1 / 26

Whole Blood Project ( different clinical needs – different strategies )

Whole Blood Project ( different clinical needs – different strategies ) Dr Soraya AMAR EL DUSOUQUI Dr Emmanuel RIGAL. Agenda. Brief description of the project and WB indications Definition „s“ of whole blood

bernie
Download Presentation

Whole Blood Project ( different clinical needs – different strategies )

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Whole Blood Project ( different clinical needs – different strategies ) Dr Soraya AMAR EL DUSOUQUI Dr Emmanuel RIGAL Regional blood transfusion centre Geneva – Haematology departement HUG

  2. Agenda • Brief description of the project and WB indications • Definition „s“ of whole blood • Distribution of WB and components in 10 BTS in SSA and 10 European countries • Plasma production in countries with limited resources • 2 major aspects of transfusion in Sub Saharan Africa • Epidemiological facts concerning HIV in Sub Saharan Africa • Different situation - different needs - different strategies • Is there an interest in FWB transfusion? • Conclusions Regional blood transfusion centre Geneva – Haematology departement HUG

  3. Brief description research on PI in whole blood bags using Intercept RBC PI technology S-303 combined with glutathione on whole blood Regional blood transfusion centre Geneva – Haematology departement HUG

  4. WB transfusion indications Indications for whole blood transfusions: • Where WB cannot be separated into components (75 % of transfusions in low resource countries ) • In the military battlefield where WB can be an alternative to treat acute massive trauma. The US Military has transfused >8000 units of FWB over the last 8 years • As an alternative in case of acute massive need ? Terrorist attack / epidemic outbreak ? Regional blood transfusion centre Geneva – Haematology departement HUG

  5. Description of project phases Regional blood transfusion centre Geneva – Haematology departement HUG

  6. Definition „s“ of whole blood • USA WB Definition for military service : • warm Fresh WB used before 8 hours • Fresh WB stored at 1-6 °C cooled within 8 hours for max. 24h • USA WB Definition in civilian context : • fresh WB that is stored at 2°C to 6°C for max. 48 hours • Definition in African transfusion manuals : • warm Fresh WB used before 8 hours • or • WB stored at 4°C for 28-35 days Regional blood transfusion centre Geneva – Haematology departement HUG

  7. Distribution of blood products in 10 European countries 10 European countries The Collection, Testing and Use of Blood and Blood Components in Europe EDQM 2008 Regional blood transfusion centre Geneva – Haematology departement HUG

  8. Distribution of WB and components in 10 BTS in SSA Tayou-Tangy et al Trans Clininque et Biologique 2009 Regional blood transfusion centre Geneva – Haematology departement HUG

  9. Plasma production in countries with limited resources Regional blood transfusion centre Geneva – Haematology departement HUG

  10. Plasma production in countries with limited resources WHO suggests to low countries to assess the clinical demand and feasibility of component processing Low income countries are hardly capable of investing their resources in • Processing whole blood into components • Buying and maintaining material to process plasma in 8-24h and keep at < - 25°C • Monitoring and managing quarantine and stock • Use surplus for producing medicinal products send to fractionation • Perform up to 5 – NAT testing • Abide to GMP standards - Buy from pharmaceutical firms drugs derived from plasma Regional blood transfusion centre Geneva – Haematology departement HUG

  11. 2 major aspects of transfusion in Sub Saharan Africa Regional blood transfusion centre Geneva – Haematology departement HUG

  12. 2 major aspects of transfusion in Sub Saharan Africa The 2011 National Blood Collection and Utilization Survey Report Natukunda et al, Transf Med 2010;20:134 Regional blood transfusion centre Geneva – Haematology departement HUG

  13. 2 major aspects of transfusion in Sub Saharan Africa Natukunda et al, Transf Med 2010;20:134 Regional blood transfusion centre Geneva – Haematology departement HUG

  14. HIV epidemiological facts on HIV in Sub Saharan Africa Regional blood transfusion centre Geneva – Haematology departement HUG

  15. HIV epidemiological facts on HIV in Sub Saharan Africa Regional blood transfusion centre Geneva – Haematology departement HUG

  16. HIV epidemiological facts on HIV in Sub Saharan Africa Regional blood transfusion centre Geneva – Haematology departement HUG

  17. Different situation - different needs - different strategies WHO Guidelines for the treatment of Malaria 2010 Regional blood transfusion centre Geneva – Haematology departement HUG

  18. Different situation - different needs - different strategies Assessing clinical demand in SSA countries : BB have to respond very frequently to bleeding indications ( ex. U 27%) Adapt transfusion in hemorrhagic shock and coagulopathy situations : • Use warm whole blood or components 1:1:1 RBC: FFP: PC or RBC: liquid plasma: PC ( no RCT to compare ) • need for fresh products (PLT functions and CF decrease with storage and cooling at 4°C° and they keep them stored up to 35d) • Recent studies suggest that storage lesions affects outcome especially in critically ill patients Regional blood transfusion centre Geneva – Haematology departement HUG

  19. Different situation - different needs - different strategies BB have to respond even more frequently to paediatric needs - children under 5 y (ex.U 42 %) Adapt transfusion : • division into smaller bags • Fresh products ( K+) • Malaria : Indicated when Hb < 4 g/dl or <5g/dl if hyperventilation and anaemia • irradiation if family donor or HIV (argument for PI) • CMV neg for HIV patients ( argument for PI) Adapt treatment strategies • Avoid malnutrition anaemia – food fortification • avoid iatrogenic anaemia • Malaria and parasite prevention • Iron / folate medication • rEPO ( optimal dose and timing ? Retinopathy age < 4 m ) Regional blood transfusion centre Geneva – Haematology departement HUG

  20. Different situation - different needs - different strategies Voxsanguinis 2010 Uganda Regional blood transfusion centre Geneva – Haematology departement HUG

  21. Is there an interest in FWB transfusion? biological rational for FWB with life threatening haemorrhagic shock and coagulopathy • PI • Irradiation • - pre-storageleucoreduction Regional blood transfusion centre Geneva – Haematology departement HUG

  22. Is there an interest in FWB transfusion? Regional blood transfusion centre Geneva – Haematology departement HUG Service - Secteur - Département…

  23. Is there an interest in FWB transfusion? Regional blood transfusion centre Geneva – Haematology departement HUG Service - Secteur - Département…

  24. Is there an interest in FWB transfusion? (Spinella PC, Sparrow RL, Hess JR, Norris PJ. Transfusion 2011;51:894 –900) Potential mechanisms of potential storage lesions of RBC Critically ill patients are most vulnerable Immune system Coagulations system Vaso-regulatory system Regional blood transfusion centre Geneva – Haematology departement HUG Service - Secteur - Département…

  25. Conclusions: • Most of the transfusions in SSA concern children and young females . • Main medical indications in SSA are massive haemolysis due to malaria and obstetrical bleedings. • The point of view of a large number of transfusion specialists in sub-Saharan Africa is that FWB is the product of choice for bleeding. • Exploring whether FWB is an appropriate option in certain circumstances is warranted ( shock and coagulopathy , combat trauma when components unavailable, extreme disaster situations) . • Blood banks will probably need to move toward more tailor made answers for patients and for clinical needs • Warm FWB trials may be possible in the developing world and could help answer our questions. Regional blood transfusion centre Geneva – Haematology departement HUG

  26. Acknowledgements : • Dr Schwabe • Dr Mansouri • Prof.Cazenave, EtablissementFrançais du Sang (EFS), Alsace, France • CERUS COOPERATION society • The directors of the Suisse Regional Transfusion Centres • Yvonne Fischer • VerenaFlück • Daniella Lev Regional blood transfusion centre Geneva – Haematology departement HUG

More Related