Don r Trombosit Aferezi: Nasil, hangi cihazla yapmaliyim

1. Don�r Trombosit Aferezi: Nasil, hangi cihazla yapmaliyim? Dr. Fevzi Altuntas Erciyes �niversitesi Tip Fak�ltesi Hematoloji Bilim Dali ve Aferez �nitesi Sayin baskanlar, degerli meslektaslarim, degerli aferez �alisanlari Sizlere donor trombositaferezinden bahsedecegim Good afternoon, ladies and gentlemen. Today, I am gonna talk about donor Trombosit apheresis.Sayin baskanlar, degerli meslektaslarim, degerli aferez �alisanlari Sizlere donor trombositaferezinden bahsedecegim Good afternoon, ladies and gentlemen. Today, I am gonna talk about donor Trombosit apheresis.

2. Trombositler ne is yapar? Trombositler nasil elde edilir? Trombositlerin asil fonksiyonu : Kanamayi durdurmak ve/veya �nlemek Trombosit toplarken iki farkli metot kullanilir: Tek verici trombositleri (SDP= single donor PLT) Otomatik toplama (aferez) y�ntemiyle elde edilir Rastgele vericiden alinan trombositler (RDP= random donor PLT) G�n�ll� tam kan bagislarindan elde edilir What are Trombosits? How do we collect Trombosits? The primary role of Trombosits is to prevent/control/stop bleeding. There are two different ways to obtain Trombosit concentrate: one is single donor Trombosits (SDPs) which are obtained by automated collection methods. another is random donor Trombosits (RDPs) which are extracted from a community volunteer whole blood donation. What are Trombosits? How do we collect Trombosits? The primary role of Trombosits is to prevent/control/stop bleeding. There are two different ways to obtain Trombosit concentrate: one is single donor Trombosits (SDPs) which are obtained by automated collection methods. another is random donor Trombosits (RDPs) which are extracted from a community volunteer whole blood donation.

3. AFEREZ TROMBOSITI : Kimlerden Hazirlanir ? Rastgele trombosit aferezi= Toplumdaki vericilerden hazirlanir Aile �yesinden trombosit aferezi= Hastalarin biyolojik aile �yelerinden hazirlanir RDP� ne yetersiz yanit veren hastalar i�in kullanilir HLA uyumlu trombosit aferezi= HLA uyumlu vericilerden hazirlanir 4/4 yada � antijen uyumu tercih edilir Sadece trombosit refrakterliginde kullanilir Apheresis Trombosit Preparations: Apheresis Trombosits are obtained from single donors. 1) Random apheresis Trombosits (RAP's) are collected from community donors. 2) Family donor matched Trombosits are collected from a patient's biologic family member. They are used primarily for patients with poor response to RDPs. 3) HLA matched Trombosits are collected from a donor with whom a recipient�s HLA type has been matched. The more desirable matches are 4 in 4 or 3 in 4 antigens. They are considered only for patients who are refractory to RDPs.Apheresis Trombosit Preparations: Apheresis Trombosits are obtained from single donors. 1) Random apheresis Trombosits (RAP's) are collected from community donors. 2) Family donor matched Trombosits are collected from a patient's biologic family member. They are used primarily for patients with poor response to RDPs. 3) HLA matched Trombosits are collected from a donor with whom a recipient�s HLA type has been matched. The more desirable matches are 4 in 4 or 3 in 4 antigens. They are considered only for patients who are refractory to RDPs.

4. Aferez Trombositi: Ni�in tercih edilir? Alloimmunizasyonu �nlemek i�in= �rnek: k�k h�cre nakli alicilari Trombosit refrakter hastalarin tedavisi i�in= HLA/Trombosit spesifik antikorlari bulunan hastalar HLA/Trombosit antijen uygun PLT Y�nlendirilmis bagis i�in: �rnek: neonatal trombositopeni Anneden bebege PLT Why are Trombositpheresis Products Requested? They are requested To prevent alloimmunization (e.g., bone marrow transplantation). For refractory patients, HLA/Trombosit antigen matched Trombosit are used for patients with specific HLA/Trombosit antibodies. 3) For directed donations, e.g., mother to baby for neonatal thrombocytopenia (NTP).Why are Trombositpheresis Products Requested? They are requested To prevent alloimmunization (e.g., bone marrow transplantation). For refractory patients, HLA/Trombosit antigen matched Trombosit are used for patients with specific HLA/Trombosit antibodies. 3) For directed donations, e.g., mother to baby for neonatal thrombocytopenia (NTP).

5. Don�r Trombositaferezi: Cihazlar Devamli akim santrifuj Baxter/Fenwal (CS-3000 Plus, Amicus�) Gambro/Cobe (Spectra, Trima �) Fresenius (AS104, AS204, Com.Tec�) Aralikli akim santrifuj Haemonetics (LN-8150 MCS, LN-9000 MCS, MCS Plus, PCS-2�) When we look at the equipment and Technique Current apheresis instruments use continuous flow centrifugation systems like COBEinstruments (Spectra, Trima), Baxter/ Fenwal (CS3000 Plus, Amicus), Fresenius (AS104, AS204, Com.Tec), or intermittent flow centrifugation systems Haemonetics equipments (MCS/MCS Plus, PCS-2) When we look at the equipment and Technique Current apheresis instruments use continuous flow centrifugation systems like COBEinstruments (Spectra, Trima), Baxter/ Fenwal (CS3000 Plus, Amicus), Fresenius (AS104, AS204, Com.Tec), or intermittent flow centrifugation systems Haemonetics equipments (MCS/MCS Plus, PCS-2)

6. Donor Trombositaferezi: Avantajlari Kanin ekonomik kullanimi Istenilen bilesenin daha fazla toplanabilmesi Daha sik bagisa olanak vermesi Lab�da bilesenlerin ayristirilmasina gerek olmamasi Fazla don�r antijenlerine maruziyet azalmasi = Hastalik bulasma risk ? HLA alloimmunizayon risk ? Alloimmunize olmus hastanin etkili tedavisi L�kosit azaltilmasi L�kosit azaltimi i�in ilave filtrasyona gerek olmamasi Advantages of donor Trombositpheresis: Besides Economic use of blood means that relatively large amount of components are collected Selectively. It is possible more frequent donation Component separation in labratory is not necessary Reduction in donor exposures = means that Reduction in risk of disease transmission and risk of HLA alloimmunization (aloimyunizeysin) It could be Effective treatment for already alloimmunized patients (aloimyunizayd) Leukoreduction no further manipulation to be labeled as a leukoreduced Advantages of donor Trombositpheresis: Besides Economic use of blood means that relatively large amount of components are collected Selectively. It is possible more frequent donation Component separation in labratory is not necessary Reduction in donor exposures = means that Reduction in risk of disease transmission and risk of HLA alloimmunization (aloimyunizeysin) It could be Effective treatment for already alloimmunized patients (aloimyunizayd) Leukoreduction no further manipulation to be labeled as a leukoreduced

7. Aferez trombositi: �zellikler If we look at characteristics of Donor Trombositapheresis Product: 1) They are available in one or more different sizes. 2) Each unit must contain at least 3x10e11 Trombosits in 200-700 mL (90%) according to AABB. 3)Leukocyte must be less than <5 x10e6 according to USA standards and <1x10e6 according to european standards. 4) pH must be 6.8-7.4 ( at least more than > 6.2 at 5 days) (90%) 5) They are stored at temperature between +20-24?C for 5 days and agitated continuously in appropriate equipment during storage 6)They are stored for 5 days. However, some studies report that if product culture is negative on days 1-3, shelf-life of products can be extended to 7 days. SDPs must be stored in plastic bags which must be gas permeable to ensure oxygen availability for Trombosits. Trombosit survival time is normal when Trombosits are stored at 22?C or above but is reduced after storage at lower temperatures. The storage duration is primarily determined by relatively high risk of bacterial growth at room temperature. Currently, IN USA, Trombosit storage is limited to 5 days due to the potential bacterial growth over time. Some studies (European) reported that if the culture of Trombosit product is negative on 1-3 days of storage, culture-negative Trombosits� shelf life can be extended to 7 days. So, the number of outdates is reduced.If we look at characteristics of Donor Trombositapheresis Product: 1) They are available in one or more different sizes. 2) Each unit must contain at least 3x10e11 Trombosits in 200-700 mL (90%) according to AABB. 3)Leukocyte must be less than <5 x10e6 according to USA standards and <1x10e6 according to european standards. 4) pH must be 6.8-7.4 ( at least more than > 6.2 at 5 days) (90%) 5) They are stored at temperature between +20-24?C for 5 days and agitated continuously in appropriate equipment during storage 6)They are stored for 5 days. However, some studies report that if product culture is negative on days 1-3, shelf-life of products can be extended to 7 days. SDPs must be stored in plastic bags which must be gas permeable to ensure oxygen availability for Trombosits. Trombosit survival time is normal when Trombosits are stored at 22?C or above but is reduced after storage at lower temperatures. The storage duration is primarily determined by relatively high risk of bacterial growth at room temperature. Currently, IN USA, Trombosit storage is limited to 5 days due to the potential bacterial growth over time. Some studies (European) reported that if the culture of Trombosit product is negative on 1-3 days of storage, culture-negative Trombosits� shelf life can be extended to 7 days. So, the number of outdates is reduced.

8. �r�n pH depolama s�resince 6.8 - 7.4 arasinda olmalidir Trombositlerin yeterli miktarda plazma ile s�spanse edildigini ve uygun isida saklandigini g�sterir pH degeri = 6 (FDA) pH degeri = 6.2 (AABB) pH degeri =6.8 (Avrupa) pH� i etkileyen en �nemli fakt�r : �r�n hacmi ve trombosit sayisidir PLT fazla ve plazma az ise pH ? pH ?= PLT sekil degisikligi ve canliligi ? Donor trombositaferezi �r�n�:pH When we look at the pH: During storage product pH must remain between 6.8 - 7.4. Lets look at the pH requirements at the end of the storage period. FDA requires no less than 6.0 AABB requires more than 6.2 Europe requires more than 6.8 As a result, component volume and the number of Trombosits in the component are the most important measures affecting Trombosit product pH. (pH may decrease during storage of Trombosit components with a high Trombosit concentraion pH is an indicator to demonstrate Trombosits are resuspended in adequate amount of plasma and stored at an optimal temperature. pH of Trombosit components decreases during storage owing to cell metabolism. When oxygen availability is limited, glycolysis ensues and lactic acid production increases. Therefore, the increased production of lactic acid in the course of glycolysis result in (lead to=cause) a decrease in pH. Trombosits naturally exist in an environment with a pH value of 7.4. If sufficient oxygen is not available, pH decreases. As the pH decreases to between 6.8 and 6.2, Trombosits gradually lose their discoid appearance and become spherical. This transformation is reversible with no loss of viability, but pH decreases to 6.0 and below an irreversible transformation takes place. The resulting Trombosits are not suitable for transfusion.) When we look at the pH: During storage product pH must remain between 6.8 - 7.4. Lets look at the pH requirements at the end of the storage period. FDA requires no less than 6.0 AABB requires more than 6.2 Europe requires more than 6.8 As a result, component volume and the number of Trombosits in the component are the most important measures affecting Trombosit product pH. (pH may decrease during storage of Trombosit components with a high Trombosit concentraion pH is an indicator to demonstrate Trombosits are resuspended in adequate amount of plasma and stored at an optimal temperature. pH of Trombosit components decreases during storage owing to cell metabolism. When oxygen availability is limited, glycolysis ensues and lactic acid production increases. Therefore, the increased production of lactic acid in the course of glycolysis result in (lead to=cause) a decrease in pH. Trombosits naturally exist in an environment with a pH value of 7.4. If sufficient oxygen is not available, pH decreases. As the pH decreases to between 6.8 and 6.2, Trombosits gradually lose their discoid appearance and become spherical. This transformation is reversible with no loss of viability, but pH decreases to 6.0 and below an irreversible transformation takes place. The resulting Trombosits are not suitable for transfusion.)

9. Trombosit �r�n�n� etkileyen fakt�rler nelerdir? Islem i�in kullanilan makine Islem �ncesi trombosit sayisi Islem �ncesi Hb seviyesi Toplam kan hacmi Don�r v�cut agirligi Don�r cinsiyeti Islem s�resi Lets look at somethings that affects Trombosit yield. Trombosit yield is affected by ��� Apheresis instruments used, Pre (pri)-donation Trombosit count, Pre-donation Hb level, Total blood volume, Donor weight, Donor gender and Procedure duration. There is wide variation in the number of Trombosits obtained from Trombositapheresis donations. Variability may stem (come=spring=result) from differences in apheresis instruments used, in donor Trombosit counts and in collection parameters (20-24).Lets look at somethings that affects Trombosit yield. Trombosit yield is affected by ��� Apheresis instruments used, Pre (pri)-donation Trombosit count, Pre-donation Hb level, Total blood volume, Donor weight, Donor gender and Procedure duration. There is wide variation in the number of Trombosits obtained from Trombositapheresis donations. Variability may stem (come=spring=result) from differences in apheresis instruments used, in donor Trombosit counts and in collection parameters (20-24).

10. Donor trombositaferez �r�n� belirleyicileri:Oniki Aferez Sistemi On this slide; you can see examples of how different instrument affects Trombosit yield. Depending on the method and instruments used each procedure gave a Trombosit yield from 2.4 to 7.1 x1011 Trombosit.On this slide; you can see examples of how different instrument affects Trombosit yield. Depending on the method and instruments used each procedure gave a Trombosit yield from 2.4 to 7.1 x1011 Trombosit.

11. Trombosit �r�n�: Yedi makinanin karsilastirilmasi The following chart (Figure, table, slide) shows Comparison of seven instruments in terms of Trombosit yield The highest Trombosit yield which was 5.6 x1011 was obtained by Cobe Spectra V4 and the lowest Trombosit yield which was 3.6 x 1011 was obtained by MCS+ (Trombosit yields varied 3.6-5.6 x 10e11).The following chart (Figure, table, slide) shows Comparison of seven instruments in terms of Trombosit yield The highest Trombosit yield which was 5.6 x1011 was obtained by Cobe Spectra V4 and the lowest Trombosit yield which was 3.6 x 1011 was obtained by MCS+ (Trombosit yields varied 3.6-5.6 x 10e11).

12. When we look at comparison of instruments with respect to Trombosit Yield in Fixed 90 Minute Duration: Amicus and Spectra Turbo were complied best with the target. When we look at comparison of instruments with respect to Trombosit Yield in Fixed 90 Minute Duration: Amicus and Spectra Turbo were complied best with the target.

13. Aferez trombosit �r�n� belirleyicileri: Hb seviyesi Donor Hb�i trombosit �r�n�n�n �nceden belirlenmesinde �nemlidir Ters iliski vardir D�s�k hb d�zeyinde daha y�ksek trombosit �r�n� alinir D�s�k hb d�zeyi y�ksek plazma vol�m�yle iliskilidir Now, Lets look at Hb level and Trombosit yield association: Donor Hb is another variable predictive of Trombosit yield but in inverse fashion: lower Hb corresponds to higher Trombosit yield. Perhaps low Hb concentraion is associated with higher plasma volume processed.Now, Lets look at Hb level and Trombosit yield association: Donor Hb is another variable predictive of Trombosit yield but in inverse fashion: lower Hb corresponds to higher Trombosit yield. Perhaps low Hb concentraion is associated with higher plasma volume processed.

14. Aferez trombosit �r�n� belirleyicileri: Cinsiyet Trombosit �r�n�nde anlamli bir fark yoktur Kadinlarda daha y�ksek trombosit �r�n�ne egilim oldugu g�r�lm�st�r Y�ksek trombosit sayisi temelde ; Uzun islem s�resi Ileri derece demir yetersizligi Hormonal etkilesim If we look at Trombosit yield and gender association: There is no significant differences in Trombosit yields between female and male. Some studies revealed that Women tend to have higher Trombosit yield. Reason could be high baseline Trombosit count combined with long procedure time, higher prevalence of iron deficiency among women and Hormonal influence. It is possible that hormonal influence also plays a role because an increase has been observed in Trombosit count in mid-menstrual cycle and decrease at the beginning of the cycle (Rivera SG et al. Arc Med Research 2003;34:120-123 and Lasky LC et al. Transfusion 1981;21:719-22, Kalis et al J Clin Apheresis 1987;3:320-234).If we look at Trombosit yield and gender association: There is no significant differences in Trombosit yields between female and male. Some studies revealed that Women tend to have higher Trombosit yield. Reason could be high baseline Trombosit count combined with long procedure time, higher prevalence of iron deficiency among women and Hormonal influence. It is possible that hormonal influence also plays a role because an increase has been observed in Trombosit count in mid-menstrual cycle and decrease at the beginning of the cycle (Rivera SG et al. Arc Med Research 2003;34:120-123 and Lasky LC et al. Transfusion 1981;21:719-22, Kalis et al J Clin Apheresis 1987;3:320-234).

15. Aferez trombosit �r�n� belirleyicileri:Islem �ncesi Trombosit sayisi Elde edilen y�ksek �r�n�n %�si ve trombosit �r�n�n�n temel belirleyicisidir Trombosit sayisinin islem �ncesi daha fazla olmasi fazla trombosit �r�n� eldesine sebep olur Y�ksek seviyede trombosit �r�n� d�s�k trombosit sayilarinda da elde edilebilir When we take a look at Predonation Trombosit count and Trombosit Yield association: Predonation Trombosit count is main predictor of Trombosit yield and % of high-yield product. Higher predonation Trombosit count (>220-270-300 x10e3) results in higher Trombosit yield. However, high Trombosit yield can be obtained even with low preprocedure Trombosit count.When we take a look at Predonation Trombosit count and Trombosit Yield association: Predonation Trombosit count is main predictor of Trombosit yield and % of high-yield product. Higher predonation Trombosit count (>220-270-300 x10e3) results in higher Trombosit yield. However, high Trombosit yield can be obtained even with low preprocedure Trombosit count.

16. Aferez trombosit �r�n� belirleyicileri:Islem �ncesi Trombosit sayisi: Pre- Trombosit sayisi ile Trombosit �r�n� baglantilidir Normal/d�s�k Trombosit degerli don�rlerde islem s�resi uzatilarak g�venli kan bagisi saglanabilir Trombosit sayisindaki azalma bagis sikligi ile daha �ok iliskilidir You can see in this slide; If you look at the numbers in blue you can see Trombosit yield correlates with pre-donation Trombosit count. If you look at the numbers in red you can see donor with low/normal Trombosit can safely donate satisfactory PCs by extending the procedure time. But, There is a risk of decrease in Trombosit count if a person donate too frequently.You can see in this slide; If you look at the numbers in blue you can see Trombosit yield correlates with pre-donation Trombosit count. If you look at the numbers in red you can see donor with low/normal Trombosit can safely donate satisfactory PCs by extending the procedure time. But, There is a risk of decrease in Trombosit count if a person donate too frequently.

17. Aferez trombositi: �ift veya daha fazla �nite Trombosit sayisi y�ksek olan don�rlerde (>250.000/uL) Iki yada �� �niteye karsilik gelen trombosit �r�n� elde edilebilir �r�n torbasinda = 6.0 x1011 trombosit olmali (�ift unite) Her bir �nite en az > 3 x 1011 trombosit i�ermeli Islem s�resinde hafif uzama Trombosit kaybinda hafif artis Ciddi olmayan donor komplikasyonlarinda hafif artis Lets look at split apheresis Trombosits: Donors with high Trombosit counts are able to donate double or triple doses Trombosit during one donation. Yield in bag must be more than = 6.0 x1011 Trombosits Each unit must contain at least 3 x 1011 Trombosits But, Procedure time is Slightly longer compared to SU.Lets look at split apheresis Trombosits: Donors with high Trombosit counts are able to donate double or triple doses Trombosit during one donation. Yield in bag must be more than = 6.0 x1011 Trombosits Each unit must contain at least 3 x 1011 Trombosits But, Procedure time is Slightly longer compared to SU.

18. Hangi cihaz ?: Iki ve daha fazla doz When we look at the studies related to split rates: Split rate varies between 5 and 85% depending on instruments used. Split rate is higher in new generation instruments as shown in this slide.When we look at the studies related to split rates: Split rate varies between 5 and 85% depending on instruments used. Split rate is higher in new generation instruments as shown in this slide.

19. Hangi cihaz ?: Iki ve daha fazla doz When we take a look at the Split Rate in selected Apheresis Instruments: Trima and Amicus have a higher split rate compared to others.When we take a look at the Split Rate in selected Apheresis Instruments: Trima and Amicus have a higher split rate compared to others.

20. Hangi cihaz ?: Islem s�resi Islem s�resinin kisa yada uzun olmasi �r�n kadar �nemlidir Yeni nesil aletlerde islem s�resi daha kisadir DN de islem s�resi daha kisadir Iki/�� �r�n eldesinde islem s�resi daha uzun If we look at procedure time: 2) In todays world, �doing more with less time� is important as much as yield when evaluating equipment. 3) new generation instruments have lower processing time compared to others. 4) SN would be expected to have longer PT. 5) Processing time plays a major role in determining CR. Processing time is that blood is being processed (did not include reinfusion or final pass return). If we look at procedure time: 2) In todays world, �doing more with less time� is important as much as yield when evaluating equipment. 3) new generation instruments have lower processing time compared to others. 4) SN would be expected to have longer PT. 5) Processing time plays a major role in determining CR. Processing time is that blood is being processed (did not include reinfusion or final pass return).

21. Hangi cihaz ?: Islem s�resi Aferez Sistemlerinin kiyaslanmasi Procedure time was 64 min for SU and 90 min for DU with Amicus and 77 min for SU and 87 min for DU with Spectra Turbo. So, you can see that we can do more with less time with todays equipments.Procedure time was 64 min for SU and 90 min for DU with Amicus and 77 min for SU and 87 min for DU with Spectra Turbo. So, you can see that we can do more with less time with todays equipments.

22. Hangi cihaz ?: Toplama yeterliligi (CE) Daha az hacim isleyerek daha fazla �r�n elde edilmesini ifade eder Toplanan trombosit ile hesaplanan trombositi karsilastirir: Trombosit �r�n� x100/ {(pre+post Trombosit)/2 x (islenen hacim-antikoag hacmi)} Islenen kan vol�m� CE belirlenmesinde �nemli rol oynar Fakat ters iliskilidir CE�nin belirlenmesine katkida bulunan bir diger fakt�rde �r�ndeki PLT sayisi Yeni cihazlar daha y�ksek CE�ne sahiptir CE compares collected amount of Trombosit with calculated. New generation instruments result in higher CE. Blood volume processed plays major role in CE but inverse fashion. For example Trima have to process significantly more whole blood to obtain Trombosit target, which results in a significantly lower CE (Burgstaler et al Transfusion 2004). Design of the collection chambers is another contributing factor in CE: The single stage channel is more efficient in Trombosit collection. This figure compares CE obtained from four Trombositpheresis systems. Amicus was significantly higher CE than all systems with 73%. CE compares collected amount of Trombosit with calculated. New generation instruments result in higher CE. Blood volume processed plays major role in CE but inverse fashion. For example Trima have to process significantly more whole blood to obtain Trombosit target, which results in a significantly lower CE (Burgstaler et al Transfusion 2004). Design of the collection chambers is another contributing factor in CE: The single stage channel is more efficient in Trombosit collection. This figure compares CE obtained from four Trombositpheresis systems. Amicus was significantly higher CE than all systems with 73%.

23. Hangi cihaz ?: Toplama yeterliligi (CE)Tek vs. �ift giris ile toplanmasi Lets look at CE in single vs double needle collections: CEs vary between 42 and 85%. New generation instruments are more efficient than other systems.Lets look at CE in single vs double needle collections: CEs vary between 42 and 85%. New generation instruments are more efficient than other systems.

24. Hangi cihaz ?: Toplama Orani (CR) Sistemleri kiyaslamada daha pratik bir y�ntemdir Es zamanli Trombosit �r�n� ve islem s�resi ile elde edilir CR= Trombosit �r�n� / islem s�resi CR� da islem s�resi �nemli rol oynar CR is most practical way to compare apheresis systems. CR address Trombosit yield and processing time simultaneously. Processing time plays a major role in determining CR. This table compares CR of 4 systems: Amicus was significantly higher.CR is most practical way to compare apheresis systems. CR address Trombosit yield and processing time simultaneously. Processing time plays a major role in determining CR. This table compares CR of 4 systems: Amicus was significantly higher.

25. Hangi cihaz ?: Toplama Orani (CR)Sekiz sistemin kiyaslanmasi The following figure shows eight systems comparison in terms of CR: Amicus-SN and DN had a significantly higher CR than all other systems. The following figure shows eight systems comparison in terms of CR: Amicus-SN and DN had a significantly higher CR than all other systems.

26. Hangi cihaz?: Lokosit azaltilmasi Except for AS104, all other systems met the AABB and European standards.Except for AS104, all other systems met the AABB and European standards.

27. Aferez ile L�kored�ksiyon Yeni kusak makinalar ile Avrupa / US standartlarinda lokosit azaltilmasi yapilabilmektedir: Laboratuar is y�k� azalabilir �r�n kalite ve g�venligi artirabilir Depolama �ncesi l�kosit sayisi azaltilabilir HLA-alloimmunizasyon riski azalabilir Hastalik bulasma riski azalabilir FNHTR �nlenebilir Filtre yetersizligi �nlenebilir Filtre ile olusabilecek h�cre kaybi �nlenebilir Toplamda maliyet avantaji saglayabilir Lets take a look at leukoreduction: A) There is no significant differences between new generation machines. New machines complied with European and US leukoreduction guidelines. C) Leukoreduced apheresis products 1) reduce laboratory workload and 2) increase product quality and safety because of Leukoreduction prior to storage Reduce risk of HLA-alloimmunization (aloimyunizeysin) Reduce risk of disease transmission Prevent FNHTR No filter failure No loss of cells in filter 3) It has also Potential cost advantage. Lets take a look at leukoreduction: A) There is no significant differences between new generation machines. New machines complied with European and US leukoreduction guidelines. C) Leukoreduced apheresis products 1) reduce laboratory workload and 2) increase product quality and safety because of Leukoreduction prior to storage Reduce risk of HLA-alloimmunization (aloimyunizeysin) Reduce risk of disease transmission Prevent FNHTR No filter failure No loss of cells in filter 3) It has also Potential cost advantage.

28. Hangi cihaz?: Islem sonrasi trombosit sayisi Trombosit sayisi %10-35 oraninda azalmakta Yeni nesil sistemler arasinda anlamli fark yoktur Islem sonrasi trombosit sayisi nadiren 90,000 alti Birka� g�nde eski d�zeyine ulasmakta D�rt g�nde islem �ncesi degere geri y�kselmekte Kanama komplikasyonu �ok nadir 1) There is no detailed data about effects of different apheresis procedures and split units on donor Trombosit counts. 2) In healthy donors,Trombosit count can drop 10-35% but there is No significant differences between new generation apheresis systems. 3) Rarely it can drop below 90.000 4) recovers in several days without bleeding complications. (Return to baseline was seen in 4 days and a rebound increase above the baseline was seen 8 to 11 days after the procedure (Lasky LC et al. Transfusion 1981;21:247-60)). 1) There is no detailed data about effects of different apheresis procedures and split units on donor Trombosit counts. 2) In healthy donors,Trombosit count can drop 10-35% but there is No significant differences between new generation apheresis systems. 3) Rarely it can drop below 90.000 4) recovers in several days without bleeding complications. (Return to baseline was seen in 4 days and a rebound increase above the baseline was seen 8 to 11 days after the procedure (Lasky LC et al. Transfusion 1981;21:247-60)).

31. Hangi cihaz? Amicus vs Com.Tec Her iki cihaz ile toplanan hedef trombosit yeterli idi Her iki cihaz ile rehberlere uygun l�koreduksiyon yapilabildi Amicus�un avantaji, daha hizli hedef trombosit �r�n� saglanmasi idi

32. Don�r Aferezi: Komplikasyonlar Nisbeten sik Sitrat toksitesi Akim hizinin ayarlanmasi yada kalsiyum uygulamasi ile kontrol edilebilir Islem �ncesi rutin kalsiyum uygulamasi �nerilmez Hematom yada damar yolu komplikasyonlari Nadir Allerji (Sitrat, set vs) Sell�lit Tromboz Vol�m durumunda degisiklik Lets take a look at complications: The most common adverse effects are related to citrate useed during the procedures. Fortunately, most citrate related symptoms can be controlled easily by adjusting the machine flow rates or administration of calcium. Authors do not recommend routine administration of oral calcium before apheresis Some authors recommend that donors with a prior history of significant citrate-related symptoms or with high risk of citrate effects (female donors receiving high citrate infusion rates) be given oral calcium 2gr, 30 min before apheresis (Bolon et al 2003) (NIH)Lets take a look at complications: The most common adverse effects are related to citrate useed during the procedures. Fortunately, most citrate related symptoms can be controlled easily by adjusting the machine flow rates or administration of calcium. Authors do not recommend routine administration of oral calcium before apheresis Some authors recommend that donors with a prior history of significant citrate-related symptoms or with high risk of citrate effects (female donors receiving high citrate infusion rates) be given oral calcium 2gr, 30 min before apheresis (Bolon et al 2003) (NIH)

33. Don�re uzun d�nem etkileri Hb, Trombosit ve WBC sayisinda anlamli degisiklik izlenmemekte Mutlak lenfosit sayisi azalabilir Immundisfonksiyona yol a�tigi g�sterilememis Demir eksikligi da az siklikla g�r�lebilir Trombositaferez tekrarlamak g�venlidir Uzun d�nemde �nemli olmayan minimal degisiklik olabilir When we look at Long Term Effects of Trombositpheresis on Donors: There is no significant changes in Hb level, Trombosit count or WBC count Absolute lymphocyte counts can be low in, but there is no evidence of immune dysfunction. Iron deficiency is less frequent 4) Repeated Trombositpheresis is safe, with minimal change of long-term effects.When we look at Long Term Effects of Trombositpheresis on Donors: There is no significant changes in Hb level, Trombosit count or WBC count Absolute lymphocyte counts can be low in, but there is no evidence of immune dysfunction. Iron deficiency is less frequent 4) Repeated Trombositpheresis is safe, with minimal change of long-term effects.

34. Trombositaferez: Ekonomik Uygulanabilirligi RDP� ile maliyet olarak karsilastirilabilir: Gerek�esi; Y�ksek tekrarlama orani Don�r maruziyetinin azaltilmasi= Enfeksiyon riskinin azaltilmasi L�koreduksiyon i�in ilave manuplasyonlara gerek olmamasi sayilabilir If we look at Economic Feasibility of SDPs: Although costs for SDP are still significantly higher than for RDPs, additional costs of SDPs may be justified by the high split rates obtained and the reduction in risk of infection due to Reduction of donor exposure 3) leukoreduced Trombosits units obtained (Do not require filtration and this contributes to reduced costs and laboratory workload). If we look at Economic Feasibility of SDPs: Although costs for SDP are still significantly higher than for RDPs, additional costs of SDPs may be justified by the high split rates obtained and the reduction in risk of infection due to Reduction of donor exposure 3) leukoreduced Trombosits units obtained (Do not require filtration and this contributes to reduced costs and laboratory workload).

35. Sonu� Yeni nesil cihazlar y�ksek performansa sahip: Trombosit �r�n�, toplama kabiliyeti, toplama hizi, ayirma hizi, islem s�resi ve don�r rahatligi Avrupa/US kilavuzlarina uygun l�kosit azaltilmasi Y�ksek ayirma hizi, enfeksiyon riskinin azaltilmasi, l�kored�ksiyon, maliyeti �nemli �l��de azaltabilir Trombositferez islemi g�venli Uzun d�nem etkilerde minimal degisiklik mevcuttur As a conclusion: Newer machines have the best overall performance: in terms of Trombosit yield, collection efficiency, collection rate, split rate, procedure time and donor comfort They Comply with European / US leukoreduction guidelines Significantly higher costs compared to RDPs may be justified by High split rates, reduced risk of infection, Leukoreduction Repeated Trombositpheresis is safe � with minimal change in long-term effects Thank you very much for your attentionAs a conclusion: Newer machines have the best overall performance: in terms of Trombosit yield, collection efficiency, collection rate, split rate, procedure time and donor comfort They Comply with European / US leukoreduction guidelines Significantly higher costs compared to RDPs may be justified by High split rates, reduced risk of infection, Leukoreduction Repeated Trombositpheresis is safe � with minimal change in long-term effects Thank you very much for your attention