Pre-operative Thrombocytopenia collection and preparation of sdp single donor platelets Hb, pt inr, platelet counts apheresis principle donation criteria sdp vs rdp guidelines for platelet transfusion etiologies of thrombocytopenia isolated thrombocytopenia management first line second line management

1. An Octogenarian Patient Of Intracapsular
Neck Of Femur Fracture With Pre-operative
Big Challenge Thrombocytopenia
Presenter- Dr. Shiny
PG JR 2nd Year
Dept. Of Immunohematology & Blood Transfusion

2. Requisition on 24/01/2024
• We received a requisition for 2 units of single Donor
Platelets for an 81 years old Male patient, at 4.20 pm.
• Indication- Pre-operative Thrombocytopenia
• Pre-transfusion platelet count- 40,000/uL

3. ABO-Rh typing
ABO-Rh typing- O positive

4. Collection and Preparation
Donor selection and
screening
Time taken
for procedure
Yield Volume Quality control
SDP 1 Family was unable to
arrange donor, so,
donors were requested
by local NGOs
Pre-collection screening
was done including
CBC and TTI screening
of the donors.
67 minutes 4.0 x 1011 286 ml Platelets- 14,90,000/uL
WBC- 0.00/uL
RBC- 0.01/uL
TTI tested by Chemiluminescence
SDP 2 76 minutes 4.0 x 1011 294 ml Platelets- 13,38,000/uL
WBC- 0.00
RBC- 0.00
TTI tested by Chemiluminescence

6. Transfusion
• Both SDP products were requested together
• Issued on 26/01/2024 at 3.45 am
• SDP 1- Transfused on 26/01/2024 at 4 am.
• SDP 2- Transfused on 26/01/2024 at 5 am.
• TTI tested by Chemiluminescence
• ABO compatible
• No Transfusion reaction was reported on both transfusions.

7. PRBC Transfusion
1st PRBC Transfusion
27/01/2024
2nd PRBC transfusion
01/02/2024
Indication- Hb 8.5 gm/dl
370 mL O positive PRBC at 5.55 pm
DOC- 14/01/2024
PTT- Compatible
No transfusion reaction reported
Indication- Hb 6.9 gm/dl
380 mL O positive PRBC at 10.46 pm
DOC- 15/01/2024
PTT- Compatible
No transfusion reaction reported

8. Follow up at Blood Centre
Antiglobulin tests- Negative
Antibody screening- Negative

9. Platelet count, Hb, INR trends
Pre-
transfusion
24/01/2024
1 hour
increment Post
2 SDP
transfusions
26/01/2024
24 hours
increment
27/01/2024
After 1st
PRBC
Transfusion
28/01/2024 29/01/24 to 01/02/24
After 2nd
PRBC
Transfusion
02/02/2024
Platelet count
(per uL)
Hb (gm/dl)
40000
9.3
1,64,000
8.0
1,60,000
8.5
1,23,000
9.6
1,05,000 to 89000 to
71000 to 55000
8.8 to 8.1 to 7.5 to 6.9
50,000 to
75,000
8.0 to 8.2
Increment- 62000/uL per SDP unit transfusion
1 gm/dl per PRBC transfusion
So, not a case of transfusion refractoriness

10. Apheresis
• In apheresis, blood is withdrawn from a donor in an
anticoagulant solution and separated into
components. One (or more) component is/are
retained, and the remaining constituents are returned
to the donor.
• In a plateletpheresis procedure, donor’s platelet are
removed from whole blood, and the remaining
components are returned back to the donor.

11. Principle
• The anticoagulated blood from the donor is pumped into a rotating bowl, separating
the incoming blood by centrifugal force in such a way that red cells move to
periphery and plasma to the inside of rotating bowl and white cells and
platelets layer between the red cells and plasma.
• A portion of the donor’s platelets and some plasma is removed with the return of the
donor’s RBCs, WBCs, and remaining plasma.
• A plateletpheresis procedure usually takes 6-8 cycles to collect a therapeutic dose.

12. Routine procedure takes 1-1.5 hours.
Storage- 5 days on platelet agitator at 22
degrees.(the day of collection of platelets-
day zero)

13. Donation Criteria
1. Donor weight >50 Kg, Age- 18 to 60 years
2. The interval between procedures should be at least 48 hours. A donor should not
undergo the procedure more than 2 times a week or 24 times a year. After the whole
blood donation, the donor should be accepted only after 28 days of interval.
3. Platelet count and Hb must be more than 150,000/μl and > 12.5 g/dl before starting
the procedure.
4. Double unit apheresis can be taken in donors whose platelet count is more than
250,000/ul and weight more than 60kg and those who are not 1st time apheresis donors.

14. SDP vs RDP
SDP RDP
Collection obtained from an apheresis donation Platelets derived from whole blood
the platelet product
Volume 50-70 mL >200 mL
Yield and Increment one SDP unit, containing a minimum
of 3x1011 platelets, should increase an
adult’s platelets by 30,000 to
70,000/μL
one RDP unit, containing at least
5.5x1010 platelets, should increase
platelet count by 5,000 to 10,000/μL.
Advantages • More platelet increment
• Safer
• Leucoreduced
• Cost effective
• ABO incompatible units can be
transfused
Disadvantages • Expensive
• Same blood group apheresis donor
required for preparation
• 5-6 folds higher risk of bacterial
contamination
• 2 folds higher risk of TTIs as
compared to SDPs

18. Age Age-specific in older adults include enhanced platelet
aggregation and increased fibrinogen, factor V, and von
Willebrand factor to maintain normal hemostasis in age-related
changed organ and vasculature systems- chronic medications,
Loss of subcutaneous tissue
Splenomegaly causes platelets to pool inside of the spleen and cause
thrombocytopenia (low platelets available in peripheral blood).
Chronic
disorders
(HTN,
NSTEMI)
Decreasing platelet counts trend may be a consequence of
platelet hyperdestruction secondary to abnormal platelet
activation in a deteriorating disease state. In addition, the
severity of thrombocytopaenia may be a marker of more severe
right heart failure and abnormal haemodynamics.

21. References
• McMahon BJ, Kwaan HC. Thrombocytopenia in older adults. Seminars in thrombosis and hemostasis.
2014;40(6):682-687. 2. Aster RH, Curtis BR, McFarland JG, Bougie DW.
• Drug-induced immune thrombocytopenia: pathogenesis, diagnosis, and management. Journal of thrombosis and
haemostasis : JTH. 2009;7(6):911-918.
• https://www.ncbi.nlm.nih.gov/books/NBK537240/#:~:text=Immune%20thrombocytopenic%20purpura%20(ITP)%
20is%20an%20autoimmune%20disease%20characterized%20by,autoantibodies%20sensitize%20the%20circulatin
g%20platelets.
• Principles and Practice of Transfusion Medicine, Dr. R. N. Makroo, 2nd edition
• Harmening DM. Modern Blood Banking & Transfusion Practices 7th edition