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Presence of medication taken by blood donors in plasma for transfusion

Presence of medication taken by blood donors in plasma for transfusion. van Tilborgh, J. Wiersum , M. S chipperus D. Touw F . Hudig. ISBT Regional Congress Amsterdam. 3-6-2013. Case historie.

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Presence of medication taken by blood donors in plasma for transfusion

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  1. Presence of medication taken by blood donors in plasma for transfusion van Tilborgh, J. Wiersum, M. Schipperus D. Touw F. Hudig ISBT RegionalCongress Amsterdam 3-6-2013

  2. Case historie • 70-year-old femalepatient, von Willebrand disease type II, withknownallergies (plasters, barium contrast, fruit, penicillin?) • Fracturedcollarbone • 21/1 14.00 hrsstart platelettransfusion, BP 160/71 • 21/1 14.10 hrsbronchospasm, glottis edema, urticaria, hypotension • Tavegilandhydrocortisone: quick recovery (BP 180/90) • No IgAdeficiency • TRIP report: Anaphylacticreaction, • imputabilityprobable, severitygrade 2 ISBT RegionalCongress Amsterdam 3-6-2013

  3. Every year TRIP receives several reports like this one. • The category of anaphylactic reaction, defined as allergic reactions with systemic features such as airway obstruction, fall in blood pressure, vomiting or diarrhoea, accounts for the largest number of serious transfusion reactions. • In most cases no cause is found for these reactions. ISBT RegionalCongress Amsterdam 3-6-2013

  4. TRIP data show that anaphylactic reactions occur relatively frequently during or after transfusion of plasma or platelet concentrates. Most platelet units are also rich in plasma. • Data from blood services show that approximately 10% or more of plasma donors use medication which is permitted under donation guidelines. Couldsome of these reactionsbeduetomedication taken by the donor? Distributed blood components ISBT RegionalCongress Amsterdam 3-6-2013

  5. This exploratory study investigated the presence of drugs or drug metabolites in donor plasma after quarantine, storage and thawing. Only samples for which the blood supply organisation confirmed that the donor had consented to research use were included. Thawed FFP  rejected for transfusion  sample 5 ml ISBT RegionalCongress Amsterdam 3-6-2013

  6. I-Tox screening The samples were analysed for approximately 800 drugs or drug metabolites ISBT RegionalCongress Amsterdam 3-6-2013

  7. All detectable substances that were recognised as drug or drugmetabolite were considered a positive screening result 87 samples have been processed ISBT RegionalCongress Amsterdam 3-6-2013

  8. ISBT RegionalCongress Amsterdam 3-6-2013

  9. ISBT RegionalCongress Amsterdam 3-6-2013

  10. The most prescribed drugs in The Netherlands in 2009/2010 • Metoprolol • Omeprazol (also OTC) • Acetylsalicylic acid (also OTC) • We expected that frequently prescribed drugs or over the counter drugs were most likely to be found in some of the donor plasma units. Whatdid we find? ISBT RegionalCongress Amsterdam 3-6-2013

  11. Anaphylacticreactions? * C. = combination of medication # Publication Yes – No / mentioned in FTK = FarmacotherapeutischKompas $Lareb = Netherlands Pharmacovigilancecenter, number of reports in database ISBT RegionalCongress Amsterdam 3-6-2013

  12. * C. = combination of medication # Publication Yes – No / mentioned in FTK = FarmacotherapeutischKompas $Lareb= Netherlands Pharmacovigilancecenter, number of reports in database ISBT RegionalCongress Amsterdam 3-6-2013

  13. ISBT RegionalCongress Amsterdam 3-6-2013

  14. Non-allergicanaphylaxis http://www.lareb.nl/LarebCorporateWebsite/media/publicaties/Anafylactische-reacties-op-NSAID-s.pdf ISBT RegionalCongress Amsterdam 3-6-2013

  15. Conclusions • It is possible to detect medication in donor plasma after freezing, quarantine, storage and thawing • It cannot be excluded that medication taken by the donor in plasma for transfusion could cause an anaphylactic reaction in the recipient ISBT RegionalCongress Amsterdam 3-6-2013

  16. Anyquestions? info@tripnet.nl Acknowledgementsto: Annet van Zijl, KCHL Haga Ziekenhuis Veronica Rodriguez, Apotheek Haagse Ziekenhuizen Sanquinbloodsupplyorganisation Eugène van Puijenbroek, Lareb ISBT RegionalCongress Amsterdam 3-6-2013

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