FIBRINOGEN MAY REQUIRE SUPPLEMENTAL CRYOPRECIPITATE THAT WOULD AUTOMATICALLY SUPPLY ADDITIONAL FACTOR VIII. FACTOR V CONTENT WOULD BE SUFFICIENT THROMBOTIC THROMBOCYTOPENIC PURPURA

    12. RESIDUAL INDICATIONS FOR USE OF FFP SEVERE FACTOR V DEFICIENCY SEVERE PROTEIN S DEFICIENCY

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