APHERESIS - TRANSFUSION RXNS

• Apheresis


  To separate or remove or to take from
• Plasmapheresis


  Removing plasma
• Plateletpheresis


  Removing platelets
• Erythrocytapheresis


  Removing RBCs
• Leukapheresis


  Removing leukocytes
• The same principle as centrifuged anticoagulated blood, wherein distinct layers develop
• Citrate


  The primary anticoagulant in apheresis procedures (ACD)
• Additional donor guidelines

  • At least 48 hours elapsed time after apheresis donation
  • A donor must not exceed more than 2x a week or 24x in a year unless otherwise allowed by the blood bank physician
  • A donor must be tested to detect cytopenia
  • If a donor donates whole blood, at least 3 months/ 2 months/ 56 days/ 8 weeks must be elapsed before he can donate for pheresis
  • Extracorporeal blood must not exceed 15% of the donor's total blood volume
  • If plateletpheresis is to be performed, a donor must have above 150 x 10^9 L
  • Possible adverse reactions to plasma expanders must be determined
• Intermittent flow centrifugation (IFC)

  Blood is processed in batches or cycles, hence the term intermittent
• Continuous flow centrifugation (CFC)


  The processes of blood withdrawal, processing, and reinfusion are performed simultaneously in an ongoing manner
• Plateletpheresis

  Equivalent to 6–10 random platelet concentrates, containing 3 x 10^11 platelets
• Plateletpheresis

  • Used to treat patients who have abnormally elevated platelet counts (>1,000,000 uL), e.g. Polycythemia Vera
• Leukapheresis

  Removal of WBCs
• HES (Hydroxyethyl Starch)


  Sedimenting agent used for granulocyte collection which causes rouleaux formation of RBCs, allowing WBCs to be harvested more efficiently
• Corticosteroids


  Administered to donors 12–24 hours before pheresis to increase the number of circulating granulocytes by pulling them from the marginal pool to the circulating pool
• Leukapheresis


  • Used to treat patients with leukemia (> 100,000/uL WBC), Hairy Cell Leukemia, AML (Acute Myeloid Leukemia), Cutaneous T Cell Lymphoma
• Lymphocytapheresis


  Removal of lymphocytes, involves immunosuppression
• Lymphocytapheresis


  • Used to treat Rheumatoid Arthritis, SLE, Kidney Transplant Rejection, Autoimmune Disease, Alloimmune Disease
• Neocytapheresis


  Transfusion of young RBCs called "neocytes"
• Neocytapheresis


  • Used for pediatric patients with Thalassemia Syndrome
• Erythrocytapheresis


  Considered an exchange procedure, where a predetermined quantity of red cells is removed from the patient and replaced with homologous blood
• Erythrocytapheresis


  • Used for Sickle Disease (Priapism), Impending stroke, Malaria, Babesia, patients with abnormal RBC appearance
• Therapeutic plasmapheresis (plasma exchange)


  Replacement fluids used: NSS, NSA, PPF, FFP
• Therapeutic plasmapheresis


  • Used for patients with TTP and HUS, to remove the offending agent in the plasma causing clinical symptoms in cases of Paraproteinemia (Multiple Myeloma, Waldenstrom Macroglobulinemia), Familial Hypercholesterolemia, to collect rare RBC and WBC antibodies, and beneficial in diseases that involve malfunction of the immune system (e.g. SLE, RA)
• Many of the adverse events seen with transfusion are related to the fact that transfusion is the introduction of foreign cells into the recipient, and non-cellular plasma and plasma-derived products involve the introduction of foreign proteins into the recipient that may cause a transfusion reaction
• AABB requirements for laboratory investigation of a transfusion reaction


  • Clerical check of the component bag, label, paperwork, and pre-transfusion patient specimen
  • Repeat ABO testing on the post-transfusion sample
  • Visual check of the pre- and post-transfusion specimens for hemolysis
  • Direct antiglobulin test (DAT) on the post-transfusion specimen
  • Quarantine additional components prepared from the same donor selection
  • Report findings to the transfusion service supervisor or medical doctor
• Pre-transfusion blood


  Used for crossmatching, kept for up to 3 weeks, signs and symptoms may manifest during transfusion or within 21–28 days
• Post-transfusion blood


  Collected during the onset of the transfusion reaction, used to double-check with the unit, test for DAT
• Classification of a transfusion reaction


  • Immediate or delayed type
  • Hemolytic or non-hemolytic
  • Immune or non-immune
• Acute/immediate type transfusion reaction

  Onset of signs and symptoms is within 24 hours, during or after transfusion
• Delayed type transfusion reaction

  Onset of signs and symptoms will occur after 14–21 days or 28 days
• Hemolytic transfusion reaction

  Positive DAT, there's an excessive lysis of RBC
• Non-hemolytic transfusion reaction

  Negative DAT
• Laboratory tests confirming hemolysis

  • Decreased fibrinogen
  • Decreased or absent haptoglobin
  • Increased unconjugated bilirubin
  • Increased LDH
  • Hemoglobinuria and hemoglobinemia
  • Decreased Hgb/Hct
• Serologic evidence of immune-mediated hemolytic transfusion reaction

  • Positive DAT
  • Positive elution with identification of 1 or more alloantibodies
• Triggering factors for immune hemolysis

  • Paroxysmal Cold Hemoglobinuria (PCH)
  • Alloimmune Acute/Delayed Hemolytic Transfusion Reaction
  • Paroxysmal Nocturnal Hemoglobinuria (PNH)
  • Autoimmune Hemolytic Anemia (AHA)
  • Drug-induced Hemolytic Anemia
  • IV Immunoglobulin Administration
  • Cold Agglutinin Disease
• Triggering factors for non-immune hemolysis

  • Osmotic
  • Thermal
  • Mechanical problems
  • Hemoglobinopathies
  • RBC Membrane or Enzyme Disorders
  • TTP
  • HUS
  • Bacterial, Viral, or Parasitic Infection
• Acute/immediate hemolytic transfusion reaction (AHTR)


  Most severe type of transfusion reaction, associated with intravascular hemolysis, triggered by IgM antibodies against ABO
• Acute/immediate hemolytic transfusion reaction

  • Manifested within 24 hours with signs and symptoms like fevers, chills, dyspnea, hypotension, bleeding, and can lead to severe complications like DIC and renal failure
• Febrile non-hemolytic transfusion reaction (FNHTR)


  Most common type of transfusion reaction, characterized by an increase in temperature of greater than 1°C after transfusion, caused by the interaction of the recipient's antibodies against the donor's HLA in WBCs or platelets